Search and read at least one article on Respectful Maternity Care and share readings by replying in this discussion forum.
Across the globe, many women continue to experience disrespectful treatment during childbirth. Studies in countries such as Ethiopia, Kenya, India, Kenya, and Ghana have revealed reports of breach of proper maternity care protocol such as failure to get fully informed consent, lack of confidentiality and gross violations of privacy, outright physical abuse, profound humiliation and verbal abuse, and coercive or unconsented medical procedures. Refusals to provide admission to health facilities or provide pain medication. Healthcare workers leaving women during childbirth to suffer life-threatening, avoidable complications then later on, detaining women and their newborns in facilities after childbirth because of their inability to pay fees - these are not even a complete list of all the violations of trust between women and their healthcare providers. Among others, women of minority groups - adolescents, unmarried women, women of low socio-economic status, women from ethnic minorities, migrant women and women living with HIV - are likely targeted victims of these discriminatory practices.
Truly, these reports are devastating and horrifying, especially as labor and childbirth are particularly vulnerable times in the continuum. Both the mother and the baby are subject to physical, emotional, and mental stress, and this is only exacerbated by outright and intentional disrespect, neglect, and abuse. Towards the end of pregnancy and the beginning of another life lies a great hurdle that women, and women alone, must endure, and to discover that healthcare workers tasked with guiding women on this journey carelessly forsake their responsibilities is a cause for outright concern.
Skilled assistance during pregnancy and childbirth has been recognized as one of the key interventions in reducing maternal morbidity and mortality. Nevertheless, research around the world has shown that unbridled institutional disrespect and abusive treatment during labor and childbirth creates a massive barrier to improving skilled care utilization and improving maternal health outcomes. Thus, this prompts a pertinent need for respectable and quality care to be provisioned and enabled to be accessed across women of all status during this period of immense pressure.
Evidence from various countries in Sub-Saharan Africa shows that women would prefer to deliver in a facility, but choose not to because of previous experiences of inadequate, low quality, and/or disrespectful care in facilities. This is especially relevant with the occurrence of the COVID-19 pandemic that has strained health systems and exacerbated system deficiencies and subpopulation vulnerabilities, thereby “exposing the damaging impact of inequities of health systems in every society”. Details of violations amidst this health crisis include (1) lack of personal protective equipment, maternity units, and maternal newborn care services; (2) unavailability of emergency transport, antenatal and postnatal contacts as well as out-of-hospital options for skilled care leading to unattended births, neglect in facilities due to fear of infection, and general restricted access to care; (3) increased execution of potentially harmful medical interventions like cesarean sections, instrumental deliveries, induction and augmentation of labor without medical indication; (4) curtailment of women’s decision-making autonomy; and (5) alteration of proven practices without evidence of need such as prohibition of a companion during labor and childbirth, mandatory separation of mother and newborn, & restriction of breastfeeding, all to make way for the supposed “priority” COVID-19 patients. Moreover, evidence shows that the problem lies not only in the presence of negative interactions such as verbal and physical abuse but also the clear absence of positive interactions such as effective communication and supportive care, which are needed for expectant mothers to get through this tough time.
Given abundant reports of this manner of low quality, obstetric care, it is no wonder that survey results reveal that many women, even in low and middle-income countries, fear various undesirable procedures and thus, prefer to deliver at home with a traditional birth attendant even if better resources are available at health centers. This violation of trust becomes a powerful disincentive for women to seek and use maternal health care services as such treatment not only violates the rights of women to respectful care, but can also threaten their rights to life, health, bodily integrity, and freedom from discrimination.
Emphasis on concepts of quality care in nursing, midwifery, and medicine began even back in the 1960s and 1970s along with the women's rights movement, which included women's health and rights, and impacted provider-thinking about provision of care. At the same time, nursing and midwifery journals published research on what we now label “evidence-based respectful care. By the early 2000s, respectful maternity care began to appear in textbooks and training courses for midwives, including training on the most basic measures of respect for pregnant women, including greeting and listening to the woman and her family, providing privacy and comfort measures, and explaining what will happen and answering questions.
Today, respectful maternity care, as recommended by the World Health Organization, has evolved to refer to “care organized for and provided to all women in a manner that maintains their dignity, privacy and confidentiality, ensures freedom from harm and mistreatment, and enables informed choice and continuous support during labor and childbirth”. They deserve respectful health care that is free from violence, discrimination, neglect, and abuse, and freedom to seek, receive, and impart information and to enjoy highest attainable standard of physical and mental health, including sexual and reproductive health, is the right of any pregant woman or postpartum mother, regardless of her background.
This statement calls for greater advocacy on maternity and newborn care. This starts by emphasizing the rights of women to dignified, respectful healthcare throughout pregnancy and childbirth. When international human rights frameworks highlight disrespect and abuse during childbirth as an important public health and human rights issue, this aids in raising awareness and developing policy initiatives on the provision of quality and respectful care at birth using rights-based systems approaches to organizing and managing healthcare systems. Health facilities and health systems must be structured in a way that supports and respects providers, and ensures adequate infrastructure and organization of the maternity ward. This includes skills development for health care providers through training on values, transforming attitudes, and interpersonal communication. Within a health facility, enabling environments must also be created by setting up quality improvement teams, monitoring experiences of poor treatment, mentorship, and improved working conditions for staff. Health systems must be held accountable for treatment of women during childbirth, ensuring clear policies on rights and ethical standards are developed and implemented.
Moreover, programs designed to improve quality of maternal health care, with strong emphasis on respectful care as an essential component, should be initiated, supported, and sustained. Greater action is needed to support changes in provider behavior, clinical environments and health systems to ensure that all women have access to respectful, competent and caring maternity health care services. This may include, but should not be limited to: social support through a companion of choice, mobility, access to food and fluids, confidentiality, privacy, informed choice, information for women on their rights, mechanisms for redress following violations, and ensuring high professional standards of clinical care. Women’s right to decide on health options regarding birth companionship, emotional support, effective communication, pain relief measures, preferred birth position, and mobility during labor should not be neglected. Upholding women’s rights to freedom from harm and ill-treatment, information, informed consent, respect for choices and preferences, privacy and confidentiality, liberty, autonomy, self-determination and freedom from arbitrary detention, adequate nutrition and breastfeeding, clean water, and sanitation, and generally speaking, right to the highest attainable level of healthcare alongside right to equality, freedom from discrimination and equitable care as well as treated with dignity and respect for one’s personhood from the moment of birth and the right to an identity and nationality from birth for both mother and child respectively is vital even amidst the COVID-19 crisis. The focus on safe, high-quality, people-centered care as part of universal health coverage can also help inform action. It is essential and crucial to address the violations to informed decision-making of women in health, and neglect in healthcare delivery towards the mother and the baby. The right to health, quality healthcare, and preservation of life are universal and indivisible; they cannot be withdrawn, put aside, or overlooked in spite of the trying times.
References
Afulani, P. A., & Moyer, C. A. (2019). “Accountability for respectful maternity care.” The Lancet,
394(10210), 1692-1693.
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://www.researchgate.net/publication/339418317_Transforming_intrapartum_care_R
espectful_maternity_care
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.
https://www.hhrjournal.org/2020/05/upholding-rights-under-covid-19-the-respectful-mater
nity-care-charter/
World Health Organization [WHO]. (n.d.). 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