Women Experience Respect and Disrespect during Childbirth in Tertiary Teaching Hospital. Southwest Part of Ethiopia: Participant Observation, qualitative study

Abstract Background: Disrespect and abuse during facility-based childbirth is a negative experience for women in developed and developing regions. Types and drivers of disrespect and abuse vary based on study settings. Few studies have explored disrespect and abuse in tertiary teaching hospitals settings. Therefore, the aim of this study was to explore women experience of disrespect and abuse in one of tertiary teaching hospitals in southwest part of Ethiopia. Method: Qualitative participant observation was used as a data collection method. Fieldwork was conducted in the labour ward, the normal postnatal ward, and the maternity recovery room for three consecutive months in Jimma University specialized teaching hospital. The participant observation units were selected purposively, and 53 episodes of women in labour and 33 episodes of post-partum women were observed. The data were organized and analysed using NVIVO qualitative analysis software.and we used the thematic analysis method.Results: Three categories of themes were identified: disrespect and abuse, contributor themes, and respectful themes. Disrespect and abuse themes were physical abuse, poor communication, non-consented care, lack of privacy, lack of confidentiality , neglected care, loss of autonomy and lack of companion,. Contributor themes for disrespect and abuse were provider-related, health system-related, and women-related themes. Provider-related themes were lack of respect among providers and lack of collaboration and communication. Health-system related themes were poor human resource management, scarcity of equipment and supplies, and wastage of supplies. A women-related contributor was women passivity. Respectful care themes were in two categories: respectful provider and respectful facility cultures. Respectful provider practice includes: timely evaluation at admission, being with women, supportive care, and teamwork during emergency. Respectful facility culture included postpartum companion and free delivery service.Conclusion: The findings of this study indicate that women experienced disrespect and abuse at a teaching health care facility. Policy makers, administrators, and quality improvement initiative activities need to address the identified contributors to improve women’s experience in health care facilities.