Women's experiences of disrespectful and abusive maternal health care in a low resource rural setting in eastern Zimbabwe

Abstract

Background: There has been an increase in recent publications, in high and medium resource settings, documenting women's dissatisfaction with the quality of maternity care they receive. Their discontent is mostly related to their midwives' disrespectful or negative attitudes.

Objective: To explore women's experiences and perceptions of disrespect and abuse from their maternity care providers in a low resource rural setting in Zimbabwe.

Design: A critical, qualitative research methodology, using in-depth interviews and two focus group discussions, was employed to capture rural women's experiences during antenatal care, postpartum care, and the use of maternity waiting homes' services.

Setting: Three rural health centres in Mutare district, Manicaland Province in eastern Zimbabwe.

Participants: A total of 20 purposively sampled women, 16-30 years of age, who were accessing various stages of maternal health services, were recruited from three conveniently selected rural health centres. Eight women participated in the in-depth interviews. A further eight women were discussants in the first focus group, and a further four women participated in the second focus group.

Findings: Multifaceted and interconnected factors contribute to midwives' attitudes and behaviours towards their clients. Midwives' subjective perceptions, women's social status, and health system constraints (i.e., availability of trained midwives and quality of midwifery training) in rural and poorly resourced community, often result in inappropriate services, negative attitudes, abusive treatment, and disrespectful behaviour towards women. Poor treatment in maternity care directly contribute to adverse health outcomes and women's satisfaction with services.

Conclusion and implications for practice: Women's social status, level of education and age, were perceived to influence the quality of care or treatment they received. Improving women's experience of maternal care requires targeted interventions at the interpersonal level between a woman and her health care providers, as well as at the level of the health care facility and the health system. The results of this study challenge all tiers of health personnel including policy makers, in low resource settings to reappraise the present situation thereby challenging these established behaviours, to ensure that the continuum of maternity care is respectfully and socio-culturally delivered.

Keywords: Abuse; Disrespect; Low resource settings; Maternal care services; Quality of care; Rights.