In 2014, the World Health Organization has stated that “every woman has the right to the highest attainable standard of health, including the right to dignified, respectful care during pregnancy and childbirth” as many women were found to be abused, disrespected, or given neglectful treatment during facility-based childbirth. These violate a woman’s right which could lead to discouraging women to access and utilize maternal and newborn care services in health facilities, clinics, or hospitals. Examples of disrespect and abuse (D&A) during labor and delivery include physical, sexual, and verbal abuse; stigma and discrimination; non-consented, non-confidential, and non-dignified care; abandonment; and detention (Bowser and Hill, 2010 and Bohren et al., 2015 as cited by Maternal Health Task Force [MHTF], 2020). There has also been evidence reported that some of the factors contributing to the risk of abusive and disrespectful childbirth care are socioeconomic status, age, race, social and health status, and parity (MHTF, 2020). Furthermore, expounding on parity, it has been suggested that multipara women tend to encounter lower cases of D&A due to avoidance of ill-treatment as aided by their past experiences or D&A has been normalized to them.
The existence of D&A during maternal care and childbirth is worrisome; thus, respectful maternity care (RMC) has become a vital component in providing childbirth care. Quality care is increased and a woman’s right as a mother and human is protected. This care component aims to implement respect and preservation of dignity for women and mothers in health facilities (MHTF, 2020). It is essential for improving maternal health across the nation and globe. It also intends to eliminate D&A and other negative behaviors and ill-treatment towards women and mothers and to have them experience satisfactory childbirth. RMC also encompasses a “humble and dutiful care,” considering not only respect and dignity for women, but also their feelings, choices, and preferences by using ethical principles. In addition, WHO also highlights the need for governments and other development partners in initiating, supporting, and sustaining quality maternal care services (Pathak and Ghimire, 2020).
A study conducted on the levels of perception of women who had childbirth in a facility—a medical ward in a hospital in Nepal—regarding experiences of RMC, or the lack thereof, has shown that 75% of their participants experienced complete RMC dimensions which include friendly care, abusive-free care, timely care, and discrimination-free care. However, there is still a 15% that did not experience at all the RMC dimensions with reports of having nonfriendly and nonrespectful care in the form of lack of concern and empathy and speaking in a nonunderstandable language, physical and verbal abuse in the form of slapping and shouting, inattention, and unfair and discriminatory treatment (Pathak and Ghimire, 2020). Factors such as length of stay during delivery, time of delivery, parity, and shortage of health worker staff impact the RMC dimensions and the kind of care given to women. Friendly care was found to be provided more for those who had a shorter stay (a day or less) than those who lengthier stay. Timely care was shown to be given more during daytime than nighttime as the number of staff is lesser at night. Multipara women were more likely to receive abusive-free care because they may either have (a) a higher likelihood of understanding and obeying health care providers easier than primigravida women or (b) quicker and easier delivery processes (Pathak and Ghimire, 2020).
This study shows that identifying different factors that influence maternal and childbirth care must be extensively explored and investigated while also educating and encouraging health care workers of the significance and delivery positive outcomes of RMC. Indeed, RMC must be strengthened to protect women and mothers and provide them the maternal health care and respect they deserve.
References:
Maternal Health Task Force [MHTF]. (2020, May 19). Respectful Maternity Care. https://www.mhtf.org/topics/respectful-maternity-care/
Pathak, P. & Ghimire, B. (2020). Perception of Women regarding Respectful Maternity Care during Facility-Based Childbirth. Obstetrics and Gynecology International 2020. https://doi.org/10.1155/2020/5142398
World Health Organization [WHO]. (2014, September 3). Prevention and elimination of disrespect and abuse during childbirth. https://www.who.int/reproductivehealth/topics/maternal_perinatal/statement-childbirth/en/