Understanding mistreatment during institutional delivery in Northeast Nigeria: a mixed-method study
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RESEARCH
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Understanding mistreatment during institutional delivery in Northeast Nigeria: a mixed-method study Nasir Umar1* , Deepthi Wickremasinghe1, Zelee Hill2, Umar Adamu Usman3 and Tanya Marchant1
Abstract Background: Improving quality of care including the clinical aspects and the experience of care has been advocated for improved coverage and better childbirth outcomes. Objective: This study aimed to explore the quality of care relating to the prevalence and manifestations of mistreatment during institutional birth in Gombe State, northeast Nigeria, an area of low institutional delivery coverage. Methods: The frequency of dimensions of mistreatment experienced by women delivering in 10 health facilities of Gombe State were quantitatively captured during exit interviews with 342 women in July–August 2017. Manifestations of mistreatment were qualitatively explored through in-depth interviews and focus groups with 63 women living in communities with high and low coverage of institutional deliveries. Results: The quantitative data showed that at least one dimension of mistreatment was reported by 66% (95% confidence interval (CI) 45–82%) of women exiting a health facility after delivery. Mistreatment related to health system conditions and constraints were reported in 50% (95% CI 31–70%) of deliveries. In the qualitative data women expressed frustration at being urged to deliver at the health facility only to be physically or verbally mistreated, blamed for poor birth outcomes, discriminated against because of their background, left to deliver without assistance or with inadequate support, travelling long distances to the facility only to find staff unavailable, or being charged unjustified amount of money for delivery. Conclusions: Mistreatment during institutional delivery in Gombe State is highly prevalent and predominantly relates to mistreatment arising from both health system constraints as well as health worker behaviours, limiting efforts to increase coverage of institutional delivery. To address mistreatment during institutional births, strategies that emphasise a broader health systems approach, tackle multiple causes, integrate a detailed understanding of the local context and have buy-in from grassroots-level stakeholders are recommended. Keywords: Quality of care, Respectful maternity care, Mistreatment, Maternal and newborn health, Mixed-methods
Plain English summary There is growing evidence from Nigeria and around the world that women who deliver their babies in health facilities can experience mistreatment. In our study, we describe how frequently this happens in Gombe state, north-eastern Nigeria, and what type of mistreatments women experience. Using a questionnaire, we interviewed consenting women as they left the facility after * Correspondence: [email protected] 1 Department of Disease Control, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK Full list of author information is available at the end of the article
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