Maternal Health Infrastructure and Interpersonal Quality of Care During Childbirth: An Examination of Facility Delivery
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Maternal Health Infrastructure and Interpersonal Quality of Care During Childbirth: An Examination of Facility Delivery in Malawi Stephanie A. Kujawski1 Accepted: 7 November 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Objectives The maternal health field has recently focused on the importance of interpersonal quality of care and continues to cite structural deficits as a contributor to poor interpersonal treatment. This hypothesis is supported by qualitative evidence. This study quantitatively tested the effect of maternal health structural inputs on interpersonal quality of care during childbirth. Methods Analyses were conducted using data from the 2013 to 2014 Malawi Service Provision Assessment, which documented the availability and quality of health facility services and included the observation of laboring and delivering women. Maternal health structural inputs were measured using 26 facility infrastructure variables. The outcome, interpersonal quality of care, was measured as a sum score of 12 items collected during the observations. Crude and adjusted associations between maternal health structural inputs on interpersonal quality of care were assessed using linear regression with cluster robust standard errors. Results 345 Observations of delivering women in 174 health facilities were included in the analysis. 19.1% of women delivered in a facility with high maternal health structural inputs, and the mean interpersonal quality of care score was 8.9/12. Maternal health structural inputs had a small, non-meaningful association with interpersonal quality of care during childbirth (adjusted β − 0.19, 95% CI − 0.85, 0.47). Conclusions for Practice These findings do not verify the quality of care frameworks or qualitative evidence that support the relationship between structure and interpersonal quality of care. While structural inputs are important for health system performance, the results suggest that they might not be necessary for a respectful childbirth experience. Keywords Interpersonal quality of care · Disrespect and abuse · Respectful maternity care · Maternal health · Health infrastructure · Malawi
Significance Statement
What This Study Adds?
What is Already Known on This Topic?
We quantitatively assessed the effect of maternal health structural inputs on interpersonal quality of care during childbirth using health facility data from Malawi. Maternal health structural inputs had a small, non-meaningful association with interpersonal quality of care during childbirth. Structural inputs are essential for the performance of technical quality in maternal health, but the results of this study suggest they might not be necessary for a respectful childbirth experience at a health facility.
The maternal health field has focused on the importance of interpersonal quality of care. Qualitative studies cite structural deficits as a contributor to poor interpersonal treatment. Electronic supplementary material The online version of this article (https://doi.org/10
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