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. 2022 Mar;26(3):481-492.
doi: 10.1007/s10995-022-03383-9. Epub 2022 Feb 26.

Experiences of Health Facility Childbirth in Sub-Saharan Africa: A Systematic Review of Qualitative Evidence

Uchenna Gwacham-Anisiobi  1   2 , Aduragbemi Banke-Thomas  3   4   5
Affiliations

Experiences of Health Facility Childbirth in Sub-Saharan Africa: A Systematic Review of Qualitative Evidence

Uchenna Gwacham-Anisiobi et al. Matern Child Health J. 2022 Mar.

Abstract

Introduction: Access to skilled birth attendance has been prioritised as an intervention to minimise burden of maternal deaths in sub-Saharan Africa (SSA). However, poor experience of care (EoC) is impeding progress. We conducted a systematic review to holistically explore EoC patterns of facility-based childbirth in SSA.

Methods: PubMed, Embase and Scopus databases were searched to identify SSA EoC studies conducted between January 2000 and December 2019. Studies meeting our pre-defined inclusion criteria were quality assessed and relevant data extracted. We utilised the EoC quality standards (defined by the World Health Organization) to summarise and analyse findings while highlighting patterns.

Results: Twenty-two studies of varying quality from 11 SSA countries were included for review. Overall, at least one study from all included countries reported negative EoC in one or more domains of the WHO framework. Across SSA, 'respect and preservation of dignity' was the most reported domain of EoC. While most women deemed the pervasive disrespect as unacceptable, studies in West Africa suggest a "normalisation" of disrespect, if the intent is to save their lives. Women often experienced sub-optimal communication and emotional support with providers in public facilities compared to non-public ones in the region. These experiences had an influence on future institutional deliveries.

Discussion: Sub-optimal EoC is widespread in SSA, more so in public facilities. As SSA heath systems explore approaches make progress towards the Sustainable Development Goal 3, emphasis needs to be placed on ensuring women in the region have access to both high-quality provision and experience of care.

Keywords: Experience of care; Facility childbirth; Institutional births; Maternal health; Quality of care; Sub-Saharan Africa.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
World Health Organization’s quality of care framework for maternal and newborn health with quality standards and statements for experience of care
Fig. 2
Fig. 2
PRISMA flow diagram of the literature review process
Fig. 3
Fig. 3
Distribution of included studies by year of publication
Fig. 4
Fig. 4
Map of Africa indicating the countries with published literature
See this image and copyright information in PMC

References

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