title: Applying a participatory approach to the promotion of a culture of respect during childbirth.
abstract: Disrespect and abuse (D&A) during facility-based childbirth is a topic of growing concern and attention globally. Several recent studies have sought to quantify the prevalence of D&A, however little evidence exists about effective interventions to mitigate disrespect and abuse, and promote respectful maternity care. In an accompanying article, we describe the process of selecting, implementing, and evaluating a package of interventions designed to prevent and reduce disrespect and abuse in a large urban hospital in Tanzania. Though that study was not powered to detect a definitive impact on reducing D&A, the results showed important changes in intermediate outcomes associated with this goal. In this commentary, we describe the factors that enabled this effect, especially the participatory approach we adopted to engage key stakeholders throughout the planning and implementation of the program. Based on our experience and findings, we conclude that a visible, sustained, and participatory intervention process; committed facility leadership; management support; and staff engagement throughout the project contributed to a marked change in the culture of the hospital to one that values and promotes respectful maternity care. For these changes to translate into dignified care during childbirth for all women in a sustainable fashion, institutional commitment to providing the necessary resources and staff will be needed.
authors.affiliation: Women and Health Initiative, Department of Global Health and Population, Harvard T.H Chan School of Public Health, Boston, MA, USA. hannah.ratcliffe@mail.harvard.edu.|Ariadne Labs at Brigham and Women's Hospital and the Harvard T.H. Chan School of Public Health, Boston, MA, USA. hannah.ratcliffe@mail.harvard.edu.
authors.forename: Hannah L
authors.initials: HL
authors.lastname: Ratcliffe
authors.affiliation: Women and Health Initiative, Department of Global Health and Population, Harvard T.H Chan School of Public Health, Boston, MA, USA.|Management and Development for Health, Dar es Salaam, Tanzania.
authors.forename: David
authors.initials: D
authors.lastname: Sando
authors.affiliation: Africa Academy for Public Health, Dar es Salaam, Tanzania.
authors.forename: Mary
authors.initials: M
authors.lastname: Mwanyika-Sando
authors.affiliation: Management and Development for Health, Dar es Salaam, Tanzania.|Africa Academy for Public Health, Dar es Salaam, Tanzania.
authors.forename: Guerino
authors.initials: G
authors.lastname: Chalamilla
authors.affiliation: Women and Health Initiative, Department of Global Health and Population, Harvard T.H Chan School of Public Health, Boston, MA, USA.
authors.forename: Ana
authors.initials: A
authors.lastname: Langer
authors.affiliation: Women and Health Initiative, Department of Global Health and Population, Harvard T.H Chan School of Public Health, Boston, MA, USA.|Boston University School of Public Health, Boston, MA, USA.
authors.forename: Kathleen P
authors.initials: KP
authors.lastname: McDonald
mesh_terms: D001291:Attitude of Health Personnel; D058445:Bullying / Q000517:prevention & control*; D065246:Culturally Competent Care / Q000941:ethics* / Q000208:ethnology / Q000592:standards; D005260:Female; D006284:Health Plan Implementation; D006779:Hospitals, Public; D006786:Hospitals, Urban; D006801:Humans; D033181:Information Dissemination; D007857:Leadership; D015279:Organizational Culture; D036801:Parturition / Q000208:ethnology; D010353:Patient Education as Topic; D028701:Patient Rights; D018743:Perinatal Care / Q000941:ethics* / Q000592:standards; D000066550:Physical Abuse / Q000208:ethnology / Q000517:prevention & control*; D011209:Power, Psychological; D011247:Pregnancy; D011369:Professional-Patient Relations / Q000941:ethics; D058996:Quality Improvement; D011787:Quality of Health Care; D013636:Tanzania; D000078329:Workforce
keywords: Disrespect and abuse; Health Workers for Change; Maternal health; Participatory dissemination; Respectful maternity care; Tanzania