The impact of COVID-19 on the provision of respectful maternity care: Findings from a global survey of health workers
Thanks to the efforts made by the World Health Organization (WHO), respectful maternity care (RMC) has the ability to provide women with care that “maintains their dignity, privacy, and confidentiality, ensures freedom from harm and mistreatment, and enables informed choice and continuous support during their labor and childbirth.” Accordingly, RMC can significantly contribute to reducing global inequities in maternal and neonatal health, therefore making it an essential component of high-quality maternal care, and in strengthening the health system globally (Asefa et al., 2021).
However, even before the COVID-19 pandemic, multiple health system barriers and challenges have already made promoting RMC difficult. These barriers include shortage of beds, supplies, and health workforce, weak referral system, and health workers demotivation. Now with COVID-19 suddenly striking the whole world, there had been an increase in reports about the pandemic’s impact on providing quality maternal and newborn care which reiterated the issues of increased stress, absenteeism, resignation, and redeployment among health workers. Additionally, though the health sector tried to maintain the provision of patient care through teleconsultations, it was simply very difficult to provide quality maternal and newborn care to those that need face-to-face support and interactions, and to those living in areas where access to telehealth technology is limited or not possible.
It's no secret that every aspect of the health system was compromised ever since the COVID-19 pandemic began. Global health experts across diverse settings even warned that it also affected women’s and newborns’ rights to receive respectful care. This study conducted by Asefa et al. (2021) is the first to globally examine how the COVID-19 pandemic has negatively affected the provision of RMC from the perspective of frontline health workers.
After gathering data from a total of 1248 maternal and newborn health workers, qualitative analysis of the data identified six central themes on how the pandemic negatively affected the health workers’ ability to provide RMC. First is less family involvement, wherein issues on the denial of birth companionship, postnatal visitation, and newborn separation from parents or family members were highlighted; second is reduced emotional support to women, wherein issues of banning cultural mediators to support women of culturally and linguistically diverse backgrounds, and women not being allowed to have birth companions were identified; the third is reduced physical support to women, which was a result of physical distancing measures, staff shortage, and limited mobility and spaces; the fourth is compromised standards of care, which was due to the reduced stay of mothers and newborns in hospitals to limit transmission of the virus; fifth is increased risk of medically unjustified cesarean sections, wherein there were reported higher than usual rates of cesarean births just to further reduce mothers’ stay as the facilities focused more on infection prevention; while the sixth and last theme is providers overwhelmed by rapidly changing guidelines and enhanced infection prevention measures which is also the overarching theme that had an effect on the first five themes discussed. It is no joke just how much the COVID-19 pandemic has drained health workers physically and emotionally as they forced themselves to cope with multiple changing guidelines in accordance with the surge of COVID-19 cases globally. Not only are they taking care of birthing mothers and their newborns, but they also had to give special attention to mothers who were suspected and positive for COVID-19, which adds to the list of guidelines and actions they have to remember during this time of the pandemic.
These results showed that the changes in the rules and guidelines in providing maternal and newborn care compromised the clinical and interpersonal elements of care, and also affected women’s right to choose their mode of childbirth, and to benefit from companionship during labor, childbirth, and postpartum. Furthermore, because of the pandemic itself, health workers often felt fear, confusion, and frustration while working, therefore limiting their capability to “provide RMC according to evidence-based guidelines.” Upon discovering the negative impacts that the pandemic has had on the provision of RMC, the study went on to discuss its implications on the health system, stating that it is imperative to “work towards strengthening a health system that is capable of absorbing shocks and preserving the quality of care in times of crises such as the COVID-19 pandemic.” Having a multidimensional health system strengthening perspective and approach ensures that little to no more violations in women’s rights during labor, childbirth, and postpartum will occur, while guidelines to prevent disease transmission during a pandemic are implemented still. Simply put, efforts should be made so that there’s no need to compromise the standards of care of one for the implementation of the other.
In the end, the study still acknowledged that the pandemic did not have a completely negative impact on the provision of RMC, which is why in their final words, the researchers stated that “opportunities that emerge in the era of the COVID-19 pandemic should be capitalized on to foster innovations and interventions that could promote RMC globally.”
Reference Article
Asefa, A., Semaan, A., Delvaux, T., Huysmans, E., Galle, A., Sacks, E., Bohren, M.A., Morgan, A., Sadler, M., Vedam, S., & Benova, L. (2021). The impact of COVID-19 on the provision of respectful maternity care: Findings from a global survey of health workers. Women and Birth. https://doi.org/10.1016/j.wombi.2021.09.003