The Nexus of Healthcare Professionals’ Conduct and Curtailing the Utilization of Unskilled Maternity Care

The art and science of caring in health practice are interwoven with professional conduct exhibited by healthcare professionals. These professional conducts include demonstrating respect for patients and observing their rights with dignity.^[1,2] But the human need for respect is more pronounced when dealing with private aspects of life. This makes maternity care a very sensitive and delicate part of healthcare practices. It requires extra attention and focus on women’s fundamental rights. One of the fundamental rights of women is respectful maternity care. Respectful maternity care advocates for care with privacy, dignity, and confidentiality to pregnant women and women in the process of birthing.^[2 ] Averting these sensitive needs can provoke women's dissatisfaction, which could instigate human protective mechanisms, and in turn use of unskilled maternity care. Pregnant women's dissatisfaction with care could reduce the possibility of hospital antenatal care, delivery, and postnatal care. Thus, there is a possible connection between the use of maternity care and healthcare providers’ conduct.

This commentary is based on the recent study by Genevieve Agboyo and colleagues on the use of traditional birth attendants (TBAs) in Ghana, where it was found that the prevalence of TBA use at childbirth was 26.5%, and 32% of respondents had used TBA services at least once in the past.^[3] The study found that the attitude of antenatal care providers was a significant determinant of unskilled maternity care utilization. The study findings indicate that women who had friendly interactions and positive experiences with healthcare professionals attended more skilled maternity care compared with those who had unfriendly and negative experiences with healthcare professionals. The authors asserted that disrespect of women by unskilled staff in the maternity ward instils fear of using healthcare facilities for women. This commentary, therefore, aims to identify healthcare professional conduct as one of the powerful pillars that can affect the process of curtailing the use of unskilled maternity care.

Unprofessional conduct is one of the factors that makes women develop a distrust of the healthcare system, leading to patronization of unskilled maternity care. The reports of women experiencing disrespectful behavior from healthcare professionals during childbirth are not uncommon mostly in low and middle-income countries.^[4] It is well documented and widely accepted that giving birth is associated with a woman’s emotional disturbances; as such, disrespecting her or violating her rights is powerful enough to further deteriorate her psyche. Uncaring conduct among healthcare professionals hinders patients from patronizing skilled health care and could affect healing and recovery.^[5] It could even negatively affect the progress and outcomes of pregnancy and labor. Moreover, the situation is capable enough to jeopardize maternal health and life due to the patronization of unskilled care such as care from TBAs. However, an act of professional conduct that involves professional caring poses a satisfactory environment and speedy recovery through emotional support. This kind of professional care is provided to create a favorable and satisfactory environment and for stabilizing a woman’s psyche. It is also a kind of care that improves the use of skilled healthcare services.

The international efforts to reduce maternal mortality continuously emphasize the utilization of skilled antenatal and delivery services. Also, the maternal and child healthcare service providers play a key role in determining the use of maternal services and in delivering satisfactory services.^[6] This brings about the need for understanding different aspects of maternity services utilization including the interface between the healthcare professionals and women for interventions. Positive conduct of healthcare professionals instils trust into the patient’s mind and develops a positive patient attitude toward seeking skilled care that is of high value.^[7] The skilled maternity care obtained by pregnant women has been found to improve maternal and child health and survival.^[8] The lack of positive healthcare professional conduct in providing maternity care is a strong force that hinders the use of skilled maternity care and in turn, can escalate the problem of maternal morbidity and mortality. It is, therefore, imperative that healthcare professionals put more effort into providing care to pregnant women and women in labor with a high level of professionalism, which includes showing respect and dignity.

Nevertheless, the problem of patronizing unskilled maternity care is found not only in Ghana but in many countries in sub-Saharan Africa. These countries have been battling with concerns about how healthcare professionals relate to patients.^[9] There is a huge difference in the use of skilled maternity care between developing and developed countries. This difference could be a contributing factor to the high disparity in the rate of maternal mortality between them.^[10]

In conclusion, for low and middle-income countries to eliminate excessive use of unskilled maternity care, there is a need for healthcare professionals to improve their conduct toward pregnant women. This will contribute to the development of trust between pregnant women and the healthcare system, which could lead to improvement of skilled maternity care utilization and denouncement of unskilled maternity care utilization. The increased use of skilled maternity care is key to the reduction in maternal and child morbidity and mortality.