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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

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
Overview of Presentation
  • Context of Guatemala
  • Opportunity to explore D&A within an existing effort
  • Data source
  • Data collection
  • Preliminary results
  • Contribution
guatemala country of contrasts
Guatemala: Country of Contrasts

Disparities in outcomes: by ethnicity, geography, income

the opportunity
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

slide6

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

data source
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
focus group discussions
Focus Group Discussions
  • Comadronas- traditional birth attendants
  • Women (home birth)- within last five years
  • Women (facility-birth)- within the last five years
in depth interviews
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
domains
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

preliminary results qualitative data
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)
preliminary results survey data
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)
survey data
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

d a rmc questions
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
d a facility cohort
D&A: Facility Cohort

“Global” disrespect and abuse question (facility cohort) indicates 7% prevalence

contribution
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
acknowledgments
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.