Table 1 Characteristics of included studies
Lead author (citation) Country | Characteristics |
|---|---|
Abuya et al. [23] Kenya | ♢ Design: multicenter pre-and post-study without a control group ♢ Participants: Women aged 15 to 45 years were surveyed for their experiences within 24–48 h of birth at discharge ♢ Sample: 1,369 (641 women at baseline and 728 women at endline) ♢ Intervention: Multi-component intervention implemented at facility, community, and policy levels in the Hashima project from June 2011 – Feb 2014 ○ Community level - Community workshops- civic education for the community on the right to sexual and reproductive health, sensitization meetings with the community members to demand respectful care - Counseling community members who experienced disrespect and abuse by the counselors in the facility ○ Facility level - Providing training for health care providers (HCPs) that aimed at enhancing the protection of clients' and providers' rights through improving quality of care - Caring for carers- counselling services for HCPs to assist them cope with high workload, critical incidents, and trauma - Monitoring D&A- through facilitating incident reporting mechanisms - Mentorship- in-service role-modeling the champion provider behavior as routine continuous professional education - Maternity open day- trust-building session prepared in health facility through explaining procedures in the maternity ward for the invited members of the local communities ○ Policy level - Continuous policy dialogue with government, civil society, and professional knowledge networks ♢ Outcome: women reported and observed experiences of disrespect and abuse ♢ Measurement: measured as dichotomous variable, percentage of women responding to six questions asking whether they were disrespected or humiliated at least for one form of categories of D&A ♢ Evaluation of effect: multivariate logistic generalized linear mixed models (GLMM) were used for both observational and exit interview data and reported as both adjusted and crude odds ratios (OR) • Observation: lack of privacy and physical aggression were reduced from baseline while non-consented care and sharing bed were increased from the baseline level • Survey with women: overall D&A was reduced from baseline level 129(20.1%) to 96(13.2% (– adjusted OR: 0.55 (0.40 – 0.75) • Physical abuse, verbal abuse, violation of confidentiality and detention were also significantly declined from their baseline levels Reliability and validity of the survey tool were not shown |
Afulani et al. [33] Ghana | ♢ Design: Pre- and post-intervention study without control groups was conducted in five high volume childbirth health facilities (one hospital and 4 health centers) ♢ Participants: women aged 15–49 years who give birth in preceding 8 weeks in study health facilities were approached at discharge from facilities ♢ Sample: 215 women at baseline (March–April 2017) and 318 at endline (November 2017) ♢ Intervention: Two days integrated simulation‐based training was provided for 43 health care providers including midwives, medical doctors, anesthetists, and nurses in two rounds. The content of the training includes: - Five simulation scenarios - Skills capturing session in identified seven areas of focus ♢ Outcome: RMC as reported by women ♢ Measurement: RMC measured as a continuous variable of score of person-centered maternity care scale (PCMC) structured into 4-point Likert scale from 24 items and then converted to 100 ♢ Evaluation of the effect: RMC, average PCMC increased by 43% from 50 (baseline score) to 72 (endline score); it was also reported as increased in linear regression coefficient (18 points than the baseline score, (β = 17.6; 95% CI = 15.6‐19.6) • Dignity and respect, communication and autonomy and supportive care were subclass indictors showed increment ♢ Used a tool validated in Kenya and India with high content, construct, and criterion validity with a good reliability |
Asefa et al. [34] Ethiopia | ♢ Design: Pre- and post-study without a control group conducted between December 2017 and September 2018 in three Hospitals in Southern Ethiopia ♢ Participants: women who gave birth in study facilities took part in the study at discharge ♢ Sample: 388 women were surveyed- 190 before intervention and 198 after intervention ♢ Intervention: Respectful Maternity care training- the contents and intensity of the interventions implemented include: ○ Facility level - Respectful maternity care training for health care providers- three-day workshops for 64 HCPs in two rounds - Five wall posters: four in English and one in Amharic posted in labor ward to be used as on job aids incorporating universal rights of childbearing women developed by White Ribbon Alliances and infographics prepared by WHO - Supportive supervisions: two round quality improvement post-training supportive supervisions were conducted through developing action plans for the standard-based identified gaps ♢ Comparator: usual care before the implementation of the intervention ♢ Outcome: women's experiences of mistreatments ♢ Measurement: measured as number of mistreatment categories women experienced using 25 items originating from six categories of mistreatment ♢ Evaluation of the effect: the effect of the intervention was evaluated using a multilevel mixed-effects Poisson regression model • Adjusted exponentiated regression coefficient = 0.82, 95% CI 0.74 to 0.91 |
