الفهرس 
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Abstract
Ensuring universal access to safe, timely, acceptable health care during pregnancy can reduce and prevent the global burden of maternal morbidity and mortality. One of the globally endorsed strategies of combating these huge burdens is the provision of respectful maternity care (RMC). This can be achieved through compliance with pregnant women’s bill of rights. This bill of rights includes eight rights. Namely: the right to be free from harm and ill treatment, the right to information, informed consent and refusal, and respect for her choices and preferences, the right to privacy and confidentiality, the right to be treated with dignity and respect, the right to equality, freedom from discrimination, and equitable care, the right to healthcare and to the highest attainable level of health, the right to liberty, autonomy, self-determination, and freedom from coercion, the right to effective interpersonal communication and with her family. Antenatal nurses hold in their hands more responsibilities for preserving those rights to pregnant women.
The present study aimed to compare between nurses’ compliance with pregnant women’s bill of rights in an urban and rural areas in Alexandria.
To fulfill the study aim: A comparative descriptive design was utilized.
Materials and Method
Settings:
This study was conducted at the following settings:
I- El Shatby Maternity University Hospital affiliated to Alexandria University. (represents an urban area) (in-patient& out-patient).
II- Four Family medicine centers in Abies were randomly selected from the ten available centers. (representing rural areas) (out-patient).
Subjects
A convenient sample of 120 nurses working for at least 2 years in the abovely mentioned settings and providing direct care for pregnant women. where all the available nurses at the time of data collection were included in the study.
Three tools were utilized for data collection.
Tool (I): Basic dataQuestionnaire:
It is composed of: Nurses’ socio demographic, academic and professional data such as: Subject’s age, academic level, position, years of experience as well as attendance of training programs.
Tool (II): Nurses’ knowledge about pregnant women’s bill of rights questionnaire:
It is comprised of 21 questions grouped in 9 main categories as follows. General knowledge about pregnant women’s bill of rights, right to privacy, right to Confidentiality, right to receive information, right to informed consent, right to Health care, right to safety, right to Nondiscrimination, as well as right to communication.
The total score ranges between 21 and 63
Nurses’ knowledge was ranked as follows:
• Poor knowledge (< 35 )
• Fair knowledge ( 35 -<49 )
• Good knowledge ( ≥ 49)
Tool (III): Nurses’ compliance with pregnant women’s bill of rights observational checklist:
It entailed 50 items grouped in 8 main categories as follows: Nurse’s role regarding the right to privacy, nurse’s role regarding the right to Confidentiality, nurse’s role regarding the right to receive information, nurse’s role regarding the right to informed consent, nurse’s role regarding the right to Health care, nurse’s role regarding the right to safety, nurse’s role regarding the right to Nondiscrimination, as well as nurse’s role regarding the right to communication.
The total score will range between 50– 150.
Nurses’ compliance was ranked as follows:
• Poor for a total score of (< 83)
• Fair for a total score of (83 - < 116)
• Good for a total score of (≥ 116)
The three tools were tested for content validity by five experts in the related field. A pilot study was conducted on (12) nurses (who were excluded from the study subjects) to ascertain the clarity, feasibility and applicability of the tools to identify obstacle that might interfere with the process of data collection and calculate the time needed to complete them.
Each nurse was observed more than one time (2-4times) until her practice had covered the 8 items inTool III. These observations were done for each nurse separately during the morning shift (8am to 2pm) in all of the aforementioned settings. In addition to the evening shift (2pm to 8pm) in El Shatby Hospital. After completing the observations through tool III, tool I and II questionnaire were disturbed to all subjects to collect their basic data and to assess their knowledge about pregnant women’s bill of rights.
Collection of data consumed six months, started from the beginning of October 2020 till the end of March 2021. Statistical analysis was done by the researcher after collection of data by statistical package for social science (SPSS) version 25 program. The collected data was categorized, coded, computerized, tabulated and analyzed by the researcher using (SPSS) version 25.
The main findings of the present study were:
Comparison between the two groups regarding their socio demographic, academic and professional characteristics:
There was almost no statistically significant difference between the subjects’basic data among the two groups. However, such difference was only obvious in relation to place of work whether in-patient or out-patient (p= <0.001). Most of urban nurses (82.2%) and rural ones (76.7%) were staff nurse. Approximately one-half (47.8%) of urban nurses, compared to about two-thirds (63.3%) of rural ones had attended antenatal training program(s). There was a statistically significant difference between the training agency among the two groups. where all rural nurses had received their training from ministry of health unlike the urban ones where 74.4% of them had received their training through El Shatby Hospital which affiliated to Alexandria University.almost one-half of urban nurses (45.6%) and rural ones (50.0%) had got information about pregnant women’s bill of rights from their undergraduate curricula.
Comparison between the two groups regarding their total score of knowledge about pregnant women’s bill of rights:
Slightly more than one-half of urban nurses and rural ones (58% and 53%), respectively, had good knowledge.
Comparison betweenthe two groups regarding their specific knowledge about pregnant women’s bill of rights:
A statistically significant differences was observed among the two groups in relation to only three out of the nine rights. Firstly, the importance of pregnant women’s bill of rights (p= 0.003). Secondly, the right to privacy(p=0.008). Thirdly, the right to health care (p= 0.003).
Comparison between the two groups regarding their total score ofcompliance with pregnant women’s bill of rights:
Nurses’s compliance with pregnant women’s bill of rights was poor in both urban setting and rural settings (87% and 83%) respectively.
A statistically significant difference in compliance level to only two rights was observed. Firstly, the right to safety (P= 0.022). Secondly, the right to effective interpersonal communication (P= 0.028).
Comparison between the two groups regarding the relationship between their total score of compliance and their basic data:
No statistically significant difference was observed among the two groups regarding the relationship between their total score of compliance and their basic data. Namely: age, academic level, position, years of experience.
Comparison between the two groups regarding the relationship between their total score of compliance and attendance of training programs:
A statistically significant difference was observed between the two groups(P=0.030), where 43.6% and 60.0% of urban and rural nurses, respectively, who had attended training programs had poor compliance.
Comparison between the two groups regarding the relationship between their total score of compliance with pregnant women’s bill of rights and total score of knowledge about it:
A statistically significant difference is observed among the two groups regarding the relationship between their total score of knowledge and level of compliance. Although, good knowledge among as much as 51.3% and 44.0% of urban and rural nurses, respectively, was associated with poor compliance level. Yet no good compliance was observed among the good knowledged rural ones unlike the urban ones. where all the good compliant ones were good knowledged.
Based on the findings of the present study, the following recommendations are suggested:
1. Pre-service and in- service training program(s) are recommended for maternity nurses addressing the importance of compliance with pregnant women’s bill of rights.
2. Continuous monitoring of antenatal nurses’ awareness and compliance with pregnant women’s bill of rights is suggested.
3. Arabic posters about pregnant women’s rights are better to be available and visible to all nurses in maternity hospitals.
4. An ethical committee is recommended to be implemented at maternity health settings to monitor nurses’ adherence with pregnant women’s bill of rights.
For further researches:
1- Replication of the present study under different circumstances (setting, sample & tools) is recommended to validation of its findings.
2- Factors associated with nurses’ compliance with pregnant women’s bill of rights needs to be explored in depth.
3- Compliance with pregnant women’s bill of rights among other health care members, i.e., physicians, lab technicians, etc needs to be investigated.
4-Pregnant women’s satisfaction concerning application of their rights in maternity health settings.