The goal of this project is to develop, pilot, and evaluate an intervention that helps providers to deal with stress and unconscious bias to improve improving quality of maternal health care in Kenya—particularly related to the person-centered dimensions of care.

Everyone has right to dignified and respectful care in health care settings. Disrespect and abuse during childbirth thus violate women’s human rights. Person-centered maternity care (PCMC)—which refers to care the is responsive and respectful to individual women and their families’ preferences, needs, and values—is also a key dimension of quality of care. Yet evidence shows that globally women are mistreated during childbirth. This manifests as disrespect and abuse, poor communication, lack of respect for their autonomy or lack of supportive care. Poor person-centered care has multiplicative effects, as it can directly lead to poor pregnancy outcomes, as well as decrease demand for services. When women have a bad childbirth experience, it discourages other women from giving birth at a health facility. Choosing to give birth at home without a skilled attendant means increased deaths from complications that could have been easily treated at a health facility. Poor person-centered care also leads to delayed, inadequate, and unnecessary care, which again leads to poor outcomes for mothers and their babies. Poor person-centered care has also been linked with poor psychological effects including post-traumatic stress disorder. Yet, little research exists on effective interventions to improve PCMHC in low-resource settings like in SSA

The research preceding this project contributed to improved measurement of person-centered maternity care as well as better understanding of the factors that contribute to poor person-centered. The current project extends this work to develop an intervention that addresses some of the drivers identified in the first phase.  We focus on healthcare provider stress and unconscious bias because they are mutually reinforcing drivers of poor-quality care.  Disrespectful behavior towards patients stems from characteristics of providers and their responses to stressful environments. Additionally, disrespect thrives in a culture that tolerates and supports disrespect, and individual biases reinforce patterns of abuse. Thus, in hierarchical societies where people of low status are more likely to be disrespected, providers may be unconsciously mistreating women of low status. People are also more likely to be biased when they are stressed out. Yet these factors are often not addressed in maternal health interventions to improve quality.