abstract: 'Background Effective communication and respect for women''s autonomy are

  critical components of person-centered care. Yet, there is limited

  evidence in low-resource settings on providers'' perceptions of the

  importance and extent of communication and women''s autonomy during

  childbirth. Similarly, few studies have assessed the potential barriers

  to effective communication and maintenance of women''s autonomy during

  childbirth. We sought to bridge these gaps. Methods Data are from a

  mixed-methods study in Migori County in Western Kenya with 49 maternity

  providers (32 clinical and 17 non-clinical). Providers were asked

  structured questions on various aspects of communication and autonomy

  followed by open ended questions on why certain practices were performed

  or not. We conducted descriptive analysis of the quantitative data and

  thematic analysis of the qualitative data. Results Despite acknowledging

  the importance of various aspects of communication and women''s autonomy,

  providers reported incidences of poor communication and lack of respect

  for women''s autonomy: 57\% of respondents reported that providers never

  introduce themselves to women and 38\% reported that women are never

  able to be in the birthing position of their choice. Also, 33\% of

  providers reported that they did not always explain why they are doing

  exams or procedures and 73\% reported that women were not always asked

  for permission before exams or procedures. The reasons for lack of

  communication and autonomy fall under three themes with several

  sub-themes: (1) work environment-perceived lack of time, language

  barriers, stress and burnout, and facility culture; (2) provider

  knowledge, intentions, and assumptions-inadequate provider knowledge and

  skill, forgetfulness and unconscious behaviors, self-protection and

  comfort, and assumptions about women''s knowledge and expectations; and

  (3) women''s ability to demand or command effective communication and

  respect for their autonomy-women''s lack of participation, women''s

  empowerment and provider bias. Conclusions Most providers recognize the

  importance of various aspects of communication and women''s autonomy, but

  they fail to provide it for various reasons. To improve communication

  and autonomy, we need to address the different factors that negatively

  affect providers'' interactions with women.'
affiliation: 'Afulani, PA (Corresponding Author), Univ Calif San Francisco UCSF, Sch
  Med, 550 16th St,3rd Floor, San Francisco, CA 94158 USA.

  Afulani, PA (Corresponding Author), UCSF Inst Global Hlth Sci, San Francisco, CA
  USA.

  Afulani, Patience A.; Cohen, Craig R., Univ Calif San Francisco UCSF, Sch Med, 550
  16th St,3rd Floor, San Francisco, CA 94158 USA.

  Afulani, Patience A.; Buback, Laura; Cohen, Craig R., UCSF Inst Global Hlth Sci,
  San Francisco, CA USA.

  Kelly, Ann Marie, Thomas Jefferson Univ, Sidney Kimmel Med Coll, Philadelphia, PA
  19107 USA.

  Kirumbi, Leah, Kenya Govt Med Res Ctr, Nairobi, Kenya.

  Lyndon, Audrey, NYU, Rory Meyers Coll Nursing, New York, NY USA.'
article-number: '85'
author: Afulani, Patience A. and Buback, Laura and Kelly, Ann Marie and Kirumbi, Leah
  and Cohen, Craig R. and Lyndon, Audrey
author-email: Patience.Afulani@ucsf.edu
author_list:
- family: Afulani
  given: Patience A.
- family: Buback
  given: Laura
- family: Kelly
  given: Ann Marie
- family: Kirumbi
  given: Leah
- family: Cohen
  given: Craig R.
- family: Lyndon
  given: Audrey
da: '2023-09-28'
doi: 10.1186/s12978-020-0909-0
eissn: 1742-4755
files: []
journal: REPRODUCTIVE HEALTH
keywords: 'Communication; Autonomy; Person-centered maternity care; Respectful

  maternity; Quality of care; Person-centered care; Patient-provider

  interactions'
keywords-plus: KNOW-DO GAP; MATERNITY CARE; LOW-INCOME; QUALITY
language: English
month: JUN 3
number: '1'
number-of-cited-references: '47'
orcid-numbers: Lyndon, Audrey/0000-0003-2215-4273
papis_id: 45fce74471acfebe9ea5993ea60dffa9
ref: Afulani2020providersperceptions
researcherid-numbers: 'Lyndon, Audrey/ABD-7493-2021

  Lyndon, Audrey/GLS-0866-2022'
tags:
- review
times-cited: '15'
title: 'Providers'' perceptions of communication and women''s autonomy during childbirth:
  a mixed methods study in Kenya'
type: Review
unique-id: WOS:000540248500001
usage-count-last-180-days: '1'
usage-count-since-2013: '3'
volume: '17'
web-of-science-categories: Public, Environmental \& Occupational Health
year: '2020'