الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Worldwide pregnancy and child birth are very important events in the lives of the
women and their families as they are highly vulnerable.
Low quality of care at maternal health units is a considered as barrier for the
pregnant women to seek maternal care.
The concept of safe motherhood must not be restricted to only prevent morbidity and
mortality but also to include respect for women’s basic human right including respect for
her dignity, autonomy and choices.
The relationship of the women with the healthcare provider is very important as the
experience of the women about healthcare provider may have a negative impact on the
utilization of the maternal health services as even when the maternal services are available
it may be exposed to ethnic, cultural and social barriers.
Some forms of disrespect and abuse during maternal care are lack of privacy, lack of
confidentiality, lack of information, detention in the facility and undignified care.
Concerns are growing up about the respectful maternity care charters especially in
the growing countries. In the lights of these concerns, the aim of the study was to evaluate
the practice of respectful maternity care charters in MCH units and with the following
specific objectives:
1. To assess respectful maternity care practices among healthcare providers.
2. To measure satisfaction with care of pregnant women and mothers of children under
5 receiving healthcare at the maternity care health units.
3. Explore feasibility of introducing respectful maternity care based guidelines in
maternity care health units
A cross sectional study was conducted in three MCH units in Alexandria that
represent three social classes.
The study was conducted in two components; a quantitative component in which a
cross sectional design was used, and a qualitative component utilizing focus group
methodology.
The target population was:
Healthcare providers in the selected MCH units including physicians, nurses, and
laboratory workers.
Women attending MCH units.
Qualitative Study: Focus group discussions conducted with mothers/women
attending MCH units to investigate their perceptions about the quality of care. The data collection was done by:
Structured questionnaire with the healthcare providers to evaluate their current
attitude regarding respectful maternity care. The questionnaire items included
questions to itemize their current practices, questions to assess their willing ability
to follow RMC charter and questions about the feasibility of introducing RMC
charter.
Patient satisfaction survey conducted with the pregnant women or mothers of
children under 5 attending the MCH units under investigation.
Pregnant mothers or mothers of children under 5 attending maternity care units
interviewed through focus group discussion to collect their expectations and
perception about the care they receive.
Observational checklist was used to detect the practice of RMC elements.
Data entry and statistical analysis were done using software Statistical Package
Social Science (SPSS) version 23, statistical analysis was both performed in both
descriptive and inferential forms.
Focus groups were recorded and transcribed verbatim. Framework analysis was used as
a method for qualitative data analysis
Our study revealed the following:
The mean mother’s satisfaction total score was 42.19±11.4 which reflects the low
satisfaction with care The main reasons that explain the reduced satisfaction of pregnant
women are that women in this study received various forms of nonfriendly care during
childbirth (16.7%), ranging from not showing concern and empathy (20.8%) to not talking
positively with the women and only 38.3 % reported that doctors treated them with respect.
Only 5% of women reported that doctors talk to them in language they could not
understand
14.2% of the females in our study reported that doctors almost call them by names.
18.3% of females in our study reported that doctors almost shouts to them.
About 30% reported that they almost wait for a long time due to overcrowding and
high work load.
Although age and family size was positively correlated with total mother score they
are not significant predictors of total mothers RMC score. Age is statistically significantly
associated with the communication dimension of RMC mothers score while family size is
significantly associated with respect dimension score.
For the healthcare providers’ questionnaire:
Our study revealed that most of the healthcare providers 95% reported that RMC
charter is a right to every woman receiving maternity care but only 36.5% of them said that
women visiting the maternity unit receive respectful care. Only 23% of healthcare
providers reported that the system fulfills the requirements for applying the RMC charters
which reflect the diverse between the perception of them toward as respectful maternity
care charters and the real situation.> 97.5% of the healthcare providers agreed that every woman has the right to be free from
harm and ill treatment.
89% of healthcare providers showed positive attitude or agreed that every woman
has the right to information, informed consent and refusal, and respect for her
choices and preferences, including companionship during maternity care.
96% of the healthcare providers agreed that it is important to ensure privacy and
confidentiality at all time while attending to client during examination.
Most of the healthcare providers 96.5% agreed that every woman has the right to be
treated with dignity and respect.
97% of the healthcare providers agreed that every woman has the right to equality,
freedom from discrimination, and equitable care.
The study revealed negative attitude of the healthcare providers toward HIV and
hepatitis positive women as 52% of them refused to examine these women.
