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Table 2 Summary of Barriers and Contextual Features at the Individual, Interpersonal, Organizational, and Community Levels

From: Barriers to provision of respectful maternity care in Zambia: results from a qualitative study through the lens of behavioral science

Barriers to Respectful Maternity CareContextual Features
Individual levelInterpersonal levelOrganizational levelCommunity 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