Providers’ self-reflections on person-centered maternity care in Kenya and Ghana
Person-centered maternity care is respectful and responsive to women and their families’ preferences, needs and values. It’s a high priority for global maternity care because of evidence of disrespect, abuse and neglect of women during childbirth in health facilities around the world. Poor person-centered maternity care shows up as mistreatment of women during prenatal clinic visits and childbirth. That mistreatment has direct and indirect effects on outcomes for mothers and babies. A new study aimed to bridge the gap on measuring this kind of care from the perspective of healthcare providers, to help inform efforts to provide respectful care.
Researchers asked maternity care providers in Ghana and Kenya nine questions about whether they had done certain things in the last month:
- Introduced themselves to patients when they first met
- Called patients by their names when talking to them
- Explained the reason for exams and procedures
- Explained the purpose of medications
- Asked patients if they had any questions
- Allowed women to have a birthing companion of their choice
- Allowed women to give birth in a position of their choice
- Shouted at, scolded or threatened a woman for any reason
- Pinched, hit, or physically restrained a woman for any reason
Based on their measurement scale, the researchers found that many providers do not consistently provide person-centered maternity care. Key factors associated with the level of care were perceived stress, burnout, training on stress management, the type of facility and the number of staff on duty in the maternity unity.
Individual items on the scale can be used to inform quality improvement. They found several gaps related to communication and autonomy, with less than half of providers in the Kenya group reporting often introducing themselves to patients, asking permission for exams and procedures, asking women if they have questions and allowing women to give birth in the position of their choice. Almost 90% reported allowing women to have a companion of their choice, which reflects efforts to promote birth companionship. On the other hand, over half of the providers in Kenya acknowledged being verbally abusive in the last month, and about 1 in 5 were physically abusive.
This is the first study to provide evidence for the validity of a scale measuring provider-reported person-centered maternity care. It fills a gap, as the scale can be used to estimate person-centered care in places where patient reports aren’t possible, or as a companion to reports from women. The study also extends the evidence on the drivers of poor care, highlighting the role of provider burnout. It identified gaps that echo call for improved care, including the need to prevent provider burnout through training and addressing root causes.