دانلود رایگان مقاله انگلیسی احترام و بی احترامی ماماها نسبت به زنان در طول زایمان بر اساس امکانات موجود در تانزانیا - PMC 2018

Abstract

Background: Over the last two decades, facility-based childbirths in Tanzania have only minimally increased by 10% partly because of healthcare providers’ disrespect and abuse (D&A) of women during childbirth. Although numerous studies have substantiated women’s experience of D&A during childbirth by healthcare providers, few have focused on how D&A occurred during the midwives’ actual care. This study aimed to describe from actual observations the respectful and disrespectful care received by women from midwives during their labor period in two hospitals in urban Tanzania. Methods: This descriptive qualitative study involved naturalistic observation of two health facilities in urban Tanzania. Fourteen midwives were purposively recruited for the one-on-one shadowing of their care of 24 women in labor from admission to the fourth stage of labor. Observations of their midwifery care were analyzed using content analysis. Results: All the 14 midwives showed both respectful and disrespectful care and some practices that have not been explicated in previous reports of women’s experiences. For respectful care, five categories were identified: 1) positive interactions between midwives and women, 2) respect for women’s privacy, 3) provision of safe and timely midwifery care for delivery, 4) active engagement in women’s labor process, and 5) encouragement of the motherbaby relationship. For disrespectful care, five categories were recognized: 1) physical abuse, 2) psychological abuse, 3) non-confidential care, 4) non-consented care, and 5) abandonment of care. Two additional categories emerged from the unprioritized and disorganized nursing and midwifery management: 1) lack of accountability and 2) unethical clinical practices. Conclusions: Both respectful care and disrespectful care of midwives were observed in the two health facilities in urban Tanzania. Several types of physical and psychological abuse that have not been reported were observed. Weak nursing and midwifery management was found to be a contributor to the D&A of women. To promote respectful care of women, pre-service and in-service trainings, improvement of working conditions and environment, empowering pregnant women, and strengthening health policies are crucial.

Conclusions

Both respectful care and disrespectful care of women during childbirth given by midwives were directly observed from health facilities in urban Tanzania. In terms of respectful care, the midwives often delivered care within the context of the women’s human rights. They developed and maintained a good relationship with the women by having positive verbal interactions, offering emotional support, and providing timely care for safe deliveries. In terms of disrespectful care, there were many disrespectful care and appalling practices during childbirth by the midwives in the forms of physical and psychological abuse, non-confidential care, nonconsented care, and abandonment of care. Some types of physical and psychological abuse had never been observed or previously reported. A closer assessment of possible factors contributing to the disrespectful care indicated the lack of accountability of the midwives as professionals resulting from weak nursing and midwifery management. To promote respectful care of women during childbirth, pre-service and in-service midwife trainings, improvements of working and environmental conditions, and streamlining of various systems by close cooperation and collaboration between researchers, health institutions, and the Tanzanian government are needed. Empowerment of women is also necessary to ensure normal delivery.