Respectful Maternity Care Interventions: A Systematic Literature Review.

Abstract

High maternal and new born mortality remains a pressing problem in developing settings. Poor treatment during childbirth contributes directly and indirectly to this problem at a rate of 82%. Many women experience disrespectful and abusive treatment during childbirth in facilities worldwide which violates their rights to respectful care and a threat to their right to life, health, bodily integrity and freedom from discrimination. Majority of women report to have experienced some form of disrespect and abuse during childbirth. This systematic literature review aimed at reviewing studies on Respectful Maternity Care interventions aimed at promoting Quality of Maternal and New born Care. Objectives were to assess literature on how mothers are treated during childbirth (experience of care/respectful maternity care), to find out the factors contributing to disrespect and abuse during childbirth, to identify strategies for addressing issues affecting respectful maternity care. The literature review employed a quality assessment tool ‘PRISMA’, by the WHO. Eligibility criteria was studies published between 1992 and 2020 in indexed national and international journals in English language focusing on Respectful Maternity Care interventions in promoting Quality of Maternal and New born Care. Literature was reviewed from academic databases, project reports and documents. Electronic searches included reference libraries: PubMed, Cochrane Reference Libraries, google scholar, Medline on Mega scope data bases, CINAHL, Embase data bases and grey literature. Studies meeting the following criteria were included in the review: 1) Respectful Maternity Care; 2) Facilitators to dignity and respect during childbirth; and 3) Quality of Maternal and New born Care (QMNC). Disrespect and abuse appear to be widespread and research and implementation efforts must continue, there is lack of standardized definitions, instruments hence affecting generalizability and comparability, there are no adequate available data to quantify the prevalence of these behaviours. No matter the conceptual framework used in future investigations, studies should seek to accomplish three objectives: (1) to measure the perceived and observed frequencies of mistreatment in maternal health settings, (2) to examine the macro and micro level factors that drive mistreatment, (3) to assess the impact of mistreatment on the health outcomes of women and their new borns, and 4)  to employ mixed method design as an optimal strategy to evaluate mistreatment and include direct observations to bridge the gap between observed measures and participants’ self-reported experiences of mistreatment.