Prevalence and Associated Factors of Disrespectful and Abusive Care during Childbirth among Women Who Gave Birth in Health Facilities in Hawassa City, Southern Ethiopia. A Cross - Sectional Study

Background: There is growing evidence that shows phenomena of disrespect and abuse during childbirth occur globally even though the degree and severity are different across countries. The problem is getting attention in recent years especially in developing countries like Ethiopia. However, there is a paucity of studies assessing the magnitude of disrespectful and abusive care during childbirth.

Objective: This study was undertaken to determine the prevalence and associated factors of disrespectful and abusive care during childbirth in health facilities of Hawassa city, Southern Ethiopia.

Method: A facility-based cross-sectional study was conducted in Hawassa city from February 8 - April 27, 2018. A total of 577 mothers from both public and private health facilities were included. Domains of disrespect and abuse that were assessed were; physical abuse, verbal abuse, stigma and discrimination, failure to meet professional standards of care and poor rapport between women and providers. Binary logistic regression model was used to examine the relationship between exposure and outcome variables. Adjusted odds ratio (AOR) with 95% confidence intervals (CI) was used to determine the association between dependent and independent variables.

Result: Overall 46.9% [95% CI: 42.8-51]of mothers reported experiencing disrespect and abusive care during childbirth in health facilities. The adjusted odds of disrespectful and abusive care among births in public health facilities were 12.9 times higher than birth in private facilities [AOR=12.94 (95% CI: 5.87, 28.50)],mothers who had total delivery four and above had 4.7 times increased odds of encountering disrespect and abusive care [AOR=4.67 95% CI: 1.69, 12.89)].In contrast to mothers who had spontaneous vaginal delivery; mothers who had instrumental delivery had 2.6 times increased chance of encountering disrespect and abusive care [AOR =2.63 (95% CI: 1.05, 6.59)]. Mothers attended by female health providers were 1.75 times more likely to be disrespected and abused than mothers whose delivery was attended by male providers [AOR= 1.75 CI: (1.14, 2.71)].

Conclusion: The prevalence of disrespectful and abusive care during labor and delivery was high in Hawassa city health facilities. Factors associated with disrespectful and abusive care are public health facility, instrumental delivery, parity and sex of health care provider. Therefore, national health strategies and policies should focus on combating disrespect and abuse during maternal care. It is also recommended to give intensive training focusing on respectful maternity care especially in public hospitals by involving more female health care providers.