Each day, around 800 women worldwide die from complications related to pregnancy, with the majority (95 percent) occurring in low- and middle-income countries. About two-thirds of these deaths happen in sub-Saharan Africa. For every woman who dies, around 20 more suffer from various pregnancy-related issues. Approximately 75 percent of these deaths occur due to complications during labor, delivery, and the first 24 hours after birth. Providing high-quality care during childbirth is crucial to prevent deaths of mothers and newborns.
Although more women in countries like Ghana and Kenya are giving birth in medical facilities, there are still notable inequalities and deficiencies in health care quality both within and between these countries. Person-centered reproductive health care is essential for better health outcomes, but research highlights a shortfall in such care—care characterized by responsiveness, respect, and compassion. The most vulnerable women often have the poorest maternity care experiences, resulting in them avoiding care or receiving delayed or inadequate treatment, which contributes to high maternal mortality and morbidity rates. However, current evidence on successful initiatives to enhance maternal care in these regions is limited. In particular, the impact of provider burnout and bias has not been thoroughly examined.
Burnout is a condition of mental, physical, and emotional exhaustion, while bias is a predisposition for or against certain people or groups. Burnout results in subpar person-centered maternity care, and bias leads to unequal care for patients. To ensure high-quality care for all women, it is vital to address both issues. To build evidence of effective improvement strategies, our team at the University of California, the Kenya Medical Research Institute, and the Global Programs for Research and Training developed and tested an initiative in Kenya’s Migori county called “Caring for Providers to Improve Patient Experience.” This work is based on our extensive research in the county focusing on person-centered maternity care, informed by past findings and literature, as well as our expertise. Over six months, we monitored the pilot, and found, based on providers’ reports, that it enhanced the experiences of both caregivers and patients.
These findings are significant in highlighting the necessity for improvements that prioritize the most vulnerable groups. Burnout significantly affects both patient and provider experiences, often resulting in detachment and poor attitudes towards patients. It is caused by prolonged stress from factors like high workload, resource shortages, unsupportive work environments, limited skills to handle emergencies, and trauma from patient loss. Before the COVID-19 pandemic, burnout was already a global issue and reached critical levels during the pandemic. Bias, whether implicit or explicit, results in different treatment based on factors like socioeconomic status and age. Patients with lower socioeconomic standing often have negative healthcare experiences and receive less attention from providers compared to wealthier patients, leading to distrust and health inequalities.
Providers are prone to bias when stressed. Our intervention aimed to address these two issues—bias and burnout—by incorporating methods like training, peer support groups, mentorship, and leadership involvement in health facilities and across the health system. In Migori, our pilot produced several outcomes: Healthcare providers learned stress-reduction techniques, managed their stress better, and were more aware of their biases, making conscious efforts to avoid discrimination. Providers reported being more accountable regarding their biases and were providing more person-centered care as a result. Improved relationships among providers created a more supportive work environment. We are now conducting a larger cluster-randomized controlled trial in Kenya and Ghana, where some facilities implement the intervention while others remain a control group, to evaluate its impact through surveys with mothers.