Most of the healthcare providers 96.5% showed positive attitude toward charter
6(Every woman has the right to healthcare and to the highest attainable level of
health).
71.9% of the healthcare providers showed positive attitude toward charter 7(Every
woman has the right to liberty, autonomy, self-determination, and freedom from
coercion).
Part 3 observational chick list:
Our study revealed that only 22.3% of women were offered a respectful greeting by
their healthcare providers
About three-quarters 74.3% of healthcare providers explain the procedure to the
women before proceeding.
About half of the healthcare providers 48.6% inform the mothers with the finding.
Lacking Privacy and confidentiality during examination was 70.3% which is high
percent.
About half of the healthcare providers50% did not treat women in a friendly and
respectful manner in our study.
About half 45.9% of the healthcare providers were being harsh to the women
The percentage of women that are not deprived from maternal care pay because they
are unable to pay for the service was 62.2%.
For the focus group discussion:
Our study revealed the following:
Majority of women were not completely satisfied with the service the receive due to
some deterrents as Medication unavailability, increased out of pocket expenditures,
value for money and effort, and long waiting time.
Summary, Conclusions & Recommendations
47
Women reported that they were more comfortable in dealing with doctors rather than
nurses as they treated them better however a woman reported that she exposed to bad
treatment from the doctor. Women also reported that they treated in bad manner from
other workers in the facility like security and cleaners.
Only one woman exposed to verbal abuse by the physician.
Our study revealed that healthcare providers respected more the women that come
with her husband than others.
Our study revealed that the privacy is only restricted to visual privacy but there is no
auditory privacy.
Participants in our study complained from unsanitary environment, overcrowding
and long waiting time.
Our study revealed that there is lack of information provision as not all the doctors
provide them with the sufficient information and also women reported that there is
no respect for their preferences which is considered as non-consented care.
6.2. Conclusion
Based on the results of the current study the following can be concluded:
The main mothers satisfaction total score was 42.19±11.4 which reflects the low
satisfaction with care, This can be explained by that women are in this study received
nonfriendly care 16.7%, the healthcare providers did not show them concern and
empathy (20.8%) and only 38.3 % of women reported that doctors treated them with
respect as individual.
About one-fifth of the women 18.3% reported that the healthcare providers almost
shout to them.
About one-third 30% of women reported that they almost wait for a long time due to
overcrowding and high workload.
Most of the healthcare providers (95%) agreed that the respectful maternity care
charter is a right to every woman receiving maternity care. but only23% one-fifth of
them reported that the system fulfills the requirements for applying respectful
maternity care charters.
Only 36.5% of the healthcare providers agreed that women visiting the facility
receive respectful care. So, there is a diverse between the perception of the healthcare
providers toward the charters and the real situation.
Most of the healthcare providers showed positive attitude toward the respectful
maternity care charter and 71.9% showed positive attitude toward charter 7 but about
half of them (52%) will avoid conducting vaginal examination for HIV or Hepatitis
C positive women.
Only 22.3% of women offered a respectful greeting by healthcare providers.
Lacking privacy and confidentiality was in 70.3% of observed cases.
Half of the healthcare providers (50%) did not treat women in a respectful manner. 45.9% of the healthcare providers were being harsh to the mothers
Majority of the women were not completely satisfied with the service they receive
due to unavailability of medication, increased out of pocket expenditure, value for
money and effort, inexperienced doctors, long waiting time, overcrowding,
unsanitary environment.
Women reported that doctors treated the better than nurses.
Healthcare providers respected more woman come to the unit with her husband.
Privacy only restricted to visual privacy but no audio privacy.
A woman reported that she was subjected to verbal abuse.
Some women reported that there is no respect for their preferences.
6.3. Recommendations:
Recommendations to Ministry of Health and Population:
Implementing awareness programs for mothers and healthcare providers about RMC
charter.
Training of the healthcare providers on how to apply RMC charter during their daily
routine work.
Recommendations to healthcare providers:
To consider the issue of privacy and confidentiality during their daily routine work. to researchers:
More research on the prevalence of disrespect and abuse in the context of maternal
healthcare in Egypt is needed.Recommendations to women:
The women should know their rights in health care and should not overstep their
rights.
Recommendations to Faculty of Medicine:
The faculty of medicine should pay more attention to female rights in health care and
include PMC as a subject in public health issues for under and post graduate.