Disrespect and abuse in maternity care: women’s experiences and healthcare providers’ perspectives in Nigeria

Abstract

Background: Disrespect and abuse (D&A) in maternity care facilities is a major public health issue affecting women worldwide. There are reports of high prevalence of D&A during facility-based childbirth in Nigeria; however, studies that explore the issue in-depth from women’s and maternity care professionals’ perspectives are sparse. This study provides an understanding of women’s experiences of and healthcare providers’ perspectives on D&A during maternity care in health facilities in Benue State, Nigeria. Methods: This is a qualitative phenomenological study conducted in two phases. Using purposive sampling, focus group discussions were conducted with women (n=32) in the first phase, and in the second, semi-structured interviews with women (n=14) and healthcare providers (n=16) from various professional backgrounds, working in two maternity care facilities. All the women received maternity care in facilities and had experienced at least one incident of D&A. The sample size was determined based on data saturation. All data collected were transcribed and analysed in NVivo version 11 using a six-stage thematic analysis. Findings: Women perceived incidents such as being shouted at and the use of abusive language as a common practice and described these incidents as devaluing and dehumanising to their sense of dignity. They also highlighted the importance of accessing facilities for safe childbirth and expressed that the experiences of D&A may not impact negatively on their intended use of but the choice of maternity facilities. However, their accounts reflected a lack of choice and the adverse effect of D&A on their emotional wellbeing. Healthcare providers recognised D&A as a violation of the human rights of women accessing maternity facilities, but usually highlighted components of respectful care with a good awareness about what it encompasses. They often considered the experiences of D&A as subjective to the women and based on their expectations of care. Their views also reflected underlying gender-related notions and societal perceptions of women being considered weaker than men. The professionals recognised several adverse effects of D&A, including its impact on women, newborns and on their own job satisfaction. Both women and professionals perceived some of the disrespectful and abusive actions were not intended to cause harm but to ensure the health and safety of the mother and her child. Additionally, they reported several factors associated with service users, health professionals and the facilities perceived to contribute to the D&A of women. Conclusion: The participants’ accounts showed that the application of respectful care in everyday maternity practice is inadequate in Nigeria. The findings reveal the need for policy and practice interventions to address the issue urgently through preventive measures such as empowering women through education to reinforce their right to respectful care. It reflects the need for sensitising and training health professionals on the importance of providing respectful care and how its elements can be incorporated into everyday practice. The underlying gender-related notion highlights the need for interventions at wider socio-political and community levels including the importance of educating family members about their right to respectful care and empowering them to report disrespectful practices.