Dignity in maternal health service delivery : Cross sectional survey on factors that promote or compromise dignity in maternal health service delivery: Perspectives of Women and Midwives from Southern Malawi.

Abstract

Background and Objective The concept of dignity is broad and complex as its interpretation is based on culture and social norms of a particular setting. According to the United Nations General Assembly and the World Health Organization (WHO), human dignity is the understanding of human rights and the foundation for patients’ rights. A number of international instruments have been developed to promote patients’ rights and dignity. Such instruments include the Universal Declaration on Human rights and the WHO statement on patients’ rights. At country level, various countries including Malawi have developed their own instruments and strategies in line with the Universal Declaration and the WHO statement on patient’s rights. However, despite development of such instruments and strategies, implementation of dignified care is impeded by a combination of challenges, for example, crowded health facilities. The purpose of this study therefore, was to explore factors that promote or compromise dignity in maternal health service delivery during labor and delivery in Malawi. Methodology A cross sectional survey that employed quantitative and qualitative data collection method was conducted at Queen Elizabeth Central Hospital in Blantyre, Chiradzulu District Hospital and Milepa Health Center in Chiradzulu, Malawi from August to December 2010. One hundred and twenty-six postnatal mothers and seventeen midwives working in the labor wards were the respondents to the survey questionnaire. Simple random sampling was used to draw the study participants. Quantitative data was analyzed using descriptive statistics and qualitative data was analyzed using content analysis. Results Major issues revealed by the study that influenced dignity in the study sites were: the physical environment, midwives and patients attitudes and behaviors, and care processes. Six out of 17 midwives expressed that the size and design of the infrastructure affect the dignity of their patients. As such 32% of the postnatal mothers’ privacy was not maintained and 33% did not deliver in a clean labor room. Fifty two percent of the postnatal mothers and eight out of seventeen midwives blamed the midwives attitudes and behavior as the reason why women are not treated with dignity. Seventy seven percent of the postnatal mothers and eight out of seventeen midwives felt that the patients’ attitudes and behavior were responsible for the undignified care that women receive. The majority of the women (62%) expressed the need to be welcomed warmly, respectfully and quickly. Fifty one percent of the postnatal mothers were not given directions or escorted to the labor ward. Thirteen percent of the mothers were treated with less courtesy and respect and 88% were not involved in decision making. Conclusion This study has provided a tunnel through which the enablers and the barriers to the provision of dignified care can be viewed in Malawi. The understanding of the influencing factors of dignity will assist to develop strategies that will enable the health system to promote the positive influencing factors and eliminate the factors that compromise dignity, consequently improving the quality of maternal health care.