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Intervention associated with reduced disrespect and abuse during childbirth in Tanzania


An intervention aimed at community and healthcare facility stakeholders was associated with a reduction in the prevalence of disrespect and abuse seen during childbirth in Tanzania, according to a new study published in PLOS Medicine by Stephanie Kujawski from Columbia University, USA, and colleagues.

Over the past decade, investigative reports have documented abusive and discriminatory treatment of women in labor and delivery rooms in countries around the world. In the new study--dubbed Staha for the Swahili word for respect--researchers involved local community members and healthcare workers in the Tanga region of Tanzania in a process to analyze their own experiences and consider actions to reduce rates of disrespect and abuse. In the study intervention, local community and facility stakeholders adapted a nationally developed charter to build consensus on respectful care, and these norms and standards were activated through a maternity ward quality-improvement process. Two hospitals were included in the study with one randomly assigned to receive the intervention. Prevalence of disrespect and abuse was measured using survey data from women who had been discharged from the maternity ward after delivery, including in 1388 women at baseline and in 1,680 women 10 months after support for the intervention's implementation ended.

Before the intervention, 18 percent of women reported disrespect and abuse during delivery. Compared with no intervention, the likelihood of self-reported disrespectful and abusive care was reduced by 66% after the intervention (95% CI: 0.21-0.58, p < 0.0001). The largest reductions were seen in physical abuse and neglect. The study was carried out in only two facilities so will need to be expanded to determine the applicability of the approach to other settings.

"Our findings have important implications for the way forward as the Respectful Maternal Care field evolves," the authors say. "Eliminating disrespect and abuse requires individual behavior change, organizational and systems change, and, ultimately, deeper societal transformation. These are complex, multidimensional challenges that do not evaporate just by order of a court or mandate of a minister."



This study was made possible by the support of the Denmark Ministry of Foreign Affairs, the National Institute of Allergy & Infectious Diseases of the National Institutes of Health under award number T32AI114398 (SAK), and the American people through the United States Agency for International Development (USAID) and its Translating Research into Action (TRAction) Project. TRAction is managed by the University Research Co., LLC (URC) under Cooperative Agreement Number GHS-A-00-09-00015-00. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests:

I have read the journal's policy and the authors of this manuscript have the following competing interests: MEK is a member of the Editorial Board of PLOS Medicine.


Kujawski SA, Freedman LP, Ramsey K, Mbaruku G, Mbuyita S, Moyo W, et al. (2017) Community and health system intervention to reduce disrespect and abuse during childbirth in Tanga Region, Tanzania: A comparative before-and-after study. PLoS Med 14(7): e1002341.

Author Affiliations:

Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America
Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, New York, United States of America
Ifakara Health Institute, Dar es Salaam, Tanzania
Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America


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