{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T01:39:55Z","timestamp":1793324395521,"version":"4.5.0"},"reference-count":54,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2020,3,10]],"date-time":"2020-03-10T00:00:00Z","timestamp":1583798400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human development","doi-asserted-by":"publisher","award":["K99\/R00"],"award-info":[{"award-number":["K99\/R00"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human development","doi-asserted-by":"publisher","award":["K99HD093798"],"award-info":[{"award-number":["K99HD093798"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100005595","name":"University of California","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100005595","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Preterm Birth Initiative (PTBi) transdisciplinary post-doctoral fellowship"},{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["OPP1107312"],"award-info":[{"award-number":["OPP1107312"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Marc and Lynne Benioff"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Disrespect and abuse during childbirth are violations of women\u2019s human rights and an indicator of poor-quality care. Disrespect and abuse during childbirth are widespread, yet data on providers\u2019 perspectives on the topic are limited. We examined providers\u2019 perspectives on the frequency and drivers of disrespect and abuse during facility-based childbirth in a rural county in Kenya. We used data from a mixed-methods study in a rural county in Western Kenya with 49 maternity providers (32 clinical and 17 non-clinical) in 2016. Providers were asked structured questions on disrespect and abuse, followed by open-ended questions on why certain behaviours were exhibited (or not). Most providers reported that women were often treated with dignity and respect. However, 53% of providers reported ever observing other providers verbally abuse women and 45% reported doing so themselves. Observation of physical abuse was reported by 37% of providers while 35% reported doing so themselves. Drivers of disrespect and abuse included perceptions of women being difficult, stress and burnout, facility culture and lack of accountability, poor facility infrastructure and lack of medicines and supplies, and provider attitudes. Provider bias, training and women\u2019s empowerment influenced how different women were treated. We conclude that disrespect and abuse are driven by difficult situations in a health system coupled with a facilitating sociocultural environment. Providers resorted to disrespect and abuse as a means of gaining compliance when they were stressed and feeling helpless. Interventions to address disrespect and abuse need to tackle the multiplicity of contributing factors. These should include empowering providers to deal with difficult situations, develop positive coping mechanisms for stress and address their biases. We also need to change the culture in facilities and strengthen the health systems to address the system-level stressors.<\/jats:p>","DOI":"10.1093\/heapol\/czaa009","type":"journal-article","created":{"date-parts":[[2020,1,19]],"date-time":"2020-01-19T04:09:14Z","timestamp":1579406954000},"page":"577-586","source":"Crossref","is-referenced-by-count":104,"title":["Providers\u2019 perceptions of disrespect and abuse during childbirth: a mixed-methods study in Kenya"],"prefix":"10.1093","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6739-234X","authenticated-orcid":false,"given":"Patience A","family":"Afulani","sequence":"first","affiliation":[{"name":"Department of Epidemiology and Biostatistics, University of California, San Francisco (UCSF) School of Medicine, 550 16th St, San Francisco, CA 94158, USA"},{"name":"UCSF Institute for Global Health Sciences, 550 16th St, San Francisco, CA 94158, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann Marie","family":"Kelly","sequence":"additional","affiliation":[{"name":"Sidney Kimmel Medical College, 1025 Walnut St, Philadelphia, PA 19107, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Buback","sequence":"additional","affiliation":[{"name":"UCSF Institute for Global Health Sciences, 550 16th St, San Francisco, CA 94158, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Asunka","sequence":"additional","affiliation":[{"name":"The William and Flora Hewlett Foundation, 2121 Sand Hill Road, Menlo Park, CA 94025, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leah","family":"Kirumbi","sequence":"additional","affiliation":[{"name":"Kenya Medical Research Institute, Mbagathi Rd, Nairobi, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Audrey","family":"Lyndon","sequence":"additional","affiliation":[{"name":"New York University Rory Meyers College of Nursing, 433 First Avenue, New York, NY 10010, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,3,10]]},"reference":[{"key":"2020072715465197500_czaa009-B1","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1186\/s12884-015-0645-6","article-title":"The effect of a multi-component intervention on disrespect and abuse during childbirth in Kenya","volume":"15","author":"Abuya","year":"2015","journal-title":"BMC Pregnancy and Childbirth"},{"key":"2020072715465197500_czaa009-B2","doi-asserted-by":"crossref","first-page":"e0123606","DOI":"10.1371\/journal.pone.0123606","article-title":"Exploring the prevalence of disrespect and abuse during childbirth in Kenya","volume":"10","author":"Abuya","year":"2015","journal-title":"PLoS One"},{"key":"2020072715465197500_czaa009-B3","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1016\/S0733-8627(05)70028-6","article-title":"The general approach to the difficult patient","volume":"16","author":"Adams","year":"1998","journal-title":"Emergency Medicine Clinics of North America"},{"key":"2020072715465197500_czaa009-B4","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1186\/s12884-018-1806-1","article-title":"Companionship during facility-based childbirth: results from a mixed-methods study with recently delivered women and providers in Kenya","volume":"18","author":"Afulani","year":"2018","journal-title":"BMC Pregnancy and Childbirth"},{"key":"2020072715465197500_czaa009-B5","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1111\/birt.12418","article-title":"Can an integrated obstetric emergency simulation training improve respectful maternity care? 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