Doctoral project: Women’s experience of disrespect and abuse during institutional delivery in eastern Nepal

Project information

Full title of the doctoral project
Women’s experience of disrespect and abuse during institutional delivery and acceptibiliy and feasibility of Forum Play in promoting respectful maternity care in eastern Nepal
Doctoral student
Narayani Paudel, Linnaeus University
Supervisors
Katarina Swahnberg, Linnaeus University, Sweden, Pranab Dahal, Linnaeus University, Sweden, Sunil Kumar Joshi, Kathmandu Medical College, Nepal
Participating organisations
Linnaeus University Kathmandu Medical College, Nepal
Funder: Linnaeus University
Timetable
14 November 2022 - 13 November 2026
Subject
Health Sciences (Department of Health and Caring Sciences, Faculty of Health and Caring Sciences)

More about the project

Main aim of the project: To find out the prevalence of disrespect of women during institutional delivery and to assess the impact of forum plays on perception of maternity care providers towards respectful maternity care.

Study I: Women’s experience of disrespect and abuse during institutional delivery in Biratnagar, Nepal

Key findings: It was focused on prevalence of disrespect reported by women during labour and delivery. All women had experienced at least one type of disrespect and/or abuse during labor and delivery, most common being non-consented care (100%), non-dignified care (72%), and non-confidential care (66.6%) respectively. Discriminatory care and physical abuse were experienced by 32.33% and 13.23%, respectively.

It has been published in IJERPH, in May 2021 https://doi.org/10.3390/ijerph18189612)

Study II:   Promoting respectful maternity care in Nepal: A pilot intervention using forum play among staff at a hospital.

Aim: To assess the feasibility of forum play intervention in promoting respectful maternity care among care providers

Brief Description on Pilot Intervention of Forum Play

Three half-day forum play workshops were conducted among 36 hospital staff; 14 nurses, 11 doctors, and 11 administrative staff.  Nurses and doctors who were mainly involved in providing care to women during facility-based childbirth and administrative staff who were in close contact with clients were selected as study participants. Separate workshop was organized for each group on 23, 24 and 26 November 2023. Forum play is a participatory theatre technique pioneered by Brazilian theatre practitioner Augusto Boal. It encourages the participants to create scenes based on their experience and perform illustrating a situation of oppression. A Swedish drama pedagogue had led the workshops.

Data analysis is ongoing.

Study III: Perception of care providers towards respectful maternity care

Aim: To explore the perception and behaviour of health care providers towards respectful maternity care before intervention

Participants will be divided into two groups: study and control group.

Data collection technique: Self-administered questionnaire for both group to collect data in a structured way, focus group discussion and key informant interview (KII) for study group only.

Data analysis: The FGDs will be recorded using audio recorder and qualitative content analysis will be done guided by strategies for qualitative content analysis outlined by Schreier.

Intervention (Forum play)

A training intervention will be developed using a participatory theatre technique called Forum Play (FP) pioneered by Brazilian theatre practitioner Augusto Boal.

First FP workshop will be conducted after three- to-four months of pre-intervention FGDs among maternity care providers (`10-12 Doctors and 10-12 Nurses). After three-to-four-months of first workshop, second FP workshop will be conducted and again after three-to-four months of second workshop, third FP workshop will be conducted for the same group (total six workshops i.e. three workshops will be carried out for all the participants within period of one year).

Study IV: Evaluation of forum play workshops in improving perception of care providers towards respectful maternity care

Aim: To evaluate the impact of forum play on perception of health care providers towards respectful maternity care after the intervention

Focused group discussion after intervention

After three- to- four months of intervention, focused group discussion will be done among all the participants who will be involved in FGDS before intervention. Again two FDGs will be conducted for the post test study and the FGDs will be recorded transcribed; translated and qualitative content analysis will be done.