Mistreatment of women during maternal health service utilisation: the case of Western Ethiopia
- Publication Type:
- Thesis
- Issue Date:
- 2025
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Background: Ensuring quality maternity care is crucial to reducing global maternal and neonatal mortality. Reports have surfaced regarding the mistreatment of women during maternity care in Ethiopia. Yet, the precise effects on the continuum of maternity care, as well as the underlying structural factors and resulting consequences, remain ambiguous. Therefore, this thesis explores the extent, types, drivers and consequences of the mistreatment of childbearing women in health facilities in East Wollega Zone, Western Ethiopia in 2022.
Methods: A mixed-methods study was conducted to investigate the mistreatment of women. Surveys that involved 760 women, accompanied by a self-administered survey with 148 healthcare providers were conducted. Subsequently, thirty-seven in-depth interviews were undertaken with selected women and health professionals to delve extensively into experiences of mistreatment and explore perceptions regarding the factors driving it and its consequences. Mixed effects and standard binary logistic regression models were used to analyse models in quantitative studies, while qualitative data underwent thematic and framework analysis. An integrated narrative approach was employed to combine results from both analyses.
Results: Two broader categories of mistreatment of women were identified in this study: interpersonal abuse (37.4%) and mistreatment during the process of care (ranging from 6.2% to 51%). The findings of the healthcare professionals survey indicated that 93.24% observed instances of mistreatment towards women by their peers, and 75.7% admitted to personally mistreating women.
Women who experienced mistreatment demonstrated a significantly reduced likelihood of completing a continuum of care pathway. Qualitative findings aligned with the survey results, resulting in three main themes: the experience of mistreatment, perceived drivers and its consequences. The mistreatment aligned with the general violence against women in the community and the lack of quality of care in the health facility. The mistreatment of women was also found to be driven by a combination of personal factors, staff and women interactions, facility conditions, limitations of the health system, and the context of society particularly gender-based oppressions.
Conclusion: This mixed-method study found widespread mistreatment of women, hindering maternal healthcare service use in East Wollega Zone, western Ethiopia. Identified drivers include provider prejudices, negative work environment perceptions, burnout, reduced staff empathy, and inadequate leadership accountability and staffing levels, along with issues related to community unrest and violence against women in society. Interventions that target both micro- and macro-level drivers, where community members also engage by demanding respectful care and reflecting on their role in promoting women's equality.
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