Implementing maternal and newborn health quality of care standards in healthcare facilities to improve the adoption of respectful maternity care in Bangladesh, Ghana and Tanzania: a controlled before and after study
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Date
2023
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Publisher
BMJ Glob Health
Abstract
Introduction Many women worldwide cannot access
respectful maternity care (RMC). We assessed the effect of
implementing maternal and newborn health (MNH) quality
of care standards on RMC measures.
Methods We used a facility-based controlled before and
after design in 43 healthcare facilities in Bangladesh,
Ghana and Tanzania. Interviews with women and health
workers and observations of labour and childbirth were
used for data collection. We estimated difference-in differences to compare changes in RMC measures over
time between groups.
Results 1827women and 818 health workers were
interviewed, and 1512 observations were performed.
In Bangladesh, MNH quality of care standards reduced
physical abuse (DiD −5.2;−9.0 to –1.4). The standards
increased RMC training (DiD 59.0; 33.4 to 84.6) and the
availability of policies and procedures for both addressing
patient concerns (DiD 46.0; 4.7 to 87.4) and identifying/
reporting abuse (DiD 45.9; 19.9 to 71.8). The control
facilities showed greater improvements in communicating
the delivery plan (DiD −33.8; –62.9 to –4.6). Other
measures improved in both groups, except for satisfaction
with hygiene. In Ghana, the intervention improved women’s
experiences. Providers allowed women to ask questions
and express concerns (DiD 37.5; 5.9 to 69.0), considered
concerns (DiD 14.9; 4.9 to 24.9), reduced verbal abuse
(DiD −8.0; −12.1 to –3.8) and physical abuse (DiD −5.2;
−11.4 to –0.9). More women reported they would choose
the facility for another delivery (DiD 17.5; 5.5 to 29.4). In
Tanzania, women in the intervention facilities reported
improvements in privacy (DiD 24.2; 0.2 to 48.3). No other
significant differences were observed due to improvements
in both groups.
Conclusion Institutionalising care standards and creating
an enabling environment for quality MNH care is feasible
in low and middle-income countries and may facilitate the
adoption of RMC.
Description
Research Article
Keywords
Ghana, maternal, newborn health
Citation
To cite: Manu A, Pingray V, Billah SM, et al. Implementing maternal and newborn health quality of care standards in healthcare facilities to improve the adoption of respectful maternity care in Bangladesh, Ghana and Tanzania: a controlled before and after study. BMJ Glob Health 2023;8:e012673. doi:10.1136/ bmjgh-2023-012673