Marshall L. Sackey & Annie Weah
edited by: Alina Prusko
In low-resource settings, nurses and midwives are often the first and only health care workers that pregnant people interact with during the antenatal and delivery period. Healthcare workers and midwives should be caring, empathetic, respectful, and communicate effectively in their practice. However, studies have shown that undignified care during labor often contributes to high maternal mortality trends in Sub-Saharan Africa1.
Childbirth is a unique experience for every birthing person and their family. Although many birthing people report good treatment during their hospital stay, research shows there is still a lack of respect, unconsented care, non-confidentiality, denial of care, and physical abuse during the birthing process in many hospitals2. Evidence suggests that in countries with high maternal mortality rates, the fear of disrespect and abuse that birthing people often encounter in facility-based maternity care, is a more powerful deterrent to accessing skilled care than commonly recognized barriers, such as cost or distance. 3
In every country and community worldwide, pregnancy and childbirth are momentous events in the lives of pregnant women and families. These events also represent a time of intense vulnerability. Hence, birthing people deserve respect from midwives and healthcare providers. All birthing people deserve a dignified birth experience, and we must address the reality that some midwives have been found to disrespect and to potentially harm those who are giving birth and their unborn children.3
The Safe Motherhood Initiative, which was launched in 1987, has focused international efforts to address maternal morbidity and mortality. Since the start of the initiative, some countries have made great progress in reducing mortality for birthing people and their newborns, and important lessons have been learned from their achievements. However, in many countries, the situation has remained unchanged, yet lessons have