Asefa et al. [35] Ethiopia | ♢ Design: Pre- and post-intervention study without a control group conducted between April and May 2018 ♢ Participants: health care providers who provide labor and childbirth and received intervention participated in the survey ♢ Sample: 64 HCPs responded to pre intervention survey and all of them participated in post intervention survey ♢ Intervention:—Facility level as described above in Asefa et al. [34], - Three days training delivered as presentations, role play, demonstrations, case studies, individual readings, videos, and a hospital visit - Contents of training- overview of maternal health in Ethiopia, human rights, and law in the context of reproductive health, RMC rights and standards, professional ethics, and continuous quality improvement ♢ Outcome: HCPs perceptions of RMC ♢ Measurement: perceptions of RMC was measured using eight domains and classified it as positive and negative perceptions ♢ Evaluation of the effect: an exact McNemar's test was performed to analyze pre-post differences in participants' perceptions of RMC - Proportion of perceiving RMC domains positively was 21.9% before the training, and 35.9% after the training (p = 0.08) |
Brown et al. [36] South Africa | ♢ Design: a pilot cluster RCT study conducted at 10 hospitals (five randomly allocated to receive educational intervention to promote childbirth companion) ♢ Participants: Postnatal women who received labor and birth care in study hospitals ♢ Sample: 2090 survey before intervention (October 1998) and 2058 exit interviews carried out after intervention (December 1999) ♢ Intervention: Childbirth companion promotion- a multidimensional educational intervention delivered as interactive workshop for HCPs, banners and posters at labor ward, brochures and video program promoting birth companion ♢ Comparator- the five control hospitals received an unrelated evidence-based intervention to promote the external cephalic version (ECV) ♢ Outcome: birth companion and indicators of mistreatment (described as inhuman care in study- being shouted at, being slapped, or struck, being left alone) ♢ Measurement: self-reported by women whether they were allowed a companion, and experiencing inhumane care mentioned ♢ Evaluation of the effect: Used non-parametric test (Mann Whitney U test) and did not report the effect size, only reported it as there were no significant effect |
Kujawski et al. [22] Tanzania | ♢ Design: cluster RCTs ♢ Participants: women aged 15 and above and gave birth in study facilities were participated in exit interview ♢ Sample: 3068 women were included (Baseline: 1388 (744 from control hospital and 644 from intervention hospital) and (Endline: 1680 (769 from control hospital and 1001 from an intervention hospital) ♢ Intervention: Staha intervention comprising two components was implemented over two years in Korogwe District, Tanzania and compared with Muheza District as: ○ Community level - Client service charter- community and health facility stakeholders adapted client service charter. The charter was issued to the communities and posted in health facilities found within the intervention district ○ Facility level: - Quality improvement program- following the adaptation of the client service charter for six-month, quality improvement activities that activated charter content were performed to address disrespectful and abusive care ♢ Comparator- compared to women gave birth in health facilities without any intervention (usual care) and to the practices existing before interventions ♢ Outcome: women's self-reported experiences of any form of D&A ♢ Measurement: labeled as experienced D&A if women reported at least one of 14 questions during labor and birth based on the Bowser and Hills' categories ♢ Evaluation of effect: adjusted logistic regression difference in difference model between baseline and endline on a total of 2983 eligible survey results • 66% reduced odds of a woman experiencing D&A (adjusted OR: 0.34, 95% CI: 0.21–0.58, p < 0.0001) • The biggest reductions were for physical abuse (aOR: 0.22, 95% CI: 0.05–0.97, p = 0.045) and neglect (aOR: 0.36, 95% CI: 0.19–0.71, p = 0.003) ♢ The validity and reliability of the survey tool was not reported |
Mihret et al. [37] Ethiopia | ♢ Design: Pre-and-post single center without a control group interventional study from November 2018 to May 2019 ♢ Participants: women who received antenatal care and gave childbirth in study hospital were surveyed for their experiences before and after intervention ♢ Sample: 738 (369 at baseline and 369 at endline/after intervention) ♢ Intervention: RMC and monitoring and evaluation training for HCPs and managers, setting up waiting room, availing resources for ensuring privacy (curtains), essential, drugs written guideline and protocol, recognizing best performing staff and continuous supportive supervision by quality improvement team ♢ Comparator- pre intervention services ♢ Outcome: proportion of disrespect and abuse among pregnant women who received ANC and labor and birth in health facility ♢ Measurement: The D&A was identified as any form of abusive care using 24 Yes/No questions based on Bohser and Hill's categories of D&A ♢ Evaluation of the effect: significance of the intervention was checked using independent t- test, reported as significant ♢ Overall D&A before intervention was 71.8 and 15.9% after intervention |
