title: The effect of a multi-component intervention on disrespect and abuse during childbirth in Kenya.
abstract: BACKGROUND
  Disrespect and abuse (D & A) during labor and delivery are important issues correlated with human rights, equity, and public health that also affect women's decisions to deliver in facilities, which provide appropriate management of maternal and neonatal complications. Little is known about interventions aimed at lowering the frequency of disrespectful and abusive behaviors.
  
  
  METHODS
  Between 2011 and 2014, a pre-and-post study measured D & A levels in a three-tiered intervention at 13 facilities in Kenya under the Heshima project. The intervention involved working with policymakers to encourage greater focus on D & A, training providers on respectful maternity care, and strengthening linkages between the facility and community for accountability and governance. At participating facilities, postpartum women were approached at discharge and asked to participate in the study; those who consented were administered a questionnaire on D & A in general as well as six typologies, including physical and verbal abuse, violations of confidentiality and privacy, detainment for non-payment, and abandonment. Observation of provider-patient interaction during labor was also conducted in the same facilities. In both exit interview and observational studies, multivariate analyses of risk factors for D & A controlled for differences in socio-demographic and facility characteristics between baseline and endline surveys.
  
  
  RESULTS
  Overall D & A decreased from 20-13% (p < 0.004) and among four of the six typologies D & A decreased from 40-50%. Night shift deliveries were associated with greater verbal and physical abuse. Patient and infant detainment declined dramatically from 8.0-0.8%, though this was partially attributable to the 2013 national free delivery care policy.
  
  
  CONCLUSIONS
  Although a number of contextual factors may have influenced these findings, the magnitude and consistency of the observed decreases suggest that the multi-component intervention may have the potential to reduce the frequency of D & A. Greater efforts are needed to develop stronger evaluation methods for assessing D & A in other settings.
authors.affiliation: Population Council, PO Box 17643-00500, Nairobi, Kenya. tabuya@popcouncil.org.
authors.forename: Timothy
authors.initials: T
authors.lastname: Abuya
authors.affiliation: Population Council, PO Box 17643-00500, Nairobi, Kenya. cndwiga@popcouncil.org.
authors.forename: Charity
authors.initials: C
authors.lastname: Ndwiga
authors.affiliation: School of Medicine, University of California San Diego, La Jolla, CA, USA. julie.e.ritter@gmail.com.
authors.forename: Julie
authors.initials: J
authors.lastname: Ritter
authors.affiliation: Health Economics Research Group, College of Health & Life Sciences, Brunel University London, Uxbridge, UB8 3PH, London, UK. Lucy.Kanya@brunel.ac.uk.
authors.forename: Lucy
authors.initials: L
authors.lastname: Kanya
authors.affiliation: Population Council, Plot 3670, No. 4 Mwaleshi Road, Olympia Park, Lusaka, 10101, Zambia. bbellows@popcouncil.org.
authors.forename: Ben
authors.initials: B
authors.lastname: Bellows
authors.affiliation: School of Medicine, University of California San Diego, La Jolla, CA, USA. nancy.binkin3@gmail.com.
authors.forename: Nancy
authors.initials: N
authors.lastname: Binkin
authors.affiliation: Population Council, 4301 Connecticut Ave NW, Suite 280, Washington, DC, 20008, USA. cwarren@popcouncil.org.
authors.forename: Charlotte E
authors.initials: CE
authors.lastname: Warren
mesh_terms: D000328:Adult; D036861:Delivery, Obstetric / Q000379:methods / Q000523:psychology* / Q000592:standards; D005260:Female; D006801:Humans; D007223:Infant; D007630:Kenya; D007743:Labor, Obstetric / Q000523:psychology*; D008427:Maternal Health Services / Q000592:standards / Q000706:statistics & numerical data; D036801:Parturition / Q000523:psychology*; D000066550:Physical Abuse / Q000706:statistics & numerical data*; D049590:Postpartum Period / Q000523:psychology; D011247:Pregnancy; D018907:Privacy / Q000523:psychology; D011369:Professional-Patient Relations; D011795:Surveys and Questionnaires; D026712:Value of Life; D014933:Women's Rights; D055815:Young Adult