Barriers to Respectful Maternity Care | Contextual Features | |||
---|---|---|---|---|
Individual level | Interpersonal level | Organizational level | Community level | |
▪ Providers do not consider the decision to provide respectful care because they already believe they are providing respectful care or what they are expected to do | ▪ Provider had a painful delivery and has attended many painful deliveries ▪ With experience provider has developed a “feel” for how care is provided | ▪ Supervision and feedback focused on clinical treatment and health risks | ▪ Training is focused on clinical treatment ▪ Clinical algorithms and guidelines, including visual cues in the facility do not provide clear guidelines for good care | ▪ Pain is seen as a natural birth experience |
▪ Providers do not consider the decision to provide respectful care explicitly since abuse and violence are normalized and therefore the default | ▪ Provider experienced violence as a child as a form of discipline | ▪ Actions of other providers reinforce the perception that maintaining control is paramount | ▪ Training emphasizes need for rigid, forcefully delivered commands and interventions | |
▪ Providers decide not to provide respectful care since they believe they do not need to provide it | ▪ Provider has never interacted with the client before delivery and client behaves erratically or does not follow instructions | ▪ No serious consequences to providers who engage in disrespectful or abusive behavior | ▪ Client appears to be low income or low status | |
▪ Providers decide not to provide respectful care consistently since they believe that the costs of providing it outweigh the gains | ▪ Maternal or infant death results in an audit ▪ No salient information or feedback on the impact of respectful or disrespectful care on health outcomes | |||
▪ Providers change their mind on providing respectful care when they believe that disrespectful care will assist their objectives | ▪ Client does not follow instructions of provider |