Kenyan providers’ perceptions of communication and women’s autonomy during childbirth

Effective communication, respecting women’s views and allowing them to make informed choices for themselves are vital components of person-centered care. Person-centered communication tools can enable providers to be more engaged with patients and ultimately provide better care and higher patient satisfaction. Previous studies have highlighted that women often experience poor communication and a lack of respect for their autonomy during childbirth. Studies have also shown that low quality of care can occur even when health care practitioners have appropriate knowledge on effective communication and autonomy. 

New research from Bixby member Patience Afulani looked into what factors contribute to this gap between provider knowledge and practice. Researchers surveyed 49 clinical and non-clinical maternity providers in Western Kenya to determine their knowledge and perception of effective communication and autonomy and potential barriers to providing person-centered care. A majority of providers displayed knowledge about the importance of effective communication and autonomy; however, they also reported incidents of poor communication and lack of respect for women’s autonomy. Some providers reported never engaging in certain practices aimed at increasing communication effectiveness.

Reasons for incidents of poor communication and lack of respect for women’s autonomy fell under three categories:

  • Work environment: This included institutional factors such as workload as well as provider stress and burnout.
  • Provider knowledge, intentions, and assumptions: Examples are forgetfulness, unconscious behaviors, self-protection, and assumptions about women’s knowledge and expectations.
  • Women’s ability to demand effective communication and respect for their autonomy: This included women’s lack of participation and empowerment as influenced by provider bias

Because there is a gap between provider knowledge of ways to increase effective communication and respect for women’s autonomy and providers actually carrying out such behaviors, interventions need to give providers the opportunity to practice person-centered communication. Trainings also need to address systemic barriers to communication and autonomy, including improvements to the work environment and facility culture, strengthening the health systems to address workload and stress, and measures to reduce language barriers. There should also be interventions that educate women on their rights to empower them to take charge of their care.