title: Experiences of and responses to disrespectful maternity care and abuse during childbirth; a qualitative study with women and men in Morogoro Region, Tanzania.
abstract: BACKGROUND
  Interventions to reduce maternal mortality have focused on delivery in facilities, yet in many low-resource settings rates of facility-based birth have remained persistently low. In Tanzania, rates of facility delivery have remained static for more than 20 years. With an aim to advance research and inform policy changes, this paper builds on a growing body of work that explores dimensions of and responses to disrespectful maternity care and abuse during childbirth in facilities across Morogoro Region, Tanzania.
  
  
  METHODS
  This research drew on in-depth interviews with 112 respondents including women who delivered in the preceding 14 months, their male partners, public opinion leaders and community health workers to understand experiences with and responses to abuse during childbirth. All interviews were recorded, transcribed, translated and coded using Atlas.ti. Analysis drew on the principles of Grounded Theory.
  
  
  RESULTS
  When initially describing birth experiences, women portrayed encounters with providers in a neutral or satisfactory light. Upon probing, women recounted events or circumstances that are described as abusive in maternal health literature: feeling ignored or neglected; monetary demands or discriminatory treatment; verbal abuse; and in rare instances physical abuse. Findings were consistent across respondent groups and districts. As a response to abuse, women described acquiescence or non-confrontational strategies: resigning oneself to abuse, returning home, or bypassing certain facilities or providers. Male respondents described more assertive approaches: requesting better care, paying a bribe, lodging a complaint and in one case assaulting a provider.
  
  
  CONCLUSIONS
  Many Tanzanian women included in this study experienced unfavorable conditions when delivering in facilities. Providers, women and their families must be made aware of women's rights to respectful care. Recommendations for further research include investigations of the prevalence and dimensions of disrespectful care and abuse, on mechanisms for women and their families to effectively report and redress such events and on interventions that could mitigate neglect or isolation among delivering women. Respectful care is a critical component to improve maternal health.
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA. shannon.aleece@gmail.com.
authors.forename: Shannon A
authors.initials: SA
authors.lastname: McMahon
authors.forename: Asha S
authors.initials: AS
authors.lastname: George
authors.forename: Joy J
authors.initials: JJ
authors.lastname: Chebet
authors.forename: Idda H
authors.initials: IH
authors.lastname: Mosha
authors.forename: Rose N M
authors.initials: RN
authors.lastname: Mpembeni
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Winch
mesh_terms: D001291:Attitude of Health Personnel; D003150:Community Health Workers; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000191:economics / Q000523:psychology* / Q000592:standards*; D005249:Fees and Charges; D005260:Female; D006268:Health Facilities / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D015279:Organizational Culture; D036801:Parturition; D005791:Patient Care / Q000941:ethics / Q000592:standards*; D011287:Prejudice; D011369:Professional-Patient Relations; D036301:Qualitative Research; D011787:Quality of Health Care; D013636:Tanzania; D014933:Women's Rights
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