Researchers from the Centre for Maternal and Newborn Health (CMNH) have conducted a study in Malawi to explore the perspectives of women and healthcare providers about what quality of care during childbirth means to them and how this can be improved.
This qualitative study was conducted in 14 healthcare facilities in 2 districts in the country: Kasungu and Thyolo. 14 focus groups discussions were conducted with women who had given birth 7-42 days previously, and 27 interviews were held with healthcare providers. The findings have been published in the journal Midwifery: “There is no time for knowing each other”: Quality of care during childbirth in a low resource setting.
The study found that perceptions of what constitutes good quality of care differed substantially between the two groups. For healthcare providers, the most important characteristics of good quality care was centred around structural aspects of care such as availability of resources, and sufficient human resources. On the other hand, patient-centred care including a positive relationship and experience was prioritised by women. However, both women and healthcare providers agreed that the current care provided at the time of childbirth does not meet their expectations. Examples of poor quality of care included: unwelcoming reception on admission, non-consented care and physical and verbal abuse. Shortage of staff, poor labour room design and a non-functional referral system were other key barriers reported.
One healthcare provider highlights some of the challenges:
“We need to build a positive relationship with women during childbirth. However, it is quite difficult. A midwife is sometimes alone and the only thing she can do is to make sure the mother and the baby are alive. There is no time for knowing each other.”
Dr Florence Mgawadere, Senior Research Associate, CMNH and the lead author of the study:
“To improve the quality of care for women at the time of childbirth, it is important to understand the concept of quality from both women’s and healthcare providers’ points-of-view. This is essential if meaningful recommendations for the improving quality of care are to be developed and successfully implemented. We will ensure that the findings from this study are incorporated into our capacity-building interventions on quality improvement in low- and middle-income countries.”