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Measuring Disrespect and Abuse during Childbirth in the Western Highlands of Guatemala

Measuring Disrespect and Abuse during Childbirth in the Western Highlands of Guatemala. Emily Peca, MA, MPH GWU/ USAID|TRAction Project Respectful Maternity Care Seminar June 24, 2014. Overview of Presentation. Context of Guatemala Opportunity to explore D&A within an existing effort

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Measuring Disrespect and Abuse during Childbirth in the Western Highlands of Guatemala

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  1. Measuring Disrespect and Abuse during Childbirth in the Western Highlands of Guatemala Emily Peca, MA, MPH GWU/USAID|TRAction Project Respectful Maternity Care Seminar June 24, 2014

  2. Overview of Presentation • Context of Guatemala • Opportunity to explore D&A within an existing effort • Data source • Data collection • Preliminary results • Contribution

  3. Guatemala: Country of Contrasts Disparities in outcomes: by ethnicity, geography, income

  4. The Opportunity TRAction Guatemala’s technical cooperation approach focused on strengthening the network of MNCH & nutrition service delivery in Ixil Health Area Data was collected on health seeking behavior and perceptions related to maternal child health and nutrition services Opportunity: to describe and quantify women’s experiences and perceptions of disrespect and abuse related to facility deliveries

  5. Study Site Ixil is comprised of 3 municipalities in the Department of El Quiche Total Pop. Ixil ~160,000 Majority of the population lives in communities of 500 people or less

  6. Data Source • Qualitative & quantitative data is from 15 rural to remote communities from all three municipalities of Ixil (total pop 7,757) • Communities are categorized as close, intermediate or far to nearest delivery facility. (1 public facility in each municipality) • Partners COTONEB; University of San Carlos

  7. Focus Group Discussions • Comadronas- traditional birth attendants • Women (home birth)- within last five years • Women (facility-birth)- within the last five years

  8. In-depth Interviews • Community leaders: religious leaders, leaders of dev’t committees • Community health workers: head mini-health posts in each of the 15 communities • Women (facility-birth)- within the last five years

  9. Domains Domains Consistent across all FGDs & IDIs • Reasons for delivering in a facility/home • Disrespect and abuse in facilities (experiences/perceptions) • Recommendations for improving facility-based services All data was collected by bilingual (Spanish & Ixil) women from the three municipalities of Ixil

  10. Preliminary Results: Qualitative Data • Quotes from women who gave birth in a facility: • “I was not attended quickly and when my baby was about to come out they pushed me without saying why, this made me feel bad.” • “They gave me cold food and when they drew my blood they never told me why.” • “The providers were not at my side when my baby was born …” • I needed help and the nurse didn’t want to help me. When I asked her help she just said levantate! (get up!), but I couldn’t.” • “They are fromthesamegroup as us (Ixil) butthey do notspeaktous in Ixil and theyscoldus…” Comadrona (TBA)

  11. Preliminary Results: Survey Data Vacant: 148; absent: 87; refused : 11 • 94% self-identified as indigenous; 6% non-indigenous • 19% gave birth to their last child in a facility; majority give birth with comadronas (TBAs)

  12. Survey Data • Questions for measuring disrespect & abuse and respect promoting practices were based on: • Disrespectful & Abusive Maternity Care Framework • Disrespect and abuse studies in East Africa • Formative research in Ixil • Guatemala’s guidelines/norms for culturally appropriate care (Disrespect/Abuse) Bribe Neglect Non-consent Neg. gestures/comment (Respect Promoting) Language Birth Companion Chose Position Preferred clothing

  13. D&A/RMC Questions • Survey included two sets of similar disrespect and abuse questions for women who had a home birth & women who had a facility birth • Facility birth cohort: asked about their own experiences • Home birth cohort: asked about perceptions/beliefs about facility births • This allows for comparison between self-reported experiences and beliefs/perceptions

  14. D&A: Facility Cohort “Global” disrespect and abuse question (facility cohort) indicates 7% prevalence

  15. Results: comparison of experiences vs. perceptions

  16. Contribution • Testing the construct of D&A in a Latin America context (rural, hard-to-reach) • What components of the D&A construct are relevant; missing in context of rural Guatemala • What are the contributors to and consequences of experiencing and perceiving D&A in this context? • Consider relationship between D&A and ‘respect-promoting’ practices • Contribute to measurement lessons: training local data collectors, adapting tool in a local language; data collection in remote areas; measurement as an intervention

  17. Acknowledgments • TRAction Guatemala team based at the URC office in Guatemala, Hernán Delgado (PI) • Implementing partner COTONEB & CHWs • Field supervisors Miguel Brito and Elena Gómez • Data collection teams from Ixil • The families from the 15 communities who shared their time and experiences with us.

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