Introduction
Methods
Data sources
Measures
Obstetric complications
Statistical analysis
Results
Univariate results
Characteristics of sample
n (%) | |
---|---|
Country/ setting | |
Rural Kenya | 873 (22%) |
Urban Kenya | 531 (13%) |
Ghana | 531 (13%) |
India | 2018 (51%) |
Age | |
15 to 22 years | 1299 (33%) |
23 to 25 years | 963 (24%) |
26 to 28 years | 748 (19%) |
29 to 48 years | 942 (24%) |
Parity (no. of prior births) | |
0–1 | 612 (19%) |
2 | 1101 (34%) |
3 | 748 (23%) |
4 + | 782 (24%) |
Marital status | |
Single | 211 (5%) |
Partnered/cohabiting | 109 (3%) |
Married | 3569 (90%) |
Widowed/ divorced/separated | 64 (2%) |
Education | |
No school or primary | 2383 (60%) |
Post primary, vocational, or secondary | 1109 (28%) |
University/ college or above | 461 (12%) |
Employed | |
No | 3307 (84%) |
Yes | 646 (16%) |
Household wealth quintile | |
Poorest | 727 (19%) |
Poor | 756 (19%) |
Middle | 738 (19%) |
Rich | 694 (18%) |
Richest | 1023 (26%) |
Had pregnancy complications | |
No | 1598 (40%) |
Yes | 2355 (60%) |
Delivery facility type | |
Government Hospital | 1603 (41%) |
Government Health Center | 2010 (51%) |
Mission or private facility | 331 (8%) |
Delivery provider gender | |
Male | 451 (11%) |
Female | 3368 (85%) |
Both | 124 (3%) |
Obstetric complications | |
No obstetric complications | 3308 (84%) |
Obstetric complications | 645 (16%) |
Mode of delivery (n = 3419)* | |
Vaginal delivery | 3287 (96%) |
C-section | 132 (4%) |
Distributions of experience of care indicators
EOC indicators | No, never n (%) | Yes, a few times n (%) | Yes, most of the time n (%) | Yes, all the time n (%) |
---|---|---|---|---|
Supportive care: mean summative score: 67.8 (SD = 14.1) d | ||||
Time to carea | 223 (6%) | 465 (12%) | 1057 (27%) | 2208 (56%) |
Labor support | 663 (17%) | 333 (8%) | 634 (16%) | 2323 (59%) |
Delivery support | 1327 (34%) | 236 (6%) | 433 (11%) | 1957 (50%) |
Able to talk about feelings | 1169 (30%) | 1311 (33%) | 873 (22%) | 600 (15%) |
Received support when anxious | 909 (23%) | 1090 (28%) | 769 (20%) | 1185 (30%) |
Received attention when needed help | 207 (5%) | 746 (19%) | 1362 (35%) | 1638 (41%) |
Provider took best care | 113 (3%) | 670 (17%) | 1596 (40%) | 1574 (40%) |
Pain control | 828 (21%) | 827 (21%) | 1219 (31%) | 1079 (27%) |
Trust in health providers | 110 (3%) | 364 (9%) | 1111 (28%) | 2368 (60%) |
Enough staff present | 232 (6%) | 656 (17%) | 1293 (33%) | 1772 (45%) |
Crowded facility* | 594 (15%) | 858 (22%) | 1264 (32%) | 1237 (31%) |
Clean environmentb | 357 (9%) | 504 (13%) | 1661 (42%) | 1431 (36%) |
Water present at facility | 317 (8%) | 224 (6%) | 741 (19%) | 2671 (68%) |
Electricity present at facility | 58 (2%) | 250 (6%) | 1359 (34%) | 2286 (58%) |
Felt safe at facility | 64 (2%) | 179 (5%) | 703 (18%) | 3007 (76%) |
Communication and autonomy: mean summative score: 43.2 (SD = 20.6)d | ||||
Provider introduced selfc | 3481 (88%) | 255 (7%) | 126 (3%) | 91 (2%) |
Called by name | 1192 (30%) | 857 (22%) | 688 (17%) | 1216 (31%) |
Involvement in care | 1482 (38%) | 626 (16%) | 608 (15%) | 1237 (31%) |
Consented to procedures | 2113 (54%) | 569 (14%) | 607 (15%) | 664 (17%) |
