Eye of the Beholder: Contradictions in the Measurement of Disrespect and Abuse During Facility-Based Childbirth

Presenter: Stephanie Kujawski, Columbia University Mailman School of Public Health

Background: In Tanzania, access to and utilization of life saving care for childbirth at health facilities is critical to mitigate the high maternal mortality ratio. Disrespect and abuse (D&A) of women during childbirth has been identified as a deterrent to facility-based delivery. Recently, this topic has garnered the attention of the maternal health community. There is currently no gold standard for the measurement of disrespect and abuse. We explored the same incidents of D&A through two different measurement methods: observation of women during labor/delivery and women’s own reports upon exit following delivery.

Methodology: Women in active labor were observed upon entry to the delivery ward to two hours postpartum by trained nurse observers at two district hospitals in the Tanga Region, Tanzania. These same women were then interviewed upon discharge from delivery with a structured questionnaire to elicit self-report of D&A. Frequencies of categories and events of D&A were compared as well as the ratio of observed events to self-reported events.

Results: 240 women participated in both the observation and the exit interview. On observation, the percent of any D&A was 70.83% (N=170) compared to 10% (N=24) on exit. The most common report of abuse was shouting or scolding on both measures (47.48% on observation; 6.25% on exit). The largest differentials of observer to self-report were for physical abuse (16.57) and threatening/negative comments (15.41).

Conclusion: The wide discrepancy between third-party observation of D&A and women’s report of D&A during delivery highlights the complexity of defining, measuring, and addressing D&A. While observations highlight events that, although they are violations of legal and professional standards, are so normalized that they are not even reported by women, self-report provides an understanding of women’s own experiences and expectations. Ultimately, different measures of D&A will be necessary depending on the research, program or advocacy purpose.