title: Exploring the prevalence of disrespect and abuse during childbirth in Kenya.
abstract: BACKGROUND
  Poor quality of care including fear of disrespect and abuse (D&A) perpetuated by health workers influences women's decisions to seek maternity care. Key manifestations of D&A include: physical abuse, non-consented care, non-confidential care, non-dignified care, discrimination, abandonment, and detention in facilities. This paper describes manifestations of D&A experienced in Kenya and measures their prevalence.
  
  
  METHODS
  This paper is based on baseline data collected during a before-and-after study designed to measure the effect of a package of interventions to reduce the prevalence of D&A experienced by women during labor and delivery in thirteen Kenyan health facilities. Data were collected through an exit survey of 641 women discharged from postnatal wards. We present percentages of D&A manifestations and odds ratios of its relationship with demographic characteristics using a multivariate fixed effects logistic regression model.
  
  
  RESULTS
  Twenty percent of women reported any form of D&A. Manifestations of D&A includes: non-confidential care (8.5%), non-dignified care (18%), neglect or abandonment (14.3%), Non-consensual care (4.3%) physical abuse (4.2%) and, detainment for non-payment of fees (8.1). Women aged 20-29 years were less likely to experience non-confidential care compared to those under 19; OR: [0.6 95% CI (0.36, 0.90); p=0.017]. Clients with no companion during delivery were less likely to experience inappropriate demands for payment; OR: [0.49 (0.26, 0.95); p=0.037]; while women with higher parities were three times more likely to be detained for lack of payment and five times more likely to be bribed compared to those experiencing there first birth.
  
  
  CONCLUSIONS
  One out of five women experienced feeling humiliated during labor and delivery. Six categories of D&A during childbirth in Kenya were reported. Understanding the prevalence of D&A is critical in developing interventions at national, health facility and community levels to address the factors and drivers that influence D&A in facilities and to encourage clients' future facility utilization.
authors.affiliation: Population Council, P.O. Box 17643-00500, Nairobi, Kenya.
authors.forename: Timothy
authors.initials: T
authors.lastname: Abuya
authors.affiliation: Population Council, 4301 Connecticut Ave, NW #280, Washington, District of Columbia, 20008, United States of America.
authors.forename: Charlotte E
authors.initials: CE
authors.lastname: Warren
authors.affiliation: Woman Care Global, 12400 High Bluff Drive, Suite 600, San Diego, California, 92130, United States of America.
authors.forename: Nora
authors.initials: N
authors.lastname: Miller
authors.affiliation: Centre for Population Health Research and Management, P.O Box 19607-00202, Nairobi, Kenya.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Njuki
authors.affiliation: Population Council, P.O. Box 17643-00500, Nairobi, Kenya.
authors.forename: Charity
authors.initials: C
authors.lastname: Ndwiga
authors.affiliation: Federation of Women Lawyers, P.O. Box 46324-00100, Nairobi, Kenya.
authors.forename: Alice
authors.initials: A
authors.lastname: Maranga
authors.affiliation: National Nurses Association of Kenya, 49422-00100, Nairobi, Kenya.
authors.forename: Faith
authors.initials: F
authors.lastname: Mbehero
authors.affiliation: Division of Reproductive Health, Ministry of Health, P. O. Box 43319-00100, Nairobi, Kenya.
authors.forename: Anne
authors.initials: A
authors.lastname: Njeru
authors.affiliation: Population Council, P.O. Box 17643-00500, Nairobi, Kenya.
authors.forename: Ben
authors.initials: B
authors.lastname: Bellows
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007630:Kenya; D036801:Parturition; D011247:Pregnancy; D015995:Prevalence; D011369:Professional-Patient Relations; D055815:Young Adult