Delivery position choice | 1402 (36%) | 905 (21%) | 705 (18%) | 941 (24%) |
Providers spoke language you understood | 55 (1%) | 436 (11%) | 1940 (49%) | 1522 (39%) |
Provider explained exams/ procedures | 1946 (49%) | 642 (16%) | 633 (16%) | 732 (19%) |
Provider explained medicines | 1601 (49%) | 680(17%) | 598 (15%) | 1074 (27%) |
Able to ask questions | 755 (19%) | 869 (22%) | 1007 (26%) | 1322 (33%) |
Dignity and respect: mean summative score: 80.1 (SD = 18.2)d | ||||
Treated with respect | 198 (5%) | 540 (14%) | 1117 (28%) | 2098 (53%) |
Health staff Friendly | 163 (4%) | 625 (16%) | 1154 (29%) | 2011 (51%) |
Verbal abuse* | 3304 (84%) | 394 (10%) | 183 (5%) | 72 (2%) |
Physical abuse* | 3811 (96%) | 82 (2%) | 44 (1%) | 16 (0.4%) |
Visual privacy | 922 (23%) | 251 (6%) | 512 (13%) | 2268 (57%) |
confidentiality of records | 408 (10%) | 672 (17%) | 912 (23%) | 1961 (50%) |
Additional EoC indicators | ||||
Asked for a bribe* | 3141 (80%) | 616 (16%) | 172 (4%) | 24 (0.6%) |
Providers showed care** | 57 (3%) | 235 (12%) | 674 (35%) | 969 (50%) |
Privacy during discussions** | 1203 (62%) | 277 (14%) | 231 (12%) | 224 (12%) |
Providers ask about pain** | 474 (25%) | 467 (24%) | 490 (25%) | 504 (26%) |
Received attention during stay at facility** | 95 (5%) | 340 (18%) | 740 (38%) | 760 (39%) |
Allowed to eat and drink** | 399 (21%) | 382 (20%) | 444 (23%) | 710 (38%) |
Patient forced to stay against their will due to lack of pay** | 1848 (96%) | 50 (3%) | 25 (1%) | 12 (1%) |
Patient treated differently because of personal attributes** | 1833 (95%) | 57 (3%) | 27 (1%) | 18 (1%) |
Bivariate results
Experience of care indicators by obstetric complications
Experience of care indicators | Obstetric complications (n = 632) | No obstetric complications (n = 3321) | ||
---|---|---|---|---|
(a) Mean score (SD) | (b) Mean score (SD) | (a-b) Difference of mean scores | P-value | |
Supportive care | 66.6 (14.4) | 68.0 (14.0) | − 1.4 | 0.02 |
Time to care | 2.27 (0.98) | 2.34 (0.87) | − 0.07 | 0.09 |
Labor support | 2.02 (1.22) | 2.20 (1.13) | − 0.17 | < 0.001 |
Delivery support | 1.27 (1.38) | 1.86 (1.33) | − 0.59 | < 0.001 |
Talked to about feelings | 1.35 (1.08) | 1.20 (1.02) | 0.15 | 0.00 |
Support anxiety | 1.51 (1.18) | 1.57 (1.14) | − 0.06 | 0.24 |
Attention when need help | 2.09 (0.96) | 2.13 (0.88) | − 0.04 | 0.33 |
Provider took best care | 2.19 (0.87) | 2.17 (0.80) | 0.02 | 0.59 |
Control pain | 1.72 (1.11) | 1.63 (1.09) | 0.09 | 0.06 |
Trust in provider | 2.38 (0.85) | 2.47 (0.76) | − 0.09 | 0.01 |
Enough staff present | 2.11 (0.93) | 2.18 (0.90) | − 0.06 | 0.08 |
Crowded facility | 1.69 (1.09) | 1.78 (1.00) | − 0.09 | 0.05 |
Clean environment | 2.06 (0.85) | 2.05 (0.93) | 0.00 | 0.79 |
Water at facility | 2.43 (0.91) | 2.46 (0.92) | − 0.04 | 0.45 |
Electricity at facility | 2.55 (0.72) | 2.47 (0.67) | 0.08 | 0.01 |
Felt safe at facility | 2.61 (0.73) | 2.70 (0.61) | − 0.09 | 0.00 |
Communication and autonomy | 45.6 (20.2) | 42.7 (20.6) | 2.9 | 0.00 |
Providers introduce self | 0.26 (0.67) | 0.19 (0.59) | 0.07 | 0.01 |
Patient called by name | 1.56 (1.20) | 1.47 (1.21) | 0.08 | 0.09 |
Involvement in care | 1.47 (1.24) | 1.39 (1.28) | 0.08 | 0.14 |
