Pregnancy and childbirth are significant events in the lives of women and families in every country and society around the world, and they represent a period of intense vulnerability. Because motherhood is a uniquely female experience, concerns of gender justice and equality are at the heart of maternity care as well (World Health Organization, 2015). Respectful maternity care is characterized as a fundamental human right that includes honoring women's beliefs, independence, feelings, dignity, and preferences, such as the ability to have a companion or practice cultural rituals. Physical abuse, non-consented care, non-confidential care, non-dignified care, discrimination based on patient's attributes, abandonment of care, and detention in facilities are the seven categories under which reported forms of Dis-Respect and Abuse (DRA) are classified (Hajizadeh et al., 2020). During pregnancy, a woman's interactions with maternity care providers and the maternity care system are very essential. The detrimental impact of DRA on skilled delivery attendance during labor is a significant barrier to service utilization and enhancement of maternal well-being. Negative patient experiences in health care facilities contribute to poor health outcomes and reinforce public distrust of institutional care. This may cause women to families to postpone or avoid getting medical help, even at the risk of their own and their newborn's health (Bulto et al., 2020). Setting up quality improvement teams, monitoring experiences of poor treatment, mentorship, and improved working conditions for staff can all help to establish enabling environments inside a health facility. To offer respectful care, health facilities and health systems must be structured in such a way that supports and respects providers while also ensuring proper infrastructure and maternity ward organization (Bohren, Tuncalp & Miller, 2020).
Currently, the COVID-19 pandemic has strained health systems and exacerbated system deficiencies and subpopulation vulnerabilities, dramatically altering maternal newborn health (MNH) care delivery. During COVID-19, a number of various abuses of human rights were reported including (1) deficits in overburdened health systems (absence of PPE; shifting of workers from maternity to COVID-19 units; maternity units converted to COVID-19 centers, and restriction of MNH services), (2) negligence, abandonment, and limited access to treatment (lack of emergency transportation; neglect in institutions due to fear of infection; lack of out-of-hospital choices for expert care, resulting in unattended deliveries), (3) changes to proven practices (obligatory separation of mother and newborn; breastfeeding restrictions, and the prohibition of having a companion during labor and birthing), (4) restriction of women’s decision-making autonomy (unavailable contraception service, abortion is classified as non-essential), (5) potentially detrimental medical interventions (instrumental deliveries,increased cesarean sections, induction and augmentation of labor without medical indication) and (6) exacerbation of care inequities (unequal access to telemedicine or health alternatives) (Jolivet et. al, 2020; Reingold et. al, 2020).
The COVID-19 crisis has highlighted deficiencies within and beyond health systems, but it also provides an opportunity for critical examination to strengthen and improve the quality and equitability of MNH care. Mechanisms to protect, uphold, and fulfill the rights of women and newborns while reducing the spread of infection require collective efforts from all actors to meet their obligations as duty bearers and rights holders. The RMC global council suggests the following interventions to address these issues: increasing safe options for out-of-hospital birth, facilitating accreditation of birth centers and increasing access to trained midwives, using digital health services, and other media to share health information, allowing a companion of choice during labor and birth, practicing universal precautions and treating every woman and newborn (regardless of COVID-19 status), without stigma or discrimination and ensuring any restrictions, including quarantine for women and newborns with COVID-19, are strictly necessary, the least intrusive and restrictive available, and evidence-based (Jolivet et al., 2020).
If anchored in facts, quality, and the gradual achievement of fundamental human rights in health, innovation and flexibility to provide important MNH services safely should be supported. All in all, respectful maternity care necessitates effective communication between patients and clinicians, especially at this time, to ensure that patients are aware of their options and that they are supported in making their decisions. Women should be active participants in the creation and implementation of related policies and practices in the context of COVID-19, given that eradicating harmful behaviors during maternity care can only be achieved through an inclusive process with their participation. While undermining rights exacerbates imbalances and further marginalizes marginalized groups, protecting rights through best practices that safeguard women, newborns, and health workers fosters a more equitable health system for all (Reingold et al., 2020).
References:
Bohren, M.A., Tuncalp, O. & Miller, S. (2020). Transforming intrapartum care: Respectful maternity care. Best Practice & Research Clinical Obstetrics & Gynaecology, 67, 113-12. ISSN 1521-6934. https://doi.org/10.1016/j.bpobgyn.2020.02.005.
Bulto, G. A., Demissie, D. B., & Tulu, A. S. (2020, August 3). Respectful maternity care during labor and childbirth and associated factors among women who gave birth at health institutions in the West Shewa Zone, Oromia Region, central Ethiopia - BMC pregnancy and childbirth. BioMed Central. https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-020-03135-z#:~:text=Respectful maternity care (RMC) is,needs [1%2C 2]
Hajizadeh, K., Vaezi, M., Meedya, S., Mohammad Alizadeh Charandabi, S., & Mirghafourvand, M. (2020, August 17). Respectful maternity care and its relationship with childbirth experience in Iranian women: A prospective cohort study - BMC pregnancy and childbirth. BioMed Central. from https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-020-03118-0
Jolivet, R. R., Warren, C. E., Sripad, P., Ateva, E., Gausman, J., Mitchell, K., Hacker, H. P., Sacks, E., & Langer, A. (2020). Upholding Rights Under COVID-19: The Respectful Maternity Care Charter. Health and human rights, 22(1), 391–394.
Reingold, R. B., Barbosa, I., & Mishori, R. (2020). Respectful maternity care in the context of COVID-19: A human rights perspective. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 151(3), 319–321. https://doi.org/10.1002/ijgo.13376
World Health Organization. (2015). The prevention and elimination of disrespect and abuse during facility-based childbirth. https://apps.who.int/iris/bitstream/handle/10665/134588/WHO_RHR_14.23_eng.pdf