Respectful maternity care in the context of COVID-19: A human rights perspective
(Reingold RB, Barbosa I, Mishori R., 2020)
The Covid-19 pandemic has changed the healthcare response worldwide, and in the local context has exposed cracks in delivery of health services. It has severely changed maternity care, especially one of its core tenants - respectful maternity care. Since the surge of cases, international bodies have developed recommendations to change the way respectful maternity care is delivered, related to accessing health services concerning pregnancy, childbirth and postpartum care. It was said that a failure to do so would result in harmful experiences that include neglect, disrespect, and discrimination that can lead to poorer physical and mental health outcomes for pregnant women and their newborns. (Reingold RB, Barbosa I, Mishori R., 2020)
The key response to this pandemic is the adoption of new policies and practices that take into consideration the presence of the virus. From the time being, reducing risks of the disease’s spread became the focus of many decision-making bodies. Unfortunately, many of these responses exacerbated the pregnant women’s experiences of harmful practices. Recent changes to some policies are clear violations to the rights to health, information and non discrimination.
For example, in order to reduce the risk of infections, in-person appointments were spaced out. This would mean that there would be less people inside the clinic thus essentially reducing the risk of infection. However, some emergencies and situations constitute immediate consultation and because of a necessary need, mothers switched to telehealth which showed worse outcomes even for women at high risk. This exacerbated the digital divide, especially to those who have no access to high-speed internet or high quality gadgets. In relation to this, companions were not allowed to be present at delivery. Companions are shown to improve labor and delivery, and WHO recommendations state that they are essential for a positive childbirth experience.
Certain medical interventions are also more likely to be performed on women who were positive for SARS-CoV-2 during labor. These include induction of labor, instrumental deliveries or cesarean deliveries, all of which are not recommended for routine labor management and are associated with significant harm. In relation to this, mothers who tested positive are given limited skin-to-skin contact and breastfeeding time for their newborns. This is in violation of policies and related literature even states that the important benefits for mothers and newborns for these interventions outweigh the low risk of harm that the newborns have.
All the situations above lead to the conclusion that there is a great impediment to adapting human rights and respectful maternity care in the context of Covid-19 pandemic. The rights to health in a sense that it is available in adequate number, accessible without discrimination and free from barriers is disregarded by policies and practices that harm women’s and child’s health. The right to information and subsequently make informed, free decisions are not given to all pregnant women. Without clear communication and adapting respectful maternity care, also gone is the right to equality and non-discrimination that mothers will experience.
This goes to show that actors (governments, health professional associations, international bodies) should be more pressed to rely on international human rights standards, best clinical practices and the latest scientific evidence to make decisions regarding COVID-19 guidelines related to maternity care. Pregnancy women have the right to receive respectful maternity care and through this, the provision of maternity care will be for women’s health, well-being and dignity.
Reference:
Reingold RB, Barbosa I, Mishori R. (2020) Respectful maternity care in the context of COVID-19: A human rights perspective. Int J Gynaecol Obstet. 2020 Dec;151(3):319-321. doi: 10.1002/ijgo.13376. Epub 2020 Oct 5. PMID: 32944956.