Table 2 Manifestations of mistreatment of women during childbirth in Kenya
Third order themes | Second order themes | Illustrative manifestations of experiences and reports of first order themes from Kenya | ||
|---|---|---|---|---|
Women | Men | Health providers (HPs)/managers | ||
Intentional mistreatment: use of violence, physical, verbal, negligent withholding of care | ||||
Physical abuse | Use of force | Slapping/pinching | Beaten by HPs | Slap to save a woman’s life |
Physical restraint | Pushing my thighs | Helped to make the woman cooperate or obey | To make room for baby to come out if mother is closing legs. Fear of being reprimand for poor out pregnancy comes | |
Sexual abuse | Sexual abuse | Not recorded in any data from this study | ||
Verbal abuse | Harsh language Threats and blaming | Insulting language; Threatening and insulting relatives/caretaker Women blamed for negative outcomes Reprimanding client if she calls for help | Insults from health providers to women and caregivers | Harsh words ‘helps’ women and relatives cooperate; You must appear tough to gain cooperation Personal attitude |
Stigma and discrimination | Discrimination based on ethnicity, socioeconomic status | Women ‘blamed’ for high parity, age and socioeconomic status Tribalism/ethnicity | Devalues my partner/wife and I or my community | Women take too long to understand. HPs overworked, stereo typing, negative attitude and values ‘that tribe behavior/react like that” |
HIV positive women avoided or abandoned | Men forced to take HIV test | Fear, stigma lack of knowledge | ||
Failure to meet professional standards of care | Lack of informed consent for physical exam and procedures | HPs discuss the examination results with others | Devalues my wife and I | Rooms do not offer audio privacy |
Student allowed to do episiotomy ‘badly’ Frequent vaginal examinations/multiple tests by HPs and students | Student must learn on clients: too many students must achieve skills in a short time. Lack of HPs skills and confidence. | |||
Lack of confidentiality and privacy | Examination, delivery and treatment required to undress without curtains or partitions | Bed sharing | Lack of curtains Too many clients Limited space | |
Women have to give personal information in public (within hearing distance of others) | Over crowding | |||
Neglect and abandonment | Older/higher parity women report left to deliver on their own as HPs abandon them due to their previous birth experience | HPs refuse to help women in labor if not come with drugs, supplies, money. Men rush to buy them. | Too busy, overworked, uncooperative mother. Poor staff attitude, “have done my shift for the day”, lack of team work. Inadequate supervision, Demotivated. | |
Ignoring clients’ calls for help | HPs not available or at night | |||
Doctor not available to conduct cesarean section | No doctor available | Absenteeism; report late on duty, no housing for doctors; lack of transport. | ||
HPs not responding to client when in pain | Some women too afraid of pain | Poor staff attitude; Lack of professional ethics; Poor leadership | ||
Poor rapport between women and health providers | Lack of autonomy | Not involved in decision making in my care Used language that I could not understand Lack of food/drink. No bathing facilities | Poor staff attitude. Too busy to explain, they do not get even if you explained, Ineffective counseling/communication. | |
Detainment | Lack of money makes mothers avoid going to hospital | Women are detained | Clients are abandoned by their relatives in hospital. | |
Ineffective communication | Not given information about my care Do not understand the need for frequent vaginal examinations | Not consulted or informed about my wife’s progress or babies condition | HPs have no time to discuss procedures due to high workload Clients do not understand | |
Structural disrespect deviations | ||||
Health system conditions an constraints | Lack of resources | Lack of equipment. bed sharing, Lack of curtains/clean linen | Facility request money to buy drugs | Inadequate supplies, lack of funds, misuse of funds, lack of maintenance, poor planning and forecasting |
No water for bathing, dirty bathrooms No food | ||||
No support staff Staff shortage/no supervision/poor leadership. Made to clean up | Have to buy the drugs and supplies | Shortages Staff and equipment and supplies | ||
Facility culture | Too few staff | Staff not supervised | Staff shortages Ineffective supervision | |
Corruption/bribery | You must stretch your hand Some behave in a way that they want to be bribed | Pay bribe to get own bed | Poor and delayed pay. Accepted norm- everyone is doing it anyway | |