Consent to procedures | 1.17 (1.26) | 0.91 (1.14) | 0.26 | < 0.001 |
Delivery position choice | 1.08 (1.19) | 1.34 (1.17) | − 0.26 | < 0.001 |
Provider used language patient understood | 2.38 (0.76) | 2.22 (0.69) | 0.16 | < 0.001 |
Explain exams/ procedures | 1.20 (1.20) | 1.01 (1.17) | 0.19 | < 0.001 |
Explain medicines | 1.29 (1.24) | 1.09 (1.20) | 0.20 | 0.00 |
Able to ask questions | 1.59 (1.16) | 1.76 (1.11) | − 0.17 | < 0.001 |
Dignity and respect | 81.1 (18.1) | 79.9 (18.2) | 1.2 | 0.12 |
Treated with respect | 2.29 (0.88) | 2.29 (0.88) | − 0.01 | 1.00 |
Friendly | 2.22 (0.92) | 2.28 (0.86) | − 0.05 | 0.13 |
Verbal abuse | 2.64 (0.77) | 2.77 (0.59) | − 0.13 | < 0.001 |
Physical abuse | 2.88 (0.47) | 2.96 (0.27) | − 0.07 | < 0.001 |
Visual privacy (were covered) | 2.27 (1.14) | 2.00 (1.27) | 0.27 | < 0.001 |
Record confidentiality | 2.34 (0.96) | 2.08 (1.04) | 0.26 | < 0.001 |
Additional indicators | ||||
Bribe | 2.68 (0.64) | 2.75 (0.55) | 0.05 | 0.01 |
Box 1. A comparison of experience of care indicators by obstetric complications*
Experience of care domain | Experience of care indicators: better when obstetric complications reported | Experience of care indicators: worse when obstetric complications reported |
---|---|---|
Supportive care domain
| Able to talk about feelings Electricity present at the facility | Labor support
Delivery support
Trust in providers Felt safe at facility |
Communication and autonomy domain
| Providers introduced themselves
Consent to procedures
Language Provider explained exams/ procedures Provider explained medicines |
Delivery position of choice
Able to ask provider questions |
Dignity and respect domain
|
Visual privacy
Confidentiality of records
| Verbal abuse Physical abuse |
Additional experience of care indicator
| Asked for bribe |
Experience of care indicators by severity of obstetric complications
Mean scores (SD) of women with no complications (n = 1058) | Mean scores (SD) of women with mild complications (n = 110) | Mean scores (SD) of women with severe complications (n = 236) | P-value | |
---|---|---|---|---|
Supportive care, mean (SD) | 68.0 (14.1) | 66.2 (14.6) | 64.3 (15.8) | 0.00 |
Time to care | 2.33 (0.87) | 2.36 (0.86) | 2.16 (1.08) | 0.04 |
Labor support | 1.88 (1.12) | 1.75 (1.14) | 1.96 (1.23) | 0.28 |
Delivery support | 0.81 (1.14) | 0.45 (0.87) | 0.50 (0.97) | 0.00 |
Talked about feeling | 1.61 (1.05) | 1.66 (1.04) | 1.54 (1.14) | 0.55 |
Support anxiety | 1.64 (1.16) | 1.66 (1.17) | 1.51 (1.21) | 0.28 |
Attention when need help | 2.09 (0.90) | 2.25 (0.84) | 2.04 (1.06) | 0.14 |
Took best care | 2.34 (0.74) | 2.39 (0.69) | 2.25 (0.94) | 0.19 |
Control pain | 1.41 (1.18) | 1.82 (1.20) | 1.58 (1.18) | 0.00 |
Trust | 2.33 (0.77) | 2.4 (0.78) | 2.31 (0.92) | 0.61 |
Enough staff present | 2.05 (1.01) | 2.01 (0.93) | 2.09 (1.01) | 0.77 |
Crowded | 1.90 (1.10) | 1.86 (1.04) | 1.71 (1.11) | 0.06 |
Clean environment | 2.02 (0.47) | 1.95 (0.30) | 2.05 (0.44) | 0.16 |
Water at facility | 2.45 (0.79) | 2.42 (0.75) | 2.36 (0.90) | 0.30 |
Electricity at facility | 2.47 (0.78) | 2.64 (0.62) | 2.56 (0.84) | 0.04 |
Felt safe at facility | 2.50 (0.72) | 2.56 (0.76) | 2.53 (0.78) | 0.64 |
