title: Association Between Disrespect and Abuse During Childbirth and Women's Confidence in Health Facilities in Tanzania.
abstract: OBJECTIVE
  In Tanzania, maternal mortality is high and coverage with health facility delivery low, despite efforts to reduce barriers to utilization. Disrespect and abuse during childbirth has not been explored as a contributor to delivery satisfaction or as a deterrent to institutional delivery. We assessed the association between reported disrespectful treatment during childbirth and delivery satisfaction, perceived quality of care, and intention to deliver at the same facility in the future.
  
  
  METHODS
  Interviews using a structured questionnaire were conducted in Tanga Region, Tanzania with women on discharge from delivery at two hospitals. Disrespect and abuse was measured by asking women about specific disrespectful events during childbirth. Multivariable logistic regression models were used to assess the association between disrespect/abuse and (1) satisfaction with delivery, (2) perceived quality of care for delivery, and (3) intent to use the same facility for a future delivery, controlling for confounders.
  
  
  RESULTS
  1388 women participated in the survey (67 % response rate). Disrespect/abuse during childbirth was associated with lower satisfaction with delivery (OR 0.26, 95 % CI 0.19-0.36) and reduced likelihood of rating perceived quality of care as excellent/very good (OR 0.55, 95 % CI 0.35-0.85). Of women who planned to have more children (N = 766), those who experienced disrespect/abuse were half as likely to plan to deliver again at the same facility (OR 0.51, 95 % CI 0.32-0.82).
  
  
  CONCLUSIONS
  Our study highlights disrespectful and abusive treatment during childbirth as an important factor in reducing women's confidence in health facilities. Improving interpersonal care must be an integral part of quality improvement in maternal health.
authors.affiliation: Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA. sak2191@columbia.edu.|Averting Maternal Death and Disability Program, Columbia University Mailman School of Public Health, 722 W. 168th Street, New York, NY, 10032, USA. sak2191@columbia.edu.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Kujawski
authors.affiliation: Ifakara Health Institute, Dar es Salaam, Tanzania.
authors.forename: Godfrey
authors.initials: G
authors.lastname: Mbaruku
authors.affiliation: Averting Maternal Death and Disability Program, Columbia University Mailman School of Public Health, 722 W. 168th Street, New York, NY, 10032, USA.
authors.forename: Lynn P
authors.initials: LP
authors.lastname: Freedman
authors.affiliation: Averting Maternal Death and Disability Program, Columbia University Mailman School of Public Health, 722 W. 168th Street, New York, NY, 10032, USA.
authors.forename: Kate
authors.initials: K
authors.lastname: Ramsey
authors.affiliation: Ifakara Health Institute, Dar es Salaam, Tanzania.
authors.forename: Wema
authors.initials: W
authors.lastname: Moyo
authors.affiliation: Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
authors.forename: Margaret E
authors.initials: ME
authors.lastname: Kruk
mesh_terms: D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D009723:Nurse-Patient Relations; D036801:Parturition / Q000523:psychology*; D010342:Patient Acceptance of Health Care; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011247:Pregnancy; D012424:Rural Population; D011795:Surveys and Questionnaires; D013636:Tanzania
keywords: Abuse; Disrespect; Maternal health; Quality of care; Respectful maternity care; Satisfaction