احترام و بی احترامی ماماها به زنان در زایمان بر اساس امکانات موجود در تانزانیا Midwives’ respect and disrespect of women during facility-based childbirth in urban Tanzania: a qualitative study

Plain English summary In recent years, numerous studies around the world have described the disrespect and abuse (D&A) experienced by some women during childbirth from healthcare providers at facilities. In particular, Tanzanian women have experienced physical and verbal abuse, as well as being ignored and neglected when birthing at facilities. Unfortunately, there have been few studies of D&A carried out by direct observations of midwives’ actual care during childbirth. This study aimed to make actual observations and describe the respectful and disrespectful care received by women from midwives during childbirth in urban Tanzania. Direct observations of the childbirth care provided by the 14 midwives revealed both respectful and disrespectful care. Some midwives had positive interactions with the women, showed respect of their privacy, provided safe and timely care for delivery, actively engaged in the women’s labor process, and encouraged mother-baby relationship. However, some midwives abused the women physically and psychologically, showed no respect of their privacy, failed to obtain consent before giving care, and ignored and neglected the women during their childbirth. Several kinds of physical and psychological abuse that have not been reported were also observed. The unprioritized and disorganized nursing and midwifery management was an important factor contributing to the disrespect for women. To promote respectful care by midwives, pre-service and in-service trainings, improvement of the working conditions and environment, and strengthening of health policies are crucial. It is also important to not only identify positive approaches to supporting midwives but also empower women to know their rights regarding being treated respectfully