Background
Methods
Study designs
Study settings
Data collection and issues
Data processing and analysis
Results
Participants’ characteristics
Variables | Experiences of mistreatment | |||
---|---|---|---|---|
Total | Yes (n = 26) | No (n = 491) |
p
| |
Health zone | 0.082 | |||
Muanda | 195 (37.7%) | 14 (7.2%) | 181 (92.8%) | |
Bolenge | 322 (62.3%) | 12 (3.7%) | 310 (96.3%) | |
Health catchment area | 0.054* | |||
Kitona | 98 (19.0%) | 5 (5.1%) | 93 (94.9%) | |
Nsiamfumu | 97 (18.8%) | 9 (9.3%) | 88 (90.7%) | |
Iyonda | 160 (30.9%) | 3 (1.9%) | 157 (98.1%) | |
Wendji Secli | 162 (31.3%) | 9 (5.6%) | 153 (94.4%) | |
Age | 0.259 | |||
Younger than 20 years | 113 (21.9%) | 8 (7.1%) | 105 (92.9%) | |
20 years and older | 404 (78.1%) | 18 (4.5%) | 386 (95.5%) | |
Age (mean ± SD) | 25.8 ± 7.3 | 25.4 ± 7.8 | 25.8 ± 7.3 | 0.757 |
Age (median, range) | 24.0 (15–48) | |||
Education level | 1.000 | |||
Below secondary school | 489 (94.6%) | 16 (3.3%) | 462 (96.7%) | |
Secondary school and above | 28 (5.4%) | 0 (0.0%) | 28 (100.0%) | |
Marital status | 0.384 | |||
Live in partnership | 447 (86.5%) | 21 (4.7%) | 426 (95.3%) | |
Live out of partnership | 70 (13.5%) | 5 (7.1%) | 65 (92.9%) | |
Respondent’s occupation | 0.496 | |||
Civil servant/police/army | 4 (0.8%) | 0 (0.0%) | 4 (100.0%) | |
Private sector employee | 8 (1.5%) | 0 (0.0%) | 8 (100.0%) | |
Farmer/fisherman | 205 (39.7%) | 9 (4.4%) | 196 (95.4%) | |
Small trader/odd jobs | 146 (28.2%) | 7 (4.8%) | 139 (95.2%) | |
No specific job | 154 (29.8%) | 10 (6.5%) | 144 (93.5%) | |
Respondent’s religion | 0.768 | |||
Catholic | 191 (36.9%) | 9 (4.7%) | 182 (95.3%) | |
Protestant | 98 (19.0%) | 5 (5.1%) | 93 (94.9%) | |
Other Christian churches | 206 (39.8%) | 11 (5.3%) | 189 (94.7%) | |
Others (Muslim, Animist, Agnostic, Atheist) | 22 (4.3%) | 1 (4.5%) | 21 (95.5%) | |
Mode of transportation | 0.536 | |||
On foot | 375 (72.5%) | 18 (4.8%) | 357 (95.2%) | |
Bicycle | 44 (8.5%) | 1 (2.3%) | 43 (97.7%) | |
Motorcycles and cars | 98 (19.0%) | 7 (7.1%) | 91 (92.9%) | |
Respondent ‘s category | 0.503 | |||
Pregnant | 149 (28.8%) | 9 (6.0%) | 140 (94.0%) | |
Recently delivered | 368 (71.2%) | 17 (4.6%) | 351 (94.4%) | |
Number of deliveries (mean ± SD) | 3.3 ± 2.4 | 3.4 ± 2.8 | 3.3 ± 2.4 | 0.786 |
Number of deliveries (median, range) | 3.00 (0–12) | 2.50 (0–12) | 3.00 (0–11) | 0.741 |
Childbirth | 0.949 | |||
No previous birth and first birth | 142 (27.5%) | 7 (4.9%) | 135 (95.1%) | |
2 births and more | 375 (72.5%) | 19 (5.1%) | 356 (94.9%) | |
Health provision location | 0.948 | |||
Local health area centre | 368 (71.2%) | 19 (5.2%) | 349 (94.8%) | |
Other health area facility | 49 (9.5%) | 2 (4.1%) | 47 (95.9%) | |
Health facility out of health area | 100 (19.3%) | 5 (5.0%) | 95 (95.0%) | |
Distance residence-health facility (Km) (mean ± SD) | 3.2 ± 4.1 | 4.1 ± 6.2 | 3.1 ± 3.9 | 0.231 |
Informed about health centres activities (yes) | 359 (62.9%) | 10 (2.8%) | 349 (97.2%) | 0.000 |
Health centres collect users’ views (Yes) | 288 (55.7%) | 10 (3.5%) | 278 (96.5%) | 0.069 |
Complications (Yes) | 97 (18.8%) | 5 (5.2%) | 92 (94.8%) | 0.168 |
Ethnicity (Bantus) | 499 (96.5%) | 26 (5.2%) | 473 (94.8%) | 0.320 |
Native of the territory/indigenous (Yes) | 255 (49.3%) | 15 (5.9%) | 240 (94.1%) | 0.381 |
Knew or heard about a relative or a neighbour who experienced described situation (Yes) | 38 (7.4%) | 2 (7.7%) | 36 (7.3%) | 0.945 |
Participants | Location | Number | Sex | Age | Education | ||
---|---|---|---|---|---|---|---|
Focus groups | M | F | Age | Lower | Higher | ||
Key informants | Muanda | 12 | 9 | 3 | 30–65 | P5 | MPH |
Bolenge | 8 | 7 | 1 | 31–45 | U3 | U6/MD | |
Community health workers and Health committee members | Muanda | 12 | 6 | 6 | 23–67 | P6 | U3 |
Bolenge | 12 | 7 | 5 | 25–65 | P4 | U1 | |
Men and men’s groups’ representatives | Muanda | 12 | 12 | – | 25–57 | P6 | U2 |
Bolenge | 12 | 12 | – | 31–63 | P4 | U1 | |
Women and women’s groups’ representatives | Muanda | 12 | – | 12 | 23–45 | P6 | S6 |
Bolenge | 12 | – | 12 | 22–54 | NE | S6 | |
