What Price a Welcome? The Role of Respect in the Improving Access to Midwifery Care in Uganda
Project Team: Professor Louise Ackers, Rachel Namiiro, Hannah Webster and Dr Richard Mugahi
Research Group: Knowledge Health and Place
Project Details: This study aimed to assess the role that ‘Disrespect’ played in shaping access to maternity services in community health facilities in Uganda. The 3-delays model (adapted widely from Thaddeus and Maine, 1994) emphasises the need to take a more holistic and less medicalised approach to maternal mortality in Low- and Middle-Income countries.
The first delay concerns health seeking behaviour; the second captures their journeys to access skilled birth attendants and the third, the quality of care they receive when they arrive. Disrespect is fundamentally a quality-of-care issue that impacts directly on health seeking behaviour.
The study addresses the relationship between quality of care and health seeking behaviour and asks the question: why do so many women and especially vulnerable and high-risk women decide not to seek antenatal support and what role does Respect play in this?
We used focus groups with practicing midwives and interviews with both midwives and local women to help us to understand what Respectful Care means in a Ugandan community health setting and identify ways of improving attendance at antenatal and related services. The study reported major concerns around continued experience of physical abuse (slapping and pinching of mothers during labour) but also, and more commonly, verbal abuse. Abuse was found to be closely linked to forms of corruption where women who were unable or unwilling to offer payments to health workers were treated with derision and neglect. Mothers were also concerned about privacy and had particular concerns about how health workers talked about them. The research also identified examples of best practice in a health facility supported by a British Charity, Knowledge For Change. In this setting interview responses suggested very high levels of respectful care and no evidence of patient charging or abuse. This demonstrates the ability to develop and sustain Respectful Care in a Uganda setting and apply that approach to other services (cervical cancer screening and blood donation and management of patients with limb loss). The work has been published and has played a major role in shaping subsequent research applications and creating opportunities for policy transfer to other health facilities and services.
It has also supported Hannah Webster’s career development (and Masters’ success) as well as supporting co-researching and co-authorship with our Ugandan colleagues.
Ackers, H.L., Webster, H., Mugahi, R. and Namiiro, R. (2018) What Price a Welcome? Understanding structure-agency in the delivery of respectful care in Uganda, International Journal of Health Governance, 23(1):46-59