Accountability for respectful maternity care is a short article published by the Lancet journal written by Patience Afulani and Cheryl Moyer. It talks about how maternal care efforts are currently transitioning from just the utilization of services to improving quality of care. Part of the latter is giving mothers respectful maternity care especially since several studies link the impact of disrespectful care to decreased health seeking behaviors.
The authors explored the different studies done to show or quantify the amount of disrespect and abuse women face when seeking maternal health. They noted that inconsistencies across these studies were common due to methodological issues and different definitions of terms. Thus, standardized and evidence-informed measurement tools to address these inaccuracies were developed rigorously by Bohren and her colleagues from the same publication. Using these methods, they found out that more than a third of women in a community survey and observation of 2000 live births (in Ghana, Guinea, Myanmar, and Nigeria) were experiencing some kind of abuse, mistreatment and disrespect. However, as with other studies that use self-report of subjective experience, this was also affected by the social desirability and recall bias of the participant. Further, the hawthorne effect, a phenomenon where the participants of a survey alter their response due to being part of a study, is a potential limitation.
The study conducted by Bohren and her colleagues show that mistreatment may be commonly occuring in low-resource settings. Yet, in another study done in high-income countries, the problem also seems to be evident.
Afulani and Moyer discussed a study which used a validated person-centered maternity care scale that revealed how disrespect is not just limited to abuse or mistreatment but also to a lack of therapeutic communication and support.
To emphasize the need for respectful maternity even more, the authors discussed the results of the worldwide survey by the White Ribbon Alliance on what women want. This revealed that more than 1 million women call for a respectful and dignified health care delivery, the top demand across 114 countries. This implies that maternal disrespect happens more often than we think, more than studies or news have shown.
Yet, with the tools to assess respectful maternity across different settings being developed and studies that reveal the extent and seriousness of the problem, no accountability can be found. Government, institutions, facilities, health officials and many more seem to be seeing the problem but no one stepped up, explained or took responsibility for such occurrences. The authors, and likewise me, think it is now time to extend the results of these studies and utilize the tools that researchers develop to catalyze change and hold people or organizations accountable.
FROM:
Afulani, P., & Moyer, C. (2019). Accountability for respectful maternity care. Www.thelancet.com, 394(10210), 1692–1693. https://doi.org/https://doi.org/10.1016/S0140-6736(19)32258-5