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Addressing Disrespect and Abuse in Tanzania

Photo of Mothers and babies at Kibaoni Health Center, Photoshare

Research Overview

An award was made in February 2011 to AMDD (Averting Maternal Death and Disability, Columbia University) to fund implementation research on disrespect and abuse during facility-based childbirth in Tanzania.  The purpose of the research is to document the manifestations and prevalence of disrespect and abuse (D&A) in facilities, measure prevalence of D&A, and to design, test, and evaluate an approach for reducing the problem. The research aims to promote respectful maternal care (the converse of disrespectful and abusive care) so demand for skilled delivery care increases and the quality of services rendered improves.

 

Project Location

Tanzania: Korogwe and Muheza Districts, in the Tanga Region

 

 

Research Objectives

The objectives of the study are as follows:

  • Develop and validate tools for assessing disrespect and abuse
  • Determine the manifestations, types, and prevalence of disrespect and abuse during childbirth
  • Identify and explore the potential drivers of disrespect and abuse
  • Design, implement, monitor and evaluate the impact of one or more interventions to reduce disrespect and abuse
  • Document and assess the dynamics of implementing interventions to reduce disrespect and abuse and generate lessons for replication

Study design and methods:

At the start of the project, the team met in Dar es Salaam to harmonize the project’s objectives, core indicators and research methodologies along with developing common definitions of disrespect and abuse.

Various study methods were adopted for the objectives of the study.

  • Develop and validate tools for assessing disrespect and abuse
  • Focus group discussions (FGDs) were performed in Korogwe and Muheza to gather qualitative data on women’s childbirth experiences and to gain a more culturally contextualized understanding of disrespect and abuse.
  • A qualitative, semi-structured in-depth interview and a quantitative, structured questionnaire were performed in order to establish concurrent validity of the exit questionnaires.
  • Determine the manifestations, types and prevalence of disrespect and abuse in childbirth
  • Facility exit interviews were pre-tested and administered to assess the manifestations, types and prevalence of disrespect and abuse in childbirth.
  • Additional community follow-up interviews were conducted in order to assess if there were any recall effect and to further analyze the effects of disrespect and abuse.
  • Identify and explore the potential drivers of disrespect and abuse
  • FGDs were conducted with the community members and were on the causes of disrespect and abuse, ability to react to disrespect and abuse and recommendations for better care.
  • Stakeholder interviews consisted of in-depth and key informant interviews and FGDs at the national, regional, district and community levels.
  • Design, implement, monitor and evaluate the impact of interventions to reduce disrespect and abuse

Further information and resources can be found on the AMDD Respectful Maternal Care page here.

 

Lessons Learned

Forthcoming

 

Dissemination of Findings

Forthcoming

 

Publications

The emerging topic of disrespect and abuse during childbirth continues to grow as researchers develop new, more robust methods to measure the prevalence of disrespect and abuse, as well as plan, implement, monitor and evaluate interventions to reduce disrespect and abuse and promote respectful maternal care. Several of the TRAction Project’s implementation partners have recently published journal articles on this topic. Click on the links below to read more.

Association Between Disrespect and Abuse During Childbirth and Women’s Confidence in Health Facilities in Tanzania

by Stepahnie Kujawski, Godfrey Mbaruku, Lynn P. Freedman, Kate Ramsey, Wema Moyo, Margaret E. Kruk. Published in Maternal and Child Health Journal, May 2015

Disrespectful and Abusive Treatment during Facility Delivery in Tanzania: A Facility and Community Survey

by Margaret E Kruk, Stephanie Kujawski, Godfrey Mbaruku, Kate Ramsey, Wema Moyo and Lynn P Freedman. Published in Health Policy and Planning, October 2014

Disrespect and Abuse of Women in Childbirth: Challenging the Global Quality and Accountability Agendas

by Lynn P Freedman, Margaret E Kruk. Published in The Lancet, June 2014.

 

Research Partners

Ifakara Health Institute

Principal Investigator: Lynn Freedman, Columbia AMDD

 

Project Status

Region: 
Country / Countries: