Understanding mistreatment during institutional delivery in Northeast Nigeria: a mixed-method study

• Published in: Reproductive health Vol. 16; no. 1; pp. 174 - 14
• Main Authors: Umar, Nasir, Wickremasinghe, Deepthi, Hill, Zelee, Usman, Umar Adamu, Marchant, Tanya
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 02-12-2019; BioMed Central; BMC
• Subjects: Adult; Attitude of Health Personnel; Births; Consent; Delivery (Childbirth); Delivery, Obstetric - methods; Delivery, Obstetric - psychology; Emergency medical care; Female; Health; Health care reform; Health facilities; Health Facilities - standards; Health Services Accessibility; Humans; Local government; Maternal and newborn health; Maternal Health Services - standards; Maternal mortality; Medical care quality; Methods; Middle Aged; Midwifery; Mistreatment; Mixed methods research; Mixed-methods; Newborn babies; Newborn infants; Nigeria; Nurses; Obstetrics; Patient care; Physical Abuse - psychology; Pregnancy; Primary care; Professional-Patient Relations; Public health; Qualitative Research; Quality; Quality of care; Quality of Health Care; Questionnaires; Reproductive health; Respectful maternity care; Women; Womens health; Workers; Young Adult; Nigeria; Maternal and newborn health; Mistreatment; Respectful maternity care; Quality of care; Mixed-methods
• ISSN: 1742-4755; 1742-4755
• DOI: 10.1186/s12978-019-0837-z

Improving quality of care including the clinical aspects and the experience of care has been advocated for improved coverage and better childbirth outcomes.
This study aimed to explore the quality of care relating to the prevalence and manifestations of mistreatment during institutional birth in Gombe State, northeast Nigeria, an area of low institutional delivery coverage.
The frequency of dimensions of mistreatment experienced by women delivering in 10 health facilities of Gombe State were quantitatively captured during exit interviews with 342 women in July-August 2017. Manifestations of mistreatment were qualitatively explored through in-depth interviews and focus groups with 63 women living in communities with high and low coverage of institutional deliveries.
The quantitative data showed that at least one dimension of mistreatment was reported by 66% (95% confidence interval (CI) 45-82%) of women exiting a health facility after delivery. Mistreatment related to health system conditions and constraints were reported in 50% (95% CI 31-70%) of deliveries. In the qualitative data women expressed frustration at being urged to deliver at the health facility only to be physically or verbally mistreated, blamed for poor birth outcomes, discriminated against because of their background, left to deliver without assistance or with inadequate support, travelling long distances to the facility only to find staff unavailable, or being charged unjustified amount of money for delivery.
Mistreatment during institutional delivery in Gombe State is highly prevalent and predominantly relates to mistreatment arising from both health system constraints as well as health worker behaviours, limiting efforts to increase coverage of institutional delivery. To address mistreatment during institutional births, strategies that emphasise a broader health systems approach, tackle multiple causes, integrate a detailed understanding of the local context and have buy-in from grassroots-level stakeholders are recommended.