Promoting respectful maternity care in Nepal: a qualitative exploratory study of a pilot forum play intervention with hospital staff.

Abstract

Background: Promoting respectful maternity care is a crucial indicator of quality maternal healthcare. However, evidence from global studies indicates that 22% -100% women experience at least one form of disrespect and abuse during facility-based births, with research conducted in Nepal reporting a prevalence of 100%. Therefore, implementing targeted interventions for healthcare providers is essential to reduce instances of disrespect and abuse of women and to foster respectful maternity care. Forum Play represents a promising approach in this regard.

Objectives: To explore the staff perspectives on disrespect and abuse of women during facility-based births and to assess the feasibility and acceptability of a Forum Play intervention in promoting respectful maternity care in Nepal.

Methods: Three half-day Forum Play workshops were conducted among hospital staff of a tertiary hospital in Kathmandu, Nepal, in November 2023. Eleven doctors, 14 nurses and 11 administrative staff were recruited for the workshops by using purposive sampling. Separate workshops were organized for the respective groups. At the end of each workshop, a focus group discussion was conducted using a semi-structured interview guide. All discussions were audio-recorded and non-verbal cues were noted by two note-takers. A total of 27 hospital staff participated in the discussions, including seven administrative staff, 10 doctors, and 10 nurses. Data analysis utilized inductive qualitative content analysis, allowing codes and categories to be developed directly from participants' responses as guided by Graneheim and Lundman.

Results: Data derived from the focus group discussions was divided into two parts: (i) staff perspectives on disrespect and abuse of women during facility-based births and (ii) Staff reflection on Forum Play in promoting respectful maternity care. Four categories were generated from the data: (1) Structural and systemic drivers of disrespect and abuse, (2) Social and interpersonal determinants of disrespect and abuse, (3) Personal and professional transformation through Forum Play, (4) Acceptance and institutional feasibility of Forum Play. These categories were extracted based on 11 subcategories classified from the codes derived from the data. Participants' reflections on the Forum Play workshop were very promising. Forum Play was identified as an innovative, interesting and acceptable method of intervention.

Conclusion: Disrespect and abuse during facility-based births arise from structural, social, and interpersonal factors and violate women's fundamental human rights. Participants' reflections indicate that Forum Play is an innovative and acceptable intervention that can raise awareness and support personal and professional growth among healthcare providers, suggesting its potential as a practical approach for promoting respectful maternity care. However, further testing is needed to confirm its feasibility and effectiveness.