title: Disrespect and abuse during childbirth in Tanzania: are women living with HIV more vulnerable?
abstract: BACKGROUND
  HIV-related stigma and discrimination and disrespect and abuse during childbirth are barriers to use of essential maternal and HIV health services. Greater understanding of the relationship between HIV status and disrespect and abuse during childbirth is required to design interventions to promote women's rights and to increase uptake of and retention in health services; however, few comparative studies of women living with HIV (WLWH) and HIV-negative women exist.
  
  
  METHODS
  Mixed methods included interviews with postpartum women (n = 2000), direct observation during childbirth (n = 208), structured questionnaires (n = 50), and in-depth interviews (n = 18) with health care providers. Bivariate and multivariate regressions analyzed associations between HIV status and disrespect and abuse, whereas questionnaires and in-depth interviews provided insight into how provider attitudes and workplace culture influence practice.
  
  
  RESULTS
  Of the WLWH and HIV-negative women, 12.2% and 15.0% reported experiencing disrespect and abuse during childbirth (P = 0.37), respectively. In adjusted analyses, no significant differences between WLWH and HIV-negative women's experiences of different types of disrespect and abuse were identified, with the exception of WLWH having greater odds of reporting non-consented care (P = 0.03). None of the WLWH reported violations of HIV confidentiality or attributed disrespect and abuse to their HIV status. Provider interviews indicated that training and supervision focused on prevention of vertical HIV transmission had contributed to changing the institutional culture and reducing HIV-related violations.
  
  
  CONCLUSIONS
  In general, WLWH were not more likely to report disrespect and abuse during childbirth than HIV-negative women. However, the high overall prevalence of disrespect and abuse measured indicates a serious problem. Similar institutional priority as has been given to training and supervision to reduce HIV-related discrimination during childbirth should be focused on ensuring respectful maternity care for all women.
authors.affiliation: *Management and Development for Health (MDH), Dar Es Salaam, Tanzania; and †Maternal Health Task Force, Women and Health Initiative, Department of Global Health and Population, Harvard School of Public Health, Boston, MA.
authors.forename: David
authors.initials: D
authors.lastname: Sando
authors.forename: Tamil
authors.initials: T
authors.lastname: Kendall
authors.forename: Goodluck
authors.initials: G
authors.lastname: Lyatuu
authors.forename: Hannah
authors.initials: H
authors.lastname: Ratcliffe
authors.forename: Kathleen
authors.initials: K
authors.lastname: McDonald
authors.forename: Mary
authors.initials: M
authors.lastname: Mwanyika-Sando
authors.forename: Faida
authors.initials: F
authors.lastname: Emil
authors.forename: Guerino
authors.initials: G
authors.lastname: Chalamilla
authors.forename: Ana
authors.initials: A
authors.lastname: Langer
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D036861:Delivery, Obstetric / Q000523:psychology*; D005260:Female; D015658:HIV Infections / Q000523:psychology* / Q000635:transmission; D007722:Health Knowledge, Attitudes, Practice; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D015999:Multivariate Analysis; D015279:Organizational Culture; D011159:Population Surveillance; D049590:Postpartum Period; D011247:Pregnancy; D011287:Prejudice; D015995:Prevalence; D011369:Professional-Patient Relations; D012742:Sex Offenses / Q000706:statistics & numerical data*; D057545:Social Stigma; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013636:Tanzania; D014933:Women's Rights; D017132:Workplace / Q000523:psychology; D055815:Young Adult