Self-reported disrespect and abuse by nurses and midwives during childbirth in Tanzania: A cross-sectional study

Abstract

Background: Facility-based childbirth has increased globally. Unfortunately, there have also been reports of women experiencing disrespect and abuse by healthcare providers during childbirth. This study aimed to measure the prevalence of self-reported disrespect and abuse (DA) by healthcare providers of women during childbirth in health facilities in Tanzania, and to clarify the factors related to DA. Methods: A cross-sectional survey was conducted in public health facilities of three regions in Tanzania from September 2016 to October 2016. Nurses and midwives who had ever conducted deliveries completed a 22-item section about DA and three sections about working conditions and environment. A model for predicting DA based on several factors such as their characteristics, working conditions, and working environment was developed by conducting multiple regression analysis. Results: Thirty public health facilities in three regions within Tanzania were selected to reflect different levels of hospitals. Among 456 participants (nurses, midwives, and nursing assistants), 439 were included in the analysis. Average number of self-reported DA out of 22 items was five, and nearly all participants (96.1%) reported enacting one form of DA at the least and two forms of DA at the most. About 25-44% of DA items were in the forms related to women's experiences with childbirth psychologically. Moreover, at least 10-30% of the participants enacted some form of DA which could directly affect the well-being of mothers and babies. DA scores increased with an increase in 'working hours per week' and 'taking a break during evening shifts'. DA scores decreased with an increase in the scores of the 'two components of the Index of Working Satisfaction (professional status and interaction between nurses)', and 'any type of supervision for new nurse-midwives'. Conclusion: Most studies about DA of healthcare providers previously focused on the reports of women. To our knowledge, this is the first report that focused on DA reported by healthcare providers. Working conditions and systems including personal relationships with colleagues were both positively and negatively related to DA of healthcare providers rather than the provider's individual and facility structural characteristics.