Study protocol for promoting respectful maternity care initiative to assess, measure and design interventions to reduce disrespect and abuse during childbirth in Kenya.
BACKGROUND
Increases in the proportion of facility-based deliveries have been marginal in many low-income countries in the African region. Preliminary clinical and anthropological evidence suggests that one major factor inhibiting pregnant women from delivering at facility is disrespectful and abusive treatment by health care providers in maternity units. Despite acknowledgement of this behavior by policy makers, program staff, civil society groups and community members, the problem appears to be widespread but prevalence is not well documented. Formative research will be undertaken to test the reliability and validity of a disrespect and abuse (D&A) construct and to then measure the prevalence of disrespect and abuse suffered by clinic clients and the general population.


METHODS
A quasi-experimental design will be followed with surveys at twelve health facilities in four districts and one large maternity hospital in Nairobi and areas before and after the introduction of disrespect and abuse (D&A) interventions. The design is aimed to control for potential time dependent confounding on observed factors.


CONCLUSIONS
This study seeks to conduct implementation research aimed at designing, testing, and evaluating an approach to significantly reduce disrespectful and abusive (D&A) care of women during labor and delivery in facilities. Specifically the proposed study aims to: (i) determine the manifestations, types and prevalence of D&A in childbirth (ii) develop and validate tools for assessing D&A (iii) identify and explore the potential drivers of D&A (iv) design, implement, monitor and evaluate the impact of one or more interventions to reduce D&A and (v) document and assess the dynamics of implementing interventions to reduce D&A and generate lessons for replication at scale.
Population Council, Nairobi, Kenya.
Charlotte
C
Warren
Rebecca
R
Njuki
Timothy
T
Abuya
Charity
C
Ndwiga
Grace
G
Maingi
Jane
J
Serwanga
Faith
F
Mbehero
Louisa
L
Muteti
Anne
A
Njeru
Joseph
J
Karanja
Joyce
J
Olenja
Lucy
L
Gitonga
Chris
C
Rakuom
Ben
B
Bellows
D000328:Adult; D001291:Attitude of Health Personnel; D002985:Clinical Protocols; D003219:Confidentiality; D036861:Delivery, Obstetric / Q000941:ethics / Q000523:psychology*; D005260:Female; D006268:Health Facilities / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D007258:Informed Consent; D007630:Kenya; D007743:Labor, Obstetric / Q000523:psychology*; D005791:Patient Care / Q000009:adverse effects* / Q000941:ethics / Q000523:psychology; D011247:Pregnancy; D011287:Prejudice / Q000941:ethics / Q000517:prevention & control*; D015995:Prevalence; D011369:Professional-Patient Relations; D011787:Quality of Health Care; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D014933:Women's Rights / Q000592:standards