Total | 92 | 53 | 39 | 22–67 | NE | MPH |
Factors influencing the capacity of women to voice
On the other hand, participants in the FGDs agreed that women in local settings do not voice their concerns regarding health services. They recognized that women did not have any capacity to voice their views.“It is important to inform the nurse in charge of the health centre of our concerns…He/she needs to know in order to address this issue. If he/she does not know, this problem will continue.”(Woman, FGD, Bolenge).
Regarding the factors that influenced the capacity of women to voice their concerns and expectations about maternal health services, data reanalysis identified four factors: (1) women’s knowledge of maternal health services and the mandate of health providers; (2) information about the health services women should expect; (3) awareness of their entitlements and rights including their rights as consumers; and (4) socio-cultural barriers to expressing themselves.“We do not have any capacity to speak out. We are not able to go to see health providers and to oblige them to correct this or that thing. What is the main issue? ...as it is a habit which exists...”(Woman, FGD, Muanda)
“When we visit for antenatal care, health providers gather us together and give us a seat in a place near the health centre. The session always begins with health education and communication…They provide us with advice…Then comes the physical examination. You go into the health provider’s room, she asks you questions about your health, examines you, and takes measures of your stomach with a ribbon meter and checks it with a metal device. Sometimes, they also take your weight and direct you in the laboratories for examinations of blood, urine and stool.”(Woman, Interview, Bolenge)
“Interviewer: You described what you received as healthcare during the last attendance. Did you know these before the first time? Could you talk about what you knew before you attended the service the first time?”“Respondent: We did not know all these before we attended the health centre for antenatal care.”(Interview, Bolenge)
“We are not able to understand their job. We know nothing about their work. Health providers perform their duty as they have learnt.”(Woman, FGD, Bolenge)
“What I want? I want that the health providers provide me with healthcare and give me necessary drugs. But I am not able to choose what care to seek for or what I need. All that health providers consider necessary for me, I accept…I am sure that they cannot harm my health.”(Woman, Interview, Bolenge)“We do not have a choice. All things are performed as they habitually do according to me.”(Woman, Interview, Bolenge)
“…And this is why I have already said that I cannot blame health providers, I cannot say so much as I do not know how to say if it is bad or it is done properly. For example, during the delivery, health providers slapped the woman. If she does not know if it is good or it is bad, how could she tell this doctor: you hurt me? Or the health provider acted inappropriately, but she says to herself that it is like that normally.”(Woman, FGD, Muanda)“If these types of meetings [FGDs] are continually organized, people will attend and gain knowledge...Then in this case, when they have to claim something from health providers, they will use clear words. They shall not doubt, the woman will not doubt either. She knows what she can say because she learned, and she knows that the thing was not done appropriately.”(Man, FGD, Muanda)
“I cannot waste my time checking the work of the health providers when I visit the health centre. It is not my job. I visit the health centre for care and not to check the others’ job”
(Woman, FGD, Bolenge)
“I think that mistreatments are very common in hospital but not here in our health centre. We have heard that in hospital, when a woman is not able to push the child out during the delivery, some birth attendants lightly slap her. It is not that she is slapped for nothing. I do not agree.”(Women CHW, FGD, Muanda).
