Disrespect and Abuse in Family Planning Service Delivery

Photo by Flynn Warren, courtesy of the Population Council.

Many women face barriers to accessing health services, not least of which is disrespectful and abusive care. Such care may entail medical procedures performed without a woman’s consent, discriminatory treatment, denial of services, lack of privacy and confidentiality, and physical and verbal abuse.

While disrespect and abuse (D&A) appear to be widespread in both low- and high-income countries, its prevalence and contributing factors are not well documented, making it difficult to design and implement appropriate and effective interventions for ending these rights abuses.

Recent efforts have been made to better define and understand the issue of respectful maternal care (RMC) and its impact on women’s maternity-care-seeking behavior. USAID, through the TRAction (Translating Research into Action) Project at University Research Co., LLC (URC), is supporting work that defines and quantitatively measures the prevalence of disrespect and abuse (D&A) experienced by women during facility-based deliveries. While the initial results of this work suggest that women experience a range of D&A during facility deliveries, there remains a need to validate the approach for measuring D&A during maternity care.

To address this need, the TRAction Project has designed a protocol for a systematic review of constructs and measures related to D&A from a range of health areas in order to inform RMC measurement strategies. This systematic review will explore the measurement of disrespect and/ or abuse in research domains similar to RMC and specifically in the areas of HIV and AIDS, intimate and gender-based violence, elder care, and family planning services.

In partnership with TRAction, the Evidence Project will undertake the systematic review related to measures of D&A in family planning service delivery. Through this literature review the Evidence Project will identify existing measures of respectful care within the family planning field and gaps in measuring D&A.

The literature-review synthesis will describe how existing family planning quality-of-care frameworks contribute to measuring respectful care and will describe the existing approaches used to measure aspects of D&A (including stigma) and their impact on demand for and delivery of family planning services. The review will seek to provide evidence on how aspects of D&A affect uptake of family planning services and the lessons learned for addressing them at the service-delivery level.