Disrespect and abuse during pregnancy, labour and childbirth: A qualitative study from four primary healthcare centres of Amhara and Southern Nations Nationalities and People's Regional States, Ethiopia

Background: In Ethiopia, only 28% of all births occur at health facilities. Disrespect and abuse of women by health providers during pregnancy, labour and immediate postpartum is one of the main reasons that affect health care seeking from health facilities. This study explored disrespect and abuse of women using seven categories (Bowser D. and Hill K) including physical abuse, non-dignified care, non-consented care, non-confidential care, discrimination, abandonment care and detention at health facilities. Methods: We conducted a qualitative research in four health centres of Amhara and Southern Nations Nationalities and Peoples' regional states between March and April 2014. Data were generated using in-depth interviews involving four midwives, 42 women (22 who delivered at the health facilities and another 20 who delivered at home) and eight focus group discussions involving 63 family members who accompanied labouring women to the health centres in the past three months before the study. The interview guides explored potentially abusive and disrespectful care and the perspectives of the participants towards such occurrences. Key themes were identified using phenomenological approach. Results: This study found that most women faced disrespectful care while few were abused during labour, delivery and immediate postpartum. Women who faced disrespect and abusive care during antenatal care reported to have avoided giving birth at health facilities. However, most women and their accompanying family members were found to have normalized non-dignified care (disrespect) and abuse as indicated by a participant "It is ok if a woman is mistreated, insulted, her consent is not asked or her privacy is violated as far as it is for the wellbeing of the delivering women and the newborn". Conclusion: These findings showed that disrespect and abuse at health facilities have negatively affected women's care-seeking from health facilities for delivery. Normalization of disrespect and abuse by labouring women could be one reason for the continuation of the practice by providers. Facilitating community dialogue on respectful and compassionate care, improving client-professional relationships and ensuring functional grievance handling systems in health facilities should be given high priority to change the situation.