Sub-Saharan Africa accounts for approximately 66% of global maternal deaths. Poor person-centered maternity care, which emphasizes the quality of patient experience, contributes both directly and indirectly to these poor outcomes. Yet, few studies in low resource settings have examined what is important to women during childbirth from their perspective. The aim of this study is to examine women’s facility–based childbirth experiences in a rural county in Kenya, to identify aspects of care that contribute to a positive or negative birth experience.
Data are from eight focus group discussions conducted in a rural county in western Kenya in October and November 2016, with 58 mothers aged 15 to 49 years who gave birth in the preceding nine weeks. We recorded and transcribed the discussions and used a thematic approach for data analysis.
The findings suggest four factors influence women’s perceptions of quality of care: responsiveness, supportive care, dignified care, and effective communication. Women had a positive experience when they were received well at the health facility, treated with kindness and respect, and given sufficient information about their care. The reverse led to a negative experience. These experiences were influenced by the behavior of both clinical and support staff and the facility environment.
This study extends the literature on person-centered maternity care in low resource settings. To improve person-centered maternity care, interventions need to address the responsiveness of health facilities, ensure women receive supportive and dignified care, and promote effective patient-provider communication.
Alkema L, Chou D, Hogan D, Zhang S, Moller A-B, Gemmill A, et al. Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN maternal mortality estimation inter-agency group. Lancet. 2016;387:462–74. CrossRefPubMed
WHO. Making pregnancy safer: the critical role of the skilled attendant. Jt. Statement WHO ICM FIGO Geneva. 2004;
Graham WJ, McCaw-Binns A, Munjanja S. Translating Coverage Gains into Health Gains for All Women and Children: The Quality Care Opportunity. PLoS Med. 2013 10 [cited 2013 Jul 30]; Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3545868/.
Koblinsky M, Moyer CA, Calvert C, Campbell J, Campbell OMR, Feigl AB, et al. Quality maternity care for every woman, everywhere: a call to action. The Lancet. 2016 [cited 2016 Sep 24]; Available from: http://linkinghub.elsevier.com/retrieve/pii/S0140673616313332.
Bowser D, Hill K. Exploring Evidence for Disrespect and Abuse in Facility-Based Childbirth: Report of a Landscape Analysis | Traction Project. 2010 [cited 2015 Aug 31]. Available from: http://www.tractionproject.org/resources/access-skilled-care-respectful-maternal-care/exploring-evidence-disrespect-and-abuse.
Miller S, Abalos E, Chamillard M, Ciapponi A, Colaci D, Comandé D, et al. Beyond too little, too late and too much, too soon: a pathway towards evidence-based, respectful maternity care worldwide. The Lancet. 2016 [cited 2016 Sep 24]; Available from: http://linkinghub.elsevier.com/retrieve/pii/S0140673616314726.
Institute of Medicine (US) Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century [Internet]. Washington (DC): National Academies Press (US); 2001 [cited 2017 Dec 22]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK222274/.
Shaw D, Guise J-M, Shah N, Gemzell-Danielsson K, Joseph K, Levy B, et al. Drivers of maternity care in high-income countries: can health systems support woman-centred care? The Lancet. 2016 [cited 2016 Sep 24]; Available from: http://linkinghub.elsevier.com/retrieve/pii/S0140673616315276.
Kenya National Bureau of Statistics, Ministry of Health, National AIDS Control Council, Kenya Medical Research Institute, National Council for Population and Development, Nairobi, Kenya, and The DHS Program, ICF International, Rockville, Maryland, USA. The DHS Program - Kenya: DHS, 2014 - Final Report (English) [Internet]. 2015 [cited 2016 Feb 18]. Available from: http://dhsprogram.com/publications/publication-FR308-DHS-Final-Reports.cfm.
Migori County Departments, Department of Health Services. 2016 [cited 2017 Jun 2]. Available from: http://migori.go.ke/index.php/migori-county-departments/department-of-health.
Health Policy Project. Kenya County Health Fact Sheets. 2015 [cited 2017 Jun 2]. Available from: https://www.healthpolicyproject.com/index.cfm?id=kenyaCHFS.
Krueger RA, Casey MA. Focus groups: a practical guide for applied research. 4th ed. Los Angeles: SAGE Publications, Inc; 2008.
Onwuegbuzie A, Dickinson W, Leech N, Zoran A, G A A qualitative framework for collecting and analyzing data in focus group research Int J Qual Methods 2009;8:1.
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77–101. CrossRef
Tunçalp Ӧ, Were W, MacLennan C, Oladapo O, Gülmezoglu A, Bahl R, et al. Quality of care for pregnant women and newborns—the WHO vision. BJOG Int J Obstet Gynaecol. 2015;122:1045–9. CrossRef
Kenya’s doctors to end 100-day strike. USA TODAY. [cited 2017 Dec 5]. Available from: https://www.usatoday.com/story/news/world/2017/03/14/kenya-doctors-strike-over/99171746/.
Abuya T, Warren CE, Miller N, Njuki R, Ndwiga C, Maranga A, et al. Exploring the Prevalence of Disrespect and Abuse during Childbirth in Kenya. PLoS ONE. 2015 10 [cited 2015 Aug 31]; Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4401776/.
Leape LL, Shore MF, Dienstag JL, Mayer RJ, Edgman-Levitan S, Meyer GS, et al. Perspective: a culture of respect, part 1: the nature and causes of disrespectful behavior by physicians. Acad. Med. J. Assoc. Am. Med. Coll. 2012;87:845–52. CrossRef
Leape LL, Shore MF, Dienstag JL, Mayer RJ, Edgman-Levitan S, Meyer GS, et al. Perspective: a culture of respect, part 2: creating a culture of respect. Acad Med J Assoc Am Med Coll. 2012;87:853–8. CrossRef
Bohren MA, Vogel JP, Tunçalp Ö, Fawole B, Titiloye MA, Olutayo AO, et al. “By slapping their laps, the patient will know that you truly care for her”: a qualitative study on social norms and acceptability of the mistreatment of women during childbirth in Abuja, Nigeria. SSM - Popul. Health. 2016;2:640–55.
- What makes or mars the facility-based childbirth experience: thematic analysis of women’s childbirth experiences in western Kenya
Patience A. Afulani
- BioMed Central
Neu im Fachgebiet Gynäkologie und Geburtshilfe
Meistgelesene Bücher aus dem Fachgebiet
Mail Icon II