Browsing by Author "Muhayimana, Alice"

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    Development of Strategies for Health Care Providers to Sustain Respectful Maternity Care to Women in Labour
    (University of the Witwatersrand, Johannesburg, 2024) Muhayimana, Alice; Kearns, Irene
    Background: Childbirth is a profound human experience that deserves utmost respect. In 2018, the World Health Organization (WHO) highlighted the significance of ensuring a positive and dignified birth experience for every woman. Respectful Maternity Care (RMC) plays a vital role in improving maternal and neonatal outcomes. The absence of RMC constitutes a violation of the rights of women and newborns. Mere avoidance of abuse does not guarantee RMC; women can experience both positive RMC practices and mistreatment during childbirth. Therefore, proactive advocacy for RMC, efforts to reduce mistreatment, and identifying respectful actions within the local context are all crucial components. Previous studies on RMC in Rwanda primarily focused on negative experiences. However, this study adopted Appreciative Inquiry (AI) to emphasize positive aspects during intrapartum care. AI was chosen for its ability to generate realistic and culturally accepted results, highlighting strengths rather than solely focusing on challenges. The study aimed to assess and explore positive experiences among women and best practices among healthcare providers (HCPs), capturing their perspectives on providing respectful care in Eastern province hospitals of Rwanda. This was conducted to develop strategies for facilitating and sustaining RMC during labour. Facilitating and sustaining RMC in health facilities are particularly effective in reducing intrapartum mistreatment, enhancing positive birth outcomes, and fostering positive childbirth experiences. Methods: This study was conducted in five hospitals in the Eastern province of Rwanda. The author executed the study in four phases with the five stages of AI: Define, Discover, Dream, Design, and Destiny. In the define stage, the author clarified the chosen research topic for focus, ensuring that it has a positive core. Phase 1 utilized a convergent parallel mixed-method approach. The quantitative part involved a cross-sectional study with 610 women who recently gave birth, while in-depth interviews (IDIs) were conducted with a subset of women who reported being respected. Data collection occurred after participants were discharged from the hospital and were preparing to exit. This phase corresponds to the dream stage of AI. In the quantitative aspect, the researcher utilized a 15-item RMC questionnaire developed by the v White Ribbon Alliance, updated in 2019. Descriptive, chi-square and logistic regression were employed to analyze the quantitative data. A median cut-off was applied to categorize experiences into binary outcomes (low and high RMC scores), followed by stepwise backward elimination logistic regression to identify predictors of high RMC. For qualitative data analysis, thematic analysis was conducted using NVivo 12 to organize the codes and create a codebook. In phase 2, the researcher used exploratory qualitative by conducting ten focus group discussions (FGDs) with midwives and nurses, ten in-depth interviews (IDIs) with physicians working in maternity and ten IDIs with maternity unit managers. HCPs expressed their perspectives on the RMC they provided and their thoughts on women's reports from the previous phase, corresponding with AI's dream and design stage. Thematic analysis was used to analyze the data. In phase 3, the strategies were developed based on findings from the previous phases. The researcher integrated findings and used the strategic formulation process during this phase, aligning with the design stage of AI. In Phase 4, using an expert review approach, the developed strategies were validated for their relevance, feasibility, acceptability, and context-fitting by ten national and international experts/stakeholders in RMC. This phase corresponds to the part of the destiny stage of AI. Findings: Most women (70.2%) reported receiving RMC higher than the mean. The most acclaimed RMC items included being allowed to take food and fluid during labour (98.5%), non-discriminatory care (96.2%), receipt of necessary services (96.1%), and privacy (91.3%). The chi-square analysis showed an association between reported high RMC and marital status (p-value = 0.006), occupation (p-value = 0.001), and mode of delivery (p-value = 0.001). Caesarean section delivery was associated with high RMC in multivariate logistic regression with a p-value of 0.001, crude odds ratio of 1.88, and confidence interval (CI) of [1.29–2.74]. The adjusted odds ratio was 2.11 with a CI [1.40–3.17]. Women recounted positive childbirth experiences with compassionate treatment, respect for preferences, and equitable care. They emphasized maintaining RMC through mother-centred approaches, effective communication, and supportive environments, suggesting improvements like provider training and awareness campaigns. HCPs prioritized RMC as integral to women's rights, ensuring privacy, equality, and satisfaction. They advocate enhanced professionalism, vi teamwork, and continuous care evaluation, emphasizing proactive hospital engagement, maternal advocacy, staff motivation, and infrastructure improvements for sustained progress. After integrating the findings, five themes emerged, each corresponding to a specific strategy. During validation, the strategies scored respectively: 1) To strengthen women-centred care and childbirth-positive experiences (91.25%), 2) To preserve and uphold community trust towards maternity services (91.25%), 3) To pursuit professional abidance and ethical conduct (90.6%) 4) To strengthen supportive leadership towards sustaining and promoting RMC (90%) 5) To maintain and promote adequate environment around childbirth facility (85.6%). The overall score of all strategies was (89.75%). Conclusion and recommendations: The findings of this study carry significant policy implications for advancing RMC practices in Rwanda. Embracing multifaceted strategies to promote positive childbirth experiences can effectively enhance RMC provision for women during maternity care. Given the sensitivity of the topic, utilizing AI to explore RMC yielded valuable insights within resource-limited settings like Rwanda. We strongly recommend the Ministry of Health establish standardized RMC practices in all health facilities across the country. These strategies could be implemented across various levels, engaging policymakers, health leaders, facility managers, communities, and individuals. The promotion and sustainability of RMC in Rwanda could be integrated into the broader health system, and the relevant stakeholders could be actively involved.