Montagu et al. [38] India | ♢ Design: cluster RCT was conducted at three primary health centers and six community health centers of Unnao and Kanpur Districts of Uttar Pradesh state in India ♢ Participants: women aged 18–49 and gave childbirth within last seven days in participating health facilities ♢ Sample: 570 (285 at each group) women at baseline from September 2016 to March 2017 and 600 (300 at each group) women at endline from May to December 2018 participated in surveys ♢ Intervention: establishing quality improvement team and participation in Improvement Collaborative workshops to work towards the improvement of person-centred maternity care through a plan-do-study-act (PDSA) ♢ Comparators: usual care at non-interventional control health facilities ♢ Outcome: Person-centered maternity care (PCMC) that includes RMC domains (dignity and respect; communication and autonomy; and supportive care.) ♢ Measurement: measured using 23 validated survey items scaled to 100-point scale, highest score indicating better PCMC/RMC care ♢ Evaluation of the effect: from baseline to endline, the adjusted mean PCMC score of the intervention group increased 22.9 points (95%CI: 20.9, 25.0) ♢ After the intervention- PCMC mean score for intervention group was 97.13 with SD of (2.91) and in a control group mean score 63.42 with SD of (11.44) |
Oosthuizen et al. [39] South Africa | ♢ Design: Pre- and post-pilot interventional study in Tshwane health district in 10 midwife-led obstetric units (MOUs) of South Africa. Five MOUs purposively selected to be part of the intervention while the remaining five were treated as a control group ♢ Participants: women who had given child in MOUs and returned for postnatal care from 3 days to six weeks ♢ Sample: 653 women at baseline from February to April 2016 and 679 at endline survey from October 2016 to March 2017 ♢ Intervention: CLEVER package- that includes awareness creation of women's experiences for strengthening health system with MOUs' participants, intensive behavioral change activities for 3-months and six-month support ♢ Comparators: usual care before intervention and care in control groups ♢ Outcome: RMC and satisfaction ♢ Measurement: validated survey tools were used to measure RMC by a question that asked to rate how women feel they were respected and the other rate their level of satisfaction ♢ Evaluation of the effect: the percentage of RMC changed from 38.1% at baseline to 74.5% endline, and satisfaction from 47% to 73.6% ○ RMC (aOR = 4.33) and satisfaction (aOR = 4.04) raised four times at endline as compared to baseline in the interventional groups (P-values < 0.0001) RMC (aOR = 1.14) and satisfaction (aOR = 1.20) raised at endline as intervention compared to control groups (P-values < 0.0001) ♢ As compared to the control groups, endline RMC was 71.6% for controls and 74.5% for interventional groups, while endline satisfaction was 71.1 for control groups and 73.6% for interventional groups |
Ratcliffe et al. [40] Tanzania | ♢ Design: Pre- and post-intervention study between January 2013 and December 2014 at large, urban regional referral hospital in Dar es Salaam, Tanzania ♢ Participants: women who gave birth at the facility during four to six weeks post-delivery in the woman's home ♢ Sample: 70 women at baseline and 149 women after intervention ♢ Interventions: two discrete interventions were implemented: ○ Health facility level - Open Birth Days (OBD), a birth preparedness and antenatal care education program for women while they are in third trimester pregnancy - Workshop with HCPs on respectful maternity care aimed at examining practice with respect to professional code of conduct, clients' preferences and discussion on barriers that prevent provision of RMC ♢ Comparator: service existing in the facility before the implementation of the intervention ♢ Outcome: women's experiences of respectful care and satisfaction with care ♢ Measurement: RMC measured as the perception of the women rating how health care providers were respectful (five Likert scale question) ♢ Evaluation of the effect: measured as the change in percentage of the RMC perception and very satisfied - Perception of respectful care: 22.8% of women rated the respect shown to them by providers as "excellent" compared to none at baseline - Satisfaction: 75.8% of women reported being very satisfied with their birth experience compared to only 12.9% at baseline |
Ratcliffe et al. [41] Tanzania | ♢ Design through intervention- as described above in Ratcliffe et al. [40] ♢ Outcome: experiences of disrespect and abuse as reported by women ♢ Measurement: D&A was measured using on the items developed based on the Bowser and Hills' categories of D&A ♢ Evaluation of outcome: evaluated as percentage difference between occurrences of individual categories of D&A and any form of abusive care as dichotomous variable: ♢ Any form of D&A: 70% at baseline and 18% at endline |
Umbeli et al. [42] Sudan | ♢ Design: Pre- and post-intervention study was conducted in Omdurman maternity hospital, Sudan ♢ Participants: women who gave childbirth in study facility were surveyed ♢ Sample: a total of 4469 women were surveyed (2000 before and 2469 after) training ♢ Intervention: training HCPs on communication skills, support during childbirth, providing information and empathy ♢ Comparators: usual care before intervention ♢ Outcome: respectful care and satisfaction level ♢ Measurement: RMC measured as a women's perceptions of friendly and respectful care ♢ Evaluation of the effect: difference between women's opinion about health care providers' behavior in labor ward ○ The proportion of HCPs who were supportive, friendly, and respectful was 1793 (89.7%) before training and 2338 (94.7%) after training ♢ Proportion of women received information on onset of labor from 76.8% to 96.8%, requested investigations from 54.9% to 94.5%, condition of the fetus from 15.3% to 92.1%, progress of labor from 9.9% to 89.9%, expected duration of labor from 8.9% to 95.0%, examination and procedure to be done from 7.5% to 57.9% from baseline level to the endline |