Title: Respectful Maternity Care from the lens of Women and Health Care Providers in Pakistan: An Exploratory Study

Introduction: Quality of care that women receive during childbirth has significant effect on the maternal and newborn outcomes and especially on their mental health. Evidence shows that lack of autonomy, choices, empowerment, and respect during childbirth in the hospitals has become a global concern. World Health Organization (WHO) recommends provision of Respectful Maternity Care (RMC) to all women to gain positive birth outcome and considered it as a basic human right. To devise the successful strategies, it is vital to establish Heath care providers’ and women’s understanding of the RMC concept.

Purpose: This study aimed to explore women and health care provider’s a) understanding regarding Respectful maternity care (RMC), its components and rights of a childbearing women, b) experiences of care during childbirth at health care facility, and c) perceptions regarding potential barriers and recommendations to promote RMC during facility-based childbirth.

Method: The study utilized qualitative descriptive design using in-depth interviews for data collection. Twenty-four participants including 12 health care providers and 12 women were recruited using purposive sampling from three health care facilities (tertiary and secondary) in Karachi, Pakistan. Data was analyzed using Creswell, (2013) steps of data analysis. The study was approved by Institutional Ethics Review Committee.

Findings: The data analysis revealed three main themes a) Understanding of Respectful Maternity Care and rights of childbearing women b) Experiences of care during childbirth with respect to RMC, and c) Perceived Barriers and recommendations to promote RMC.

Conclusion: The study highlighted non consented care, breech of privacy, verbal abuse, lack of support and autonomy as common form of disrespect and abuse women experienced during childbirth. Also, there is limited understanding of women and health care providers regarding RMC and childbearing women rights; this led women to acceptance of disrespectful care and considered it as normal. Results also revealed some system level challenges that need to be addressed along with other interventions to enhance knowledge of HCPs and women around the concept to improve positive birth outcome.

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Sadia Abbas Ali

Title: Experiences and Perceptions of Women and Health Care Providers Regarding Pregnancy Loss and Bereavement

Introduction: The unexpected loss of pregnancy including abortions and stillbirths can be a source of great distress to the parents. Approximately one in four women face difficulty in the normal grieving process and experience complicated grief leading to mental health problems such as anxiety and depression. However, it has been observed that the focus remains on the physiological management of women and the psychological aspect of a mother is often neglected during this period especially in low- and middle-income countries (LMIC).

Purpose: The study explored the experiences of women who had suffered pregnancy loss, their needs, and expectations during that period and the experiences and perceptions of health care providers dealing with grieving women regarding their challenges/facilitators and capacity in addressing the needs of women.

Method: A qualitative descriptive design was used to explore the experiences and perceptions of 16 women who had experienced pregnancy loss through in-depth individual interviews and three Focus Group discussions (FGDs) were conducted from the health care providers from the maternal child health department. The study sites were private tertiary and secondary care hospitals located in Karachi, Pakistan.

Findings: Four main themes were identified: (1) understanding of pregnancy loss and bereavement, (2) Experiences related to pregnancy loss and bereavement, (3) Coping with pregnancy loss and bereavement, and (4) Recommendations for improving the care of women with pregnancy loss.

Conclusion: Women had several myths and misconceptions regarding pregnancy loss. Knowledge related to pregnancy loss s usually obtained first from family and friends, and later health care provider is approached. Coping was mainly influenced by the presence of a support system, health care system policies, available resources, and provider competence. Provision of customized care, improving the competency of care providers, and creation of support groups were highly recommended. These findings will guide in developing strategies to improve the care of women with pregnancy loss including healthcare provider competencies to deal with the pregnancy loss.

Shahnaz Shahid

​Title: Midwives’ Perspectives on Perinatal Mental Health: A Qualitative Exploratory Study in a Maternity Setting in Karachi, Pakistan

Introduction: During pregnancy, labor and after childbirth women are emotionally labile due to the drastic change in hormones. Perinatal Mental Health (PMH) issues including perinatal depression is estimated to be 7-15% in high-income countries (HICs) and 19-25% in low- and middle-income countries (LMICs). Midwives are the primary care providers in many maternity settings in Pakistan, but they lack knowledge and skills related to PMH. The purpose of this study was to explore midwives’ perceptions and experiences about PMH.

Methods: The study used a qualitative approach, and it was conducted in Koohi Goth hospital which is a maternity setting in Malir district of Karachi. Purposive sampling technique was used to recruit ten midwives. Data was collected by conducting In-depth Interviews (IDIs) in Urdu language. An interview guide was used for IDIs. Each IDI lasted for 45 to 60 minutes; and it was audio-recorded. Data analysis was done manually to identify the codes, categories, and themes.

Findings: Following four themes emerged from data analysis: 1) Dearth of PMH competencies; 2) Importance of PMH; 3) Myths related to PMH; and 4) Role of midwives in PMH. Each theme has further three categories.

Discussion: PMH is an important component of health and an element of maternity care as it has an impact on childbirth outcomes; hence, health care providers specifically midwives should be competent to identify and manage cases in a timely manner to prevent complications.

Conclusion: Pregnant women in Pakistani communities often choose midwives as their primary care provider for childbirth; therefore, they should have knowledge and skills to identify cases suffering from PMH issues. It should be covered in detail in the midwifery curriculum and the midwives should be assessed for the related competencies. Moreover, refresher trainings should be provided to strengthen the skills of the midwives based on the recent evidence.

Shireen Shehzad