The effect of a multi-component intervention on disrespect and abuse during childbirth in Kenya

BACKGROUND: Disrespect and abuse (D those who consented were administered a questionnaire on D & A in general as well as six typologies, including physical and verbal abuse, violations of confidentiality and privacy, detainment for non-payment, and abandonment. Observation of provider-patient interaction during labor was also conducted in the same facilities. In both exit interview and observational studies, multivariate analyses of risk factors for D & A controlled for differences in socio-demographic and facility characteristics between baseline and endline surveys. RESULTS: Overall D & A decreased from 20-13% (p < 0.004) and among four of the six typologies D & A decreased from 40-50%. Night shift deliveries were associated with greater verbal and physical abuse. Patient and infant detainment declined dramatically from 8.0-0.8%, though this was partially attributable to the 2013 national free delivery care policy. CONCLUSION: Although a number of contextual factors may have influenced these findings, the magnitude and consistency of the observed decreases suggest that the multi-component intervention may have the potential to reduce the frequency of D & A. Greater efforts are needed to develop stronger evaluation methods for assessing D & A in other settings.