We found that nearly all women (n = 211; 99%) held one or more document following birth at three hospitals in The Gambia’s capital city. The government-issued maternal record was most commonly used and complete, though key information was omitted. HCPs were familiar with the maternal records, knew the information that was to be recorded on them and knew they cover the postnatal period. Whilst two HCPs thought maternal records were only used for normal births, the quantitative data disputes this. None of the women’s sociodemographic or clinical factors contributed to the completeness of the documents, suggesting that completeness is universally sub-optimal.
Most women had more than one document (n = 157; 74%), supporting the comments made from HCPs regarding the various documents they must complete and give to women. Five items were recorded less on the maternal record; four of which were better recorded on the discharge checklist. The checklist was not universally given to women, but the maternal record was. It is therefore more practical to consolidate all necessary items onto the maternal record and it be the only women-held document after discharge. Completing and explaining to women just one document could save HCPs valuable time, thus increase time for patient care and likelihood of the correct document being taken to postnatal appointments by women.
A national protocol on what women-held discharge document to complete (the maternal record) and minimum criteria of information to include could aid in the document’s completeness and consistent use. Additional supervision and monitoring of the discharge information given to women would further enhance implementation of such a protocol.
Our results complement the existing literature on women’s opinions and use of women-held documents.(9,10,12,19) Despite some HCPs in this study thinking women find these documents unimportant, most women said a written explanation on what happened during birth was important and they would use the document(s) given to them. It is possible that the HCPs’ perceptions on what women think about the documents, lack of staff, lack of a national protocol, or a combination of these factors could be impacting completeness.
A national training plan for staff could help change perceptions, stress the impact of women-held documents and encourage them to complete the document(s) consistently. It should be clarified to HCPs that women rarely forget to bring their documents to healthcare appointments in The Gambia and elsewhere.(10,12,20) It is crucial for HCPs to understand that the maternal record does not just improve continuity of care. Providing women with clear information to take home can increase their confidence in the care they receive and improve communication with HCPs.(9,21–23)
Despite women’s positive opinions, 19% said they did not know how they would inform the next HCP about the birth, indicating that further education and explanation of the documents are needed and emphasising the need for adequately completed women-held documents. Further studies are required to understand the health and social impact of women-held documents following discharge. Findings from such research could assist in determining minimum criteria for information on women-held documents and strengthen the evidence needed to educate women and HCPs on the importance of these documents.
This study had some limitations. The criteria used to assess document completeness was partially based on the maternal record. Consequently, this may have positively influenced the completeness of maternal records; however, the criteria were also guided by WHO recommendations. Results may be less generalisable to rural Gambia, although all rural areas around Banjul referred women to these hospitals. The time it took for women to reach the hospital did not predict completeness and 99% of woman held a document, suggesting that use and completeness would not differ between urban inhabitants near the hospitals and rural inhabitants further away.