Level and correlates of disrespect and abuse among newborns in selected public hospitals of Addis Ababa, Ethiopia

BackgroundThe provision of respectful and dignified maternal and newborn care is an important component of the quality of childbirth care. Although a growing body of evidence was generated on disrespect and abuse (D & A) of women during childbirth in the past decade there is limited evidence on D & A experienced by newborns. Our study aimed to determine the level of and factors associated with D & A among newborns.MethodsWe conducted the study in three public hospitals in Addis Ababa. We directly observed childbirth care starting from the first stage of labor through two hours after the birth of 498 mother-baby dyads. We used frequencies and percentages to describe different forms of D & A among newborns. We used binary and multivariable logistic regression analysis to assess the association between the D & A among newborns and independent variables.ResultAll of the newborns 496/496 (100%) experienced at least one form of D & A. Physical abuse was experienced by 41.1% of newborns in the form of unnecessary airway suctioning (23.2%) or slapping or holding upside down (33.5%). Additionally, 42.3% weren't dried immediately after birth, 9.1% weren't placed on the mother's abdomen skin-to-skin, 61.7% had their cord cut before 1 min of birth, 34.9% weren't breastfed within an hour of birth, 24.2% didn't receive vitamin K and 1.8% didn't receive tetracycline. All newborns who developed complications (69/69) received treatments without the consent of parents/caregivers. Moreover, 93.6% of parents/caregivers didn't receive explanations regarding newborn care while the lack of breastfeeding counseling and thermal support during the immediate post-partum period was 87.3%. The likelihood of D & A was higher among newborns who were preterm (AOR = 2.02; 95% CI: 1.11-3.69), female (AOR = 2.01; 95% CI: 1.37-2.95), delivered assisted by instrument (AOR = 2.19; 95%CI: 1.20-3.99), whose mothers reside in rural areas (AOR = 1.97; 95%CI: 1.22-3.20), born from unmarried mothers (AOR = 2.77; 95%CI (1.26-6.06) and whose mothers received fewer than four-time antenatal care (ANC) visits (AOR = 2.37; 95%CI: 1.42-3.96).ConclusionOur study found a high magnitude D & A among newborns. Gestational age at birth, sex of the newborn, maternal residence, maternal marital status, number of ANC visits, and mode of delivery were statistically significantly associated with D & A among newborns. The provision of respectful and dignified care to mothers and newborns during antenatal, childbirth, and postnatal periods is crucial to improve their health outcomes and experiences. Although there is a growing body of knowledge on respectful maternity care, there is limited evidence that systematically assessed newborns' experiences of care.We measured the level of disrespect and abuse among newborns and assessed factors that increase the likelihood of experiencing disrespect and abuse among newborns born in three hospitals in Addis Ababa. We directly observed the care provision to assess whether the newborn was (1) physically abused (suction of the nose or mouth without medical indication; shaken, slapped, or held upside down), (2) stigmatized or discriminated (care compromised because the newborn was considered too sick to save, HIV exposed, or has congenital malformation), (3) didn't receive standard care, and (4) mothers/caregivers didn't receive counseling on breastfeeding and thermal care.We found that all of the newborns have experienced at least one form of disrespect and abuse during childbirth or the postpartum period. 41% experienced physical abuse; 99.6% didn't receive standard care; 87.3% didn't receive counseling on breastfeeding and thermal care; and 13%, 75%, and 67% of the newborns who were identified as too sick to save, HIV exposed, and congenital malformation, respectively, were ignored, denied care or treated differently. In addition, the likelihood of experiencing disrespect and abuse was high among newborns who were preterm, female, from rural areas, of unmarried mothers, whose mothers received fewer than four ANC visits and delivered by instrument.