“Regarding physical abuses in the delivery room…I think that we cannot call them physical abuses or slaps. For us, there are ways to encourage women. The health providers do not slap them nor hurt them. These cannot kill them. It is to remind you that you have to make the step and push out the child.”
(Woman, FGD, Bolenge,)
“We have here women who are not able to take care of their children nor of their own hygiene. In this case, health providers act as a well-intentioned parent who reprimands her daughter. It is not a scolding nor an insult.”
(Woman, FGD, Bolenge).
Grouped mistreatment events | Yes |
---|---|
Undignified care | 10 (1.9%) |
Shouting at patient/scolding the patient | 7 (1.4%) |
Threatening to withhold treatment | 4 (0.8%) |
Threatening comments or negative or discouraging/disparaging comments | 3 (0.6%) |
Abandonment or neglect | 8 (1.5%) |
Ignoring or abandoning patient when in need or when called | 2 (0.4%) |
Delivered alone/no performance of antenatal care actions during visit | 6 (1.2%) |
Physical abuse | 8 (1.5%) |
Hitting, slapping, pushing, pinching or otherwise beating the patient | 8 (1.5%) |
Sexual abuse or harassment | 2 (0.4%) |
Otherwise hurting the patient | 0 (0.0%) |
No/Lack of confidential care | 0 (0.0%) |
Allowing patient body seen by others | 0 (0.0%) |
Revealing confidential patient’s information to other persons | 0 (0.0%) |
No consented care (perform healthcare without permission/ information) | 5 (1.0%) |
Inappropriate demands for payment | 9 (1.7%) |
Request or demand for informal payment for better care | 6 (1.2%) |
Detention of the mother or of the baby due to failure to pay | 4 (0.8%) |
Health service responsiveness aspects | Yes (n = 517) |
---|---|
Lack of attention/health provider does not respond in reasonable time | 31 (6.0%) |
Health facility rooms are unclean | 11 (2.1%) |
Health facility rooms are small | 18 (3.5%) |
Did not choose the health providers | 499 (95.6%) |
Have an explanation of her health problem or healthcare provided | 373 (72.1%) |
Give her opinion in the choice of healthcare | 167 (32.3%) |
Health services quality satisfaction assessment | Total | Mistreatment experiences |
p
| |
---|---|---|---|---|
Yes | No | 0.016 | ||
Very satisfied | 77 (15.1%) | 1 (3.8%) | 76 (15.7%) | |
Satisfied | 232 (45.4%) | 11 (42.3%) | 221 (45.6%) | |
Indifferent/Neutral | 50 (9.8%) | 7 (26.9%) | 43 (8.9%) | |
Not satisfied/Unsatisfied | 124 (24.3%) | 7 (26.9%) | 117 (24.1%) | |
Very unsatisfied | 28 (5.5%) | 0 (0.0%) | 28 (5.8%) |
Intention of future attendance or of recommending to another relative | ||||
---|---|---|---|---|
Mistreatment experiences | Total | Yes | No | 0.000 |
Yes | 26 (5.0%) | 18 (69.2%) | 8 (30.8%) | |
No | 491 (95.0%) | 473 (96.3%) | 18 (3.7%) |