BACKGROUND: A human rights-based approach (HRBA) to maternal health care is generally recognized as key to improving quality and acceptability of care. Yet examples of a HRBA in practice are limited. Crises exacerbate underlying challenges in current approaches to maternal child healthcare (MCH) and provide an ideal, if unfortunate, opportunity to assess alternatives. The midwifery model of care is a HRBA based on the relationship between the midwife and woman. It is appropriate for the majority of healthy pregnant women, and has been found to provide safe, cost effective, evidence based, and satisfying care. Yet midwives working in the medical model may struggle to fully express midwifery. A quasi-experimental design was used to assess the impact of three models of care on women’s experiences of respectful care, trust and their fear and knowledge around COVID-19, before and during the COVID-19 pandemic. The models were: the fully enabled midwifery (“FEM”) model in a midwifery center, the midwifery and medicine (“MAM”) model in facilities with midwives working alongside medical practitioners, and the no midwifery (“NoM”) model in facilities without midwives.
METHODS: Phone survey data were collected and analyzed from all women (n=1191) who delivered from Jan 2020-June 2020 at 7 health care facilities in Bangladesh. Descriptive statistics and ANOVA, post hoc Tukey and effect size analyses were used to explore the relationships between the models, outcomes and time periods. Linear regression was used to explore relationships between outcomes, models and covariates.
RESULTS: The experiences of respectful care, and trust were significantly higher (p=<0.01) and the experience of COVID fear/stigma was significantly lower (p=<0.01) for women who gave birth in the FEM model, compared to the other models, in both the pre and pandemic periods, with the exception of respectful care compared to the MAM model in the pre-pandemic period.
CONCLUSION: Midwives, when working in the fully enabled environment of midwifery centers, provided care that was positively related to women’s experience of care. As midwives are used in many countries to prevent maternal mortality, the importance of an enabling environment should not be overlooked. Midwifery centers are an example of an HRBA that should be considered wherever midwives work and considered an important response during a crisis. / 2023-01-24T00:00:00Z
| Identifer | oai:union.ndltd.org:bu.edu/oai:open.bu.edu:2144/43691 |
| Date | 25 January 2022 |
| Creators | Stevens, Jennifer Rebecca |
| Contributors | Declercq, Eugene R. |
| Source Sets | Boston University |
| Language | en_US |
| Detected Language | English |
| Type | Thesis/Dissertation |
| Rights | Attribution 4.0 International, http://creativecommons.org/licenses/by/4.0/ |
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