Respectful Maternity Care Associated Factors and Intent to Reuse Maternity Needs Among Women Delivering in Longisa Hospital, Kenya: Cross-sectional Study

Abstract

Background: An intervention to reduce maternal mortality is having women deliver under skilled birth attendants (SBA). When women are not treated with respect and dignity during pregnancy, labour and delivery, they are unlikely to utilize SBA for their future maternity needs putting them at risk for complications. According to Kenya Demographic Health Survey (KDHS) 2014, Bomet County has a high fertility rate of 4.3 and a low SBA of 52.2% compared to the national fertility rate of 3.42 and SBA attendants of 62%. Respectful maternity care is critical to the provision of quality care. We aimed to assess RMC, associated factors and women intend to reuse and recommend the hospital for future maternity needs in Longisa County Referral Hospital (LCRH). Objective: To determine the prevalence of RMC, associated factors and women’s intent to reuse or recommend the hospital for future maternity needs at LCRH, Bomet County, Kenya. Methodology: A cross-sectional study was undertaken within the post-natal ward at LCRH between March to April 2022. A structured paper-based questionnaire was used to collect data which included data on; socio-demographics, obstetric characteristics, health system factors, RMC and women's intent to reuse and recommend the hospital for future maternity needs. Data on RMC was collected through person-centred maternity care (PCMC) exit interviews to cover three themes: dignity and respect, supportive care, autonomy and communication. The PCMC section had 30 items, each of which was graded on a four-point scale. The analysis was conducted using IBM SPSS version 26, wherein the prevalence of RMC was presented as a percentage 0f 95% confidence interval (CI). Associated factors and willingness to reuse or recommend the hospital for future maternity needs were analysed using Chi-square tests with statistical significance set at p <0.05. Results: Out of the 277 women, 235 received RMC giving a prevalence of 84.8% (95% CI 80.5- 89.2). From the RMC subscale, dignity and respect had the highest score at 265(95.7%) followed by communication and autonomy 235(84.3%) and least was supportive care 217(78.3%). Neither sociodemographic, obstetric nor health system factors were associated with RMC. Ninety seven percent of the patient were willing to reuse and recommend the hospital for future maternity needs. Conclusion and recommendation: Overall prevalence of RMC was high in LCRH and the majority of the women were willing to reuse or recommend the hospitalthough none of the factors was associated with RMC. It is important to educate and train health care providers on the importance of continuously providing respectful maternity with an increased focus on the provision of supportive care. There is a need to promote patient delivery under skilled birth attendance for themselves or recommendations of others at the health facility. A qualitative study in future would improve the understanding of the factors engaged with patient experience with respectful maternity care.