New Study Offers Recommendations to End Abusive Maternity Care in Namibia

Photo by Morgana Wingard for IntraHealth International.

Photo by Morgana Wingard for IntraHealth International.

Spurred by negative media reports on the quality of maternity care in Namibia, which made health workers the target of popular distrust and animosity, the Namibian Ministry of Health and Social Services (MoHSS) commissioned a study to examine the factors that affect health workers’ approaches when providing maternal and neonatal health care. The results are now available in Provider and Client Perspectives on Maternity Care in Namibia: Results from Two Cross-Sectional Studies.

Through a series of surveys and focus group discussions on the state of maternity care in public hospitals in Namibia, IntraHealth International and our partners found that many clients have experienced disrespectful, rude, or abusive behavior from nurses or midwives. We also found that heavy workloads and understaffing in many facilities contribute to health workers’ negative behaviors—and may lead many women to give birth at home rather than at health facilities. 

Clients who participated in the study described health workers yelling, pinching, and slapping women during labor to encourage them to push. They also reported instances of inappropriate care practices—such as women having to clean up delivery rooms themselves after giving birth—and mismanagement of pain. 

Nurses who took part in the study described stressful work environments and having to work above or below their scopes of work, often on empty stomachs and with few or subpar resources. But they repeatedly cited their dedication to the health of babies during deliveries (sometimes at the expense of respectful treatment for the mother) and a commitment to their vocation, which many viewed as a professional calling. 

"The nurses who participated in the study greatly appreciated the opportunity to relate their experiences and felt sometimes they were persecuted inappropriately,” says IntraHealth’s Jennifer Wesson, who implemented the study. “This study gave nurses a voice, too.”

Health worker focus groups recommended action at various levels, including: 

  • Acknowledgement of society’s role in the creation of a supportive environment, and positive feedback and publicity to recognize health workers’ hard work 
  • Collaborative effort to identify common needs between clients and health workers paired with collective interventions to address these needs
  • Better preservice training, including on client-centered care and ethics
  • Establishment of a code of conduct and accountability mechanisms
  • Further dissemination and community education about client rights outlined in the little-known 1998 Patient Charter of Namibia  

Provider and Client Perspectives on Maternity Care in Namibia: Results from Two Cross-Sectional Studies was published in BMC Pregnancy and Childbirth and is a collaboration of IntraHealth International, the Tulipohamba Training and Assessment Institute, and the University of Namibia. IntraHealth’s work in Namibia is funded by the US Agency for International Development.