"There is no time for knowing each other": Quality of care during childbirth in a low resource setting

Abstract

Objective: To explore women's and healthcare provider's perspectives of what quality of care during childbirth means to them and how this can be improved.

Design: 14 Focus Group Discussions (FGD) with women and 27 Key Informant Interviews (KII) with healthcare providers. Thematic framework analysis was used.

Setting: 14 public healthcare facilities across two districts in Malawi. Mothers who had given birth at a healthcare facility within the last 7-42 days and healthcare providers who were directly involved in maternity care.

Findings: Perceptions of what constitutes good quality of care differed substantially. For healthcare providers, the most important characteristics of good quality care included structural aspects of care such as availability of materials, and sufficient human resources. For women, patient-centred care including a positive relationship and experience was prioritised. However, both groups had similar views on what constitutes poor quality of care; unwelcoming reception on admission, non-consented care, physical and verbal abuse were described as examples of poor care. Shortage of staff, poor labour room design and a non-functional referral system were key barriers identified.

Key conclusions: Women as well as healthcare providers want good quality, professional care at birth and are disappointed if this is not in place.

Implication for practice: There is a need to incorporate women as well as healthcare provider's views when designing, implementing, monitoring and evaluating maternal health programmes. For a positive birth experience, a healthcare facility needs to have an enabling environment and good communication between healthcare providers and women should be actively promoted.

Keywords: Childbirth; Enabling environment; Positive experience of childbirth; Quality of care.