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Respectful Treatment of Women in Midwife Obstetric Units: An Interventional Study to Improve Clinical Care in Tshwane District, South Africa
Thesis (PhD Family Medicine)--Univeristy of Pretoria, 2019
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| Format: | Thesis |
| Language: | English |
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University of Pretoria
2026
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| _version_ | 1867613690565492736 |
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| access_status_str | Open Access |
| author2 | Pattinson, Robert C |
| author_browse | Pattinson, Robert C |
| author_facet | Pattinson, Robert C |
| collection | Thesis |
| dc_rights_str_mv | © 2025 University of Pretoria. All rights reserved. The copyright in this work vests in the University of Pretoria. No part of this work may be reproduced or transmitted in any form or by any means, without the prior written permission of the University of Pretoria. |
| description | Thesis (PhD Family Medicine)--Univeristy of Pretoria, 2019 |
| format | Thesis |
| id | oai:repository.up.ac.za:2263/110462 |
| institution | University of Pretoria (South Africa) |
| language | English |
| last_indexed | 2026-06-10T12:40:09.614Z |
| license_str | Other — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UPSpace — University of Pretoria Institutional Repository |
| publishDate | 2026 |
| publishDateRange | 2026 |
| publishDateSort | 2026 |
| publisher | University of Pretoria |
| publisherStr | University of Pretoria |
| record_format | dspace |
| source_str | UPSpace — University of Pretoria Institutional Repository |
| spelling | oai:repository.up.ac.za:2263/110462 Respectful Treatment of Women in Midwife Obstetric Units: An Interventional Study to Improve Clinical Care in Tshwane District, South Africa Pattinson, Robert C sarie.silberbaurer@gmail.com Oosthuizen, Susara J. UCTD Sustainable Development Goals (SDGs) Respectful care Midwife-led obstetric units CLEVER intervention package Quality obstetric care Perinatal morbidity and mortality Thesis (PhD Family Medicine)--Univeristy of Pretoria, 2019 South Africa did not meet its Millennium Development Goals 4 and 5. In 2014/2015 the country had a maternal mortality of ratio of 132.5 per 100 000 live births, a national stillbirth rate of 21.5 per 1000 total births and a child mortality rate of 39 per 1000 live births. A large proportion of child deaths occur in the perinatal and early neonatal period. Furthermore, many birthing women in South Africa, and worldwide, do not receive intrapartum care with empathy and endure disrespectful and abusive care, seldom voicing their complaints after these events. The consequence of not addressing mistreatment during labour could possibly contribute to the high maternal and perinatal mortality and morbidity in labour wards in South Africa. The aim of this study was to identify, implement and evaluate interventions to reduce mistreatment and to promote respectful, high-quality maternity care in five midwife obstetric units (MOUs) in Tshwane District, South Africa. A mixed-methods study was conducted in three phases in 10 MOUs. A purposive sample of five units was selected for the intervention. The study took place in three phases: (1) baseline measurements in all 10 units (health-systems building blocks, perinatal outcomes and women’s perceptions and experiences of care received during delivery); (2) the development of an intervention package – called CLEVER’ – based on the results of the first phase and implementation in the five intervention units; and (3) an end-line review of health-systems improvements and a repeat assessment of perinatal outcomes and respectful care in all 10 MOUs. The intervention had three pillars: (1) feedback of the results of the baseline measurements to the intervention units to raise awareness and solicit participation; (2) health-systems strengthening; and (3) an intensive weekly engagement with each intervention unit for three months, with monthly support for a further six months afterwards. Perinatal outcome indicators were compared over a period of three years: one year before the intervention (2015); the year of the intervention (2016); and the year after the intervention (2017). In the intervention units, significant reductions were observed between the baseline and end-line assessment for in-facility fresh stillbirths (from 8.50 to 1.30 per 1000 births), meconium aspiration (from 12.18 to 4.55 per 1000 live births) and birth asphyxia (from 15.56 to 8.12 per 1000 live births). For all three indicators the slope of change was much faster in the intervention MOUs than in the control units. Some improvements in the control units could possibly be ascribed to the supportive supervision programme of the district clinical specialist team. Women’s perceptions and experiences of the care received during childbirth were measured at baseline and end-line for all 10 MOUs with an anonymous, self-administered questionnaire completed by 653 women at baseline and 679 women at end-line. Six key items were used as proxies for clinical and respectful care. The end-line measurement recorded a significant improvement of 11 to 20% in women’s perceptions and experiences in the intervention MOUs with regard to consented care before pelvic examinations, positive communication behaviour, respectful treatment and overall satisfaction with birthing care. Working ‘CLEVER’, a clinically-focused intervention package, has the potential to reduce key perinatal mortality rates in midwife obstetric units and improve survival and health for newborns delivered at district health care level. Respectful care embedded in the package has the potential to improve communication and empathetic care to birthing women. Family Medicine PhD (Family Medicine) Unrestricted Faculty of Health Sciences SDG-03: Good health and well-being SDG-05: Gender equality 2026-06-08T09:41:02Z 2026-06-08T09:41:02Z 2019-04 2018-11 Thesis * A2019 http://hdl.handle.net/2263/110462 N/A en © 2025 University of Pretoria. All rights reserved. The copyright in this work vests in the University of Pretoria. No part of this work may be reproduced or transmitted in any form or by any means, without the prior written permission of the University of Pretoria. application/pdf University of Pretoria |
| spellingShingle | UCTD Sustainable Development Goals (SDGs) Respectful care Midwife-led obstetric units CLEVER intervention package Quality obstetric care Perinatal morbidity and mortality Respectful Treatment of Women in Midwife Obstetric Units: An Interventional Study to Improve Clinical Care in Tshwane District, South Africa |
| title | Respectful Treatment of Women in Midwife Obstetric Units: An Interventional Study to Improve Clinical Care in Tshwane District, South Africa |
| title_full | Respectful Treatment of Women in Midwife Obstetric Units: An Interventional Study to Improve Clinical Care in Tshwane District, South Africa |
| title_fullStr | Respectful Treatment of Women in Midwife Obstetric Units: An Interventional Study to Improve Clinical Care in Tshwane District, South Africa |
| title_full_unstemmed | Respectful Treatment of Women in Midwife Obstetric Units: An Interventional Study to Improve Clinical Care in Tshwane District, South Africa |
| title_short | Respectful Treatment of Women in Midwife Obstetric Units: An Interventional Study to Improve Clinical Care in Tshwane District, South Africa |
| title_sort | respectful treatment of women in midwife obstetric units an interventional study to improve clinical care in tshwane district south africa |
| topic | UCTD Sustainable Development Goals (SDGs) Respectful care Midwife-led obstetric units CLEVER intervention package Quality obstetric care Perinatal morbidity and mortality |
| url | http://hdl.handle.net/2263/110462 |