Lay and healthcare providers' experiences to inform future of respectful maternal and newborn care in Tanzania and Malawi: an Appreciative Inquiry.

OBJECTIVES: Disrespectful care, which remains prevalent in low and middle-income countries (LMICs), acts as a barrier to women accessing skilled birth attendance, compromising care when services are available. Building on what was positive in facilities, we aimed to explore lay and healthcare providers' experience of respectful care to inform future interventions. SETTING: Five maternity facilities in Mwanza Tanzania and Lilongwe Malawi. PARTICIPANTS: 94 participants in Malawi (N=46) and Tanzania (N=48) including 24 women birthing live baby within the previous 12 months; 22 family members and 48 healthcare providers who regularly provided maternity care in the included facilities DESIGN: The study was guided by Appreciative Inquiry (AI). Semistructured, one-to-one interviews were conducted between January and December 2019. Interviews were audio-recorded, translated where necessary, transcribed verbatim, and analysed using the framework approach. RESULTS: Four main themes describing participants positive experience and their vision of respectful care were identified: (1) empathic healthcare provider-woman interactions including friendly welcome and courteous language, well-timed appropriate care and information sharing, (2) an enabling environment, characterised by improvement of physical environment, the use of screens, curtains and wall partitions for privacy, availability of equipment and provision of incentives to staff, (3) supportive leadership demonstrated by the commitment of the government and facility leaders to provision of respectful care, ensuring availability of guidelines and policies, supportive supervision, reflective discussion and paying staff salaries timely, (4) providers' attitudes and behaviours characterised by professional values through readiness, compassionate communication and commitment. CONCLUSION: The positive experiences of service users, families and healthcare providers provided insight into key drivers of respectful care in facilities in Tanzania and Malawi. Interventions targeting improved environment and privacy, healthcare provider communication and developing positive leadership structures in facilities could provide the basis for sustained improvement in respectful and dignified maternal and newborn care in LMICs.

Isn't pregnancy supposed to be a joyful time? A cross-sectional study on the types of domestic violence women experience during pregnancy in Malawi.

Background: Domestic violence against pregnant women exists in Malawi but its magnitude and types were, until recently published data, unknown due to scanty published data on the subject. This study aimed at identifying types of abuse women experience during pregnancy. Methods: The study design was cross-sectional descriptive quantitative using a random sample of 292 pregnant women attending an antenatal clinic at Nsanje District Hospital, southern region of Malawi. A structured questionnaire was administered to each pregnant woman that consented to participate. Data was analyzed using SPSS software version 16. Descriptive statistics were computed for demographic data and type of violence. Results: The findings indicate that a majority (59%) of women experienced more abuse during pregnancy, compared to 12.5% prior to current pregnancy. The women were psychologically (29%), sexually (28%) and physically (14%) abused during pregnancy. There was a significant association (P<0.05) between domestic violence and witnessing abuse as a child in the home. Additionally, domestic violence was significantly associated (P<0.05) with a woman being pregnant. No significant association (P>0.05) was found between domestic violence and other demographic variables; age, low education level and low income. Conclusion: The pregnancy period is not a joyful time for all women. The study found high levels of psychological, sexual and physical domestic abuse among pregnant women. We advocate for community awareness creation on domestic violence, strengthening victim support units and One-Stop centres, and training health workers to screen for and counsel victims during antenatal care.