Abstract
BACKGROUND: In countries where the proportion of births attended by skilled providers is low, maternal mortality is high. According to the 2016 EDHS report, the proportion of births attended by skilled providers was only 26% and the maternal mortality ratio was 412 per 100,000 live-births. Disrespectful and abusive behavior of health workers and other facility staff experienced by women during facility-based childbirth is important, but the little-understood barrier of institutional delivery. OBJECTIVE: This study assessed the prevalence of disrespect and abuse experienced by mothers during facility-based childbirth and associated factors. METHODS: A facility based cross-sectional study was undertaken from October to December 2016. Data were collected by face-to-face interview using a structured questionnaire from 290 mothers consecutively included in the study immediately prior to discharge from the hospital. Reports of disrespect and abuse during childbirth were measured using 23 performance indicators. Data were entered into EpiData and analyzed by SPSS; bivariate and multivariable binary logistic regression analyses were performed to identify factors associated with disrespect and abuse. RESULT: Three-fourths (217,[74.8%]) of participants were Muslim. Nearly half (142,[49%]) had a primary level of education. Most (232,[80%]) were housewives and 175(60.3%) were from outside Jimma town. The prevalence of disrespect and abuse during childbirth was 91.7% (266/290; 95%CI:0.879,0.946). The most common types of disrespect and abuse reported were culturally inappropriate care (218,[75.2%]), failure to encourage the client to ask questions (220,[75.9%]), the provider not introducing him/herself (232,[80.0%]), failure to obtain consent/permission prior to any procedure (185,[63.8%]) and not using curtains/visual barriers to protect client (237,[81.7%]). Being non-married [95%CI:(0.009,0.222), ≥para-II [95%CI:(0.093,0.862)] and being attended by female care provider [95%CI:(0.026,0.224)] were associated with the reduced chance of reporting disrespect and abuse. However, achieving ≥secondary education [95%CI:(1.028,10.272)] was associated with a higher chance of reporting disrespect and abuse. CONCLUSION: The very high prevalence of abuse or disrespect during facility-based delivery shows a health system in crisis. A key implication of this finding is that efforts to increase facility-based delivery must address disrespect and abuse to ensure higher utilization by women. Making facility-based deliveries attended by female providers may reduce the problem.