Communication and autonomy | 42.7 (20.6) | 47.9 (22.8) | 47.1 (22.1) | 0.00 |
Introduce self | 0.46 (0.87) | 0.45 (0.84) | 0.34 (0.77) | 0.15 |
Called by name | 1.57 (1.23) | 1.44 (1.15) | 1.75 (1.27) | 0.05 |
Involvement in care | 1.81 (1.17) | 1.66 (1.10) | 1.56 (1.24) | 0.01 |
Consent to procedures | 1.54 (1.22) | 1.79 (1.22) | 1.44 (1.30) | 0.05 |
Delivery position choice | 0.77 (1.06) | 0.94 (1.14) | 0.80 (1.12) | 0.28 |
Language | 2.52 (0.74) | 2.6 (0.68) | 2.53 (0.86) | 0.57 |
Explain exams/ procedures | 1.55 (1.20) | 1.17 (1.20) | 1.45 (1.23) | 0.01 |
Explain medicines | 1.65 (1.20) | 1.54 (1.30) | 1.34 (1.27) | 0.00 |
Able to ask questions | 1.50 (1.14) | 1.36 (1.10) | 1.37 (1.23) | 0.18 |
Dignity and respect domain | 79.9 (18.2) | 82.8 (18.0) | 82.5 (18.6) | 0.03 |
Treated with respect | 2.37 (0.79) | 2.15 (0.85) | 2.33 (0.86) | 0.03 |
Friendly | 2.33 (0.81) | 2.15 (0.86) | 2.28 (0.92) | 0.09 |
Verbal abuse | 2.79 (0.61) | 2.66 (0.79) | 2.63 (0.88) | 0.00 |
Physical abuse | 2.93 (0.36) | 2.88 (0.48) | 2.82 (0.60) | 0.00 |
Visual privacy (were covered) | 2.28 (1.09) | 2.44 (0.93) | 2.33 (1.07) | 0.30 |
Record confidentiality | 2.29 (0.86) | 2.6 (0.77) | 2.44 (0.87) | 0.00 |
Additional experience of care indicators | ||||
Bribe | 2.90 (0.41) | 2.89 (0.41) | 2.80 (0.54) | 0.01 |
Lack of privacy during discussions | 2.14 (1.10) | 2.08 (1.15) | 2.26 (1.07) | 0.24 |
Providers ask about pain | 1.51 (1.12) | 1.69 (1.11) | 1.62 (1.19) | 0.15 |
attention during stay at facility | 2.16 (0.84) | 2.27 (0.81) | 2.09 (0.99) | 0.19 |
Allowed to eat and drink | 1.46 (1.16) | 1.67 (1.17) | 1.75 (1.19) | 0.00 |
Patient forced to stay | 2.91 (0.40) | 2.93 (0.40) | 2.90 (0.43) | 0.81 |
Patient treated differently | 2.90 (0.44) | 2.95 (0.27) | 2.83 (0.60) | 0.04 |
Providers showed care | 2.34 (0.79) | 2.31 (0.83) | 2.35 (0.83) | 0.91 |
Experience of care indicators by mode of delivery (c-section/vaginal delivery)
C-Section, N = 132 Mean (SD) | Vaginal Delivery, N = 3287 Mean score (SD) | Difference between mean scores | p-value | |
---|---|---|---|---|
Supportive care domain1 | 68.3 (SD = 14.6) | 68.2 (SD = 14.2) | 0.1 | 0.96 |
Time to care | 2.26 (1.05) | 2.31 (0.89) | − 0.05 | 0.61 |
Labor support | 1.91 (1.22) | 1.88 (1.15) | 0.03 | 0.79 |
Delivery support | 0.68 (1.14) | 0.75 (1.13) | − 0.07 | 0.54 |
Talk about feeling | 1.86 (1.08) | 1.57 (1.05) | 0.29 | 0.01 |
Support Anxiety | 1.94 (1.21) | 1.70 (1.33) | 0.24 | 0.04 |
Attention when need help | 2.26 (0.90) | 2.07 (0.93) | 0.18 | 0.03 |
Took best care | 2.48 (0.70) | 2.31 (0.78) | 0.17 | 0.01 |
Control pain | 1.75 (1.11) | 1.44 (1.18) | 0.32 | 0.00 |
Trust | 2.50 (0.66) | 2.31 (0.81) | 0.19 | 0.00 |
Enough staff present | 2.35 (0.87) | 2.01 (1.01) | 0.33 | < 0.001 |
Crowded | 1.81 (1.06) | 1.89 (1.10) | − 0.07 | 0.43 |
Clean environment | 2.15 (0.65) | 2.17 (0.60) | − 0.02 | 0.74 |
Water present at facility | 2.59 (0.69) | 2.40 (0.82) | 0.19 | 0.00 |
Electricity present at facility | 2.52 (0.82) | 2.49 (0.77) | 0.04 | 0.70 |
Felt safe at facility | 2.58 (0.69) | 2.49 (0.74) | 0.09 | 0.16 |
Communication and autonomy domain1 | 55.7 (SD = 22.2) | 40.6 (SD = 20.0) | 15.1 | 0.00 |
Introduce self | 0.54 (1.00) | 0.42 (0.84) | 0.12 | 0.18 |
Called by name | 1.85 (1.25) | 1.55 (1.22) | 0.30 | 0.01 |
Involvement in care | 2.08 (1.15) | 1.78 (1.27) | 0.30 | 0.01 |
Consent to procedures | 1.89 (1.17) | 1.50 (1.23) | 0.39 | < 0.001 |
Delivery position choice | 0.82 (1.12) | 0.78 (1.07) | 0.04 | 0.70 |
Language | 2.48 (0.83) | 2.52 (0.75) | − 0.04 | 0.70 |
Explain exams/ procedures | 1.88 (1.19) | 1.46 (1.21) | 0.42 | < 0.001 |
Explain medicines | 1.85 (1.32) | 1.79 (1.28) | 0.06 | 0.63 |
Able to ask questions | 1.75 (1.21) | 1.43 (1.14) | 0.32 | 0.01 |
Dignity and respect domain1 | 84.7 (SD = 16.4) | 80.0 (SD = 18.5) | 4.7 | 0.00 |
Treated with respect | 2.39 (0.88) | 2.33 (0.82) | 0.06 | 0.46 |
Friendly | 2.29 (0.94) | 2.30 (0.84) | 0.00 | 0.91 |
Verbal abuse | 2.73 (0.73) | 2.76 (0.67) | − 0.04 | 0.66 |
Physical abuse | 2.82 (0.54) | 2.91 (0.41) | − 0.09 | 0.07 |
Visual privacy (were covered) | 2.38 (0.73) | 2.59 (0.72) | − 0.22 | 0.00 |
Record confidentiality | 2.42 (0.84) | 2.32 (0.87) | 0.10 | 0.21 |
Additional experience of care indicators | ||||
Bribe | 2.86 (0.47) | 2.88 (0.44) | − 0.02 | 0.65 |
Lack of privacy during discussions** | 2.12 (1.20) | 2.16 (1.09) | − 0.04 | 0.72 |
Providers ask about pain** | 1.84 (1.10) | 1.51 (1.13) | 0.33 | 0.00 |
Received attention during stay at facility** | 2.29 (0.76) | 2.14 (0.88) | 0.15 | 0.04 |
Allowed to eat and drink** | 1.35 (1.18) | 1.54 (1.165) | − 0.19 | 0.09 |
Patient forced to stay** | 2.73 (0.73) | 2.93 (0.35) | − 0.20 | 0.00 |
Patient treated differently** | 2.78 (0.67) | 2.90 (0.44) | − 0.12 | 0.05 |
Providers showed care** | 2.48 (0.76) | 2.32 (0.81) | 0.16 | 0.03 |
Box 2. A comparison of experience of care indicators by mode of delivery*
Experience of care domain | Experience of care indicators: better when c-section delivery reported | Experience of care indicators: worse when c-section delivery reported |
---|---|---|
Supportive care domain
|
Able to talk about feelings
Support anxiety Attention when need help Took best care
Control pain
Trust in providers
Enough staff present
Water present at delivery facility | |
Communication and autonomy domain
|
Called by name
Involved in care
Consent to procedures
Explain exams/procedures
Able to ask questions
| |
Dignity and respect domain
| Visual privacy | |
Additional experience of care indicator
|
Providers ask about pain
Received attention during stay at delivery facility Providers showed they cared | Patient forced to stay in delivery facility |
Multivariable results
PCMC | Supportive care | Communication and autonomy | Dignity and respect | |
---|---|---|---|---|
Coef. [robust std. err.] | Coef. [robust std. err.] | Coef. [robust std. err.] | Coef. [robust std. err.] | |
Obstetric complications | ||||
No obstetric complications | Ref. | |||
Obstetric complications | 1.13 [− 2.72, 0.46] | − 1.12 [− 2.73,0.49] | − 1.39 [− 3.65, 0.87] | − 0.71 [− 2.64, 1.23] |
Mode of delivery | ||||
Vaginal delivery | Ref. | |||
Cesarean delivery | 4.36** [1.56, 7.16] | 4.06** [1.18, 6.95] | 7.87*** [3.82, 11.9] | 0.22 [− 2.91, 3.36] |
Constant | 58.8*** [55.9, 61.8] | 60.6*** [57.6, 63.6] | 40.6*** [36.4, 44.8] | 78.4*** [75.0, 81.8] |