Are respectful maternity care (RMC) interventions effective in reducing intrapartum mistreatment against adolescents? A systematic review.

Intrapartum mistreatment of women by health professionals is a widespread global public health challenge. It leads to a decreased quality of maternity care and is evinced to precipitate detrimental maternal and neonatal outcomes, especially among adolescents. Relatedly, research indicates that Respectful Maternity Care (RMC) interventions are especially effective in mitigating intrapartum mistreatment and improving birth outcomes. However, evidence on the success of RMC, specifically for adolescents, is insufficient and unaggregated. Accordingly, this review specifically aims to synthesize existing evidence on RMC care provision to adolescent parturients. This review searched for relevant literature from published and gray sources including PubMed, ScienceDirect, Cochrane, CINAHL, PsycINFO, Scopus, as well as Population Council, WHO and White Ribbon Alliance data sources published between January 1990 and December 2021. Based on eligibility, studies were selected and quality appraised after which thematic analysis and narrative synthesis was conducted. Twenty-nine studies were included in the systematic review. Due to paucity and heterogeneity of quantitative studies, the review was limited to a thematic analysis. Adolescent and health provider perspectives alike underscored the burden and outcomes of mistreatment. Need for RMC interventions to improve quality of maternity care was recommended by majority of studies. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier: CRD42020183440.

Evidence on respectful maternity care for adolescents: a systematic review protocol.

BACKGROUND: Intrapartum mistreatment of women is an ubiquitous public health and human rights challenge. The issue reportedly has severe maternal and neonatal outcomes including mortality, and generally leads to a decreased satisfaction with maternity care. Intrapartum mistreatment, despite being ubiquitous, indicates higher incidence amongst adolescent parturients who are simultaneously at a higher risk of maternal morbidity and mortality. Studies have suggested that Respectful Maternity Care interventions reduce intrapartum mistreatment and improve clinical outcomes for women and neonates in general. However, evidence on the effect of RMC on adolescents is unclear. Hence, the specific aim of this study is to synthesise the available evidence relating to the provision of RMC for adolescents during childbirth. METHODS: The methodology of the proposed systematic review follows the procedural guideline depicted in the preferred reporting items for systematic review protocol. The review will include published studies and gray literature from January 1, 1990, to June 30, 2021. Electronic databases including MEDLINE, PubMed, ScienceDirect, Cochrane, CINAHL, PsycINFO, Scopus, Google Scholar and Web of Science will be searched to retrieve available studies using the appropriate search strings. Studies included in the review will be appraised for quality using tools tailored to each study design. If appropriate, we will conduct random effects meta-analysis of data to summarise the pooled estimates of respectful maternity care prevalence and outcomes. The selection of relevant studies, data extraction and quality assessment of individual studies will be carried out by two independent authors. RESULTS: Summaries of the findings will be compiled and synthesised in a narrative summary. In addition to the narrative synthesis, where sufficient data are available, a random-effects meta-analysis will be conducted to obtain a pooled estimate value for respectful maternity care prevalence and outcomes. DISCUSSION: Respectful Maternity Care for adolescents holds great promise for improved maternal and neonatal care. However, there is a gap in knowledge on the interventions that work and the extent of their effectiveness. Findings from this study will be beneficial in improving Adolescents Sexual and Reproductive Health and Rights and reducing maternal mortality, especially for adolescents. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020183440.

Factors associated with condom breakage among female sex workers in the Western Region of Ghana.

Condoms have been extensively demonstrated as being effective in reducing Human Immunodeficiency Virus (HIV) infection rates among both men and women. With proper use and production, condom breakage is ideally minimal. However, breakage is reportedly a widespread problem among Female Sex Workers (FSWs), who are classified as a Key Population and warrant special transmission prevention efforts. Nationally, Ghana records an average rate of 5% of condom breakage. This study sought to identify the factors associated with condom breakage among FSWs in the western region of Ghana, a region with an extensive sex worker population and HIV incidence rate of 2.5%, higher than the national average. This study employed a cross-sectional survey among FSW populations in the Western region, Ghana. A sample of 416 participants were proportionately invited between brothel based and roamer communities to participate in the surveys. A total of 403 consented to participate indicating a response rate of 96.9%. Data were analysed for frequencies and prevalence of variables including condom breakage. At the bivariate level, associations with breakage were examined and statistically significant variables were analysed with simple and multiple logistic regression analysis. Of the 403 research participants who consented to participate, 17.4% had experienced breakage over the past week. Brothel-based FSWs were only half as likely to report condom breakage as non-brothel based FSWs (aOR = 0.526; 95% CI, 0.296 - 0.936). Notably, FSWs who consumed alcohol-containing drinks every day were only 65.2% as likely as those who consumed alcohol at least once a week or less than once a week or never to experience condom breakage (aOR = 0.348; 95% CI, 0.164 - 0.740). The study determined that the occurrence of condom breakage among FSWs in the western region was 17.4%. Factors significantly associated with condom breakage were being non-brothel based, frequency of alcohol consumption and parity. Condom use education programmes targeted at non-brothel based FSWs are necessary to reduce breakage and lower the risk of HIV transmission.

Promoting respectful maternity care for adolescents in Ghana: a quasi-experimental study protocol.

BACKGROUND: Intra-partum mistreatment by healthcare providers remains a global public health and human rights challenge. Adolescents, who are typically younger, poorer and less educated have been found to be disproportionately exposed to intra-partum mistreatment. In Ghana, maternal mortality remains a leading cause of death among adolescent females, despite increasing patronage of skilled birth attendance in health facilities. In response to the the World Health Organisation Human Reproduction Programme (WHO-HRP) recommendations to address mistreatment with Respectful Maternity Care (RMC), this study aims to generate evidence on promoting respectful treatment of adolescents using an intervention that trains health providers on the concept of mistreatment, their professional roles in RMC and the rights of adolescents to RMC. METHODS: This study will employ a pre-test post-test quasi-experimental design. At pre-test and post-test, quantitative surveys will be conducted among adolescents who deliver at health facilities about their labour experience with mistreatment and RMC. A total target of 392 participants will be recruited across intervention and control facilities. Qualitative interviews will also be conducted with selected adolescents and health professionals for an in-depth understanding of the phenomenon. Following the pre-test, a facility-based training module will be implemented at intervention facilities for the facility midwives. The modules will be co-facilitated by the principal investigator and key resource persons from the district health directorate Quality of Care teams. Training will cover the rights of adolescents to quality healthcare, classifications of mistreatment, RMC as a concept and the role of professionals in providing RMC. No intervention will occur in the control facilities. Descriptive statistics, logistic regressions and difference in differences analyses will be computed. Qualitative data will be transcribed and thematically analysed. DISCUSSION: This study is designed to test the success of an intervention in promoting RMC and reducing intra-partum mistreatment towards adolescents. It is expected that the findings of this study will be beneficial in adding to the body of knowledge in improving maternal healthcare and reducing maternal mortality, especially for adolescents. TRIAL REGISTRATION: Name of the registry: Pan African Clinical Trials Registry. PACTR202008781392078 .