This study assessed the magnitude and associated factors of disrespect and abuse among women who gave birth in public health facilities in East Hararghe zone, eastern Ethiopia. We found almost four in every five women gave birth in public health facilities were disrespected and abused during childbirth. Factors: average monthly income, distance from nearby health facilities, parity, attending ANC visits and delivery time were found to be statistically significant associated with disrespect and abuse during childbirth.
This finding was consistent with the study conducted in Addis Ababa, Ethiopia 78% [16]. This finding also is in line with the study conducted in western Ethiopia 74.8% [23]. However, this finding was higher than the studies conducted in Bale, Ethiopia 37.5% [22], Addis Ababa, Ethiopia 17.5% [25], Bahir Dar, Ethiopia 67.1% [20], Kenya 20% [15], and Tanzania 15% [26]. This difference might be due to socio-demographic different, almost all study participants were from urban residence [20, 25] compare to three-forth of our study participants were from rural residence. The women from urban residences were more defenses for their rights during childbirth than the women from rural residences. In addition, this variation might be due to poor attending facilities for ANC service during the current pregnancy in our study, while almost all study participants of studies conducted in Bale and Bahir Dar attended health facility for ANC service. Contact with good health facility behavior could improve relationship between women and health care providers, which might improve the communication barrier between health workers and women during childbirth.
On the other hand, this finding was lower than the studies conducted in Jimma, southern Ethiopia 91.7% [21], Malawi 93.7% [27], Nigeria 98% [14], and Pakistan 97% [28]. This variation was introduced due to differences in verification criteria used to measure disrespect and abuse, of 24 verification items were used for seven domains of disrespect and abuse in our study, while comparable studies used 48 or more verification criteria [29, 30] which may result for over reporting.
The study showed that, women who got an average monthly income less than 2000 birr were 2 times more likely to be disrespected and abused than those who got greater than or equal 2000 birr. This possible might be due to the women discrimination applied during childbirth due to their economic status.
Women living far from health facilities will more likely disrespect and abuse during childbirth. This possible might be due to poor knowledge about respectful maternity care, and they cannot ask for their right. It’s a problem that women living far from health facilities not receiving respectful maternity care during childbirth. It is important to improve health facilities access coverage in order to improve respectful maternity care.
The parity status of less than or equal four was about 1.7 times more likely increasing the risks of disrespect and abuse during childbirth in health facilities. This finding in agreement with study conducted in Kenya [15]. Multi-parus women more familiar with maternity care service to be provided by care provider and they might be ask for the missed services in health facilities.
The study indicated that, women who did not attend ANC visit during pregnancy were 4 times more likely to experience disrespect and abuse during childbirth. This finding was supported by the studies conducted in Bale, Ethiopia [22], Bahir Dar, Ethiopia [31]. Good maternity care utilization habits could improve the women awareness about the health system, which are support women to empower them for defense of disrespect and abuse. In addition, attending an ANC visits on time might build a strong bond between women and care providers. This means access to ANC visits to all pregnant women in health facilities is important in reducing mistreatment during childbirth in health facilities.
Women who delivered during nighttimes were about 2 times more likely to be disrespected and abused than those who delivered during a daytime. This finding was supported by studies conducted in Central Ethiopia [32] and Northwest Ethiopia [33], which indicated that women delivered during a daytime were more likely received respectful maternity care than those who delivered during a nighttime. This possible might be due to inadequate number of staff assigned during nighttime might be leads to health care provider become tired due to work overload and sleep disturbance. It’s worrisome that women attending labor ward during nighttime were more disrespected and abused. Mechanisms to support such women ensure respectful maternity care during the nighttime, including the number of care providers assigned and supervision plan in the nighttime should be implemented in all health facilities.
The strength of this study is since the exit interview was carried out during discharge time, recall bias was minimized. Moreover, hospitals and health centers which serving women with different maternity care services were included, and therefore can be generalized to eastern Ethiopia and beyond. However, disrespect and abuse was measured using interviews alone; the extent might be deviated from true value by women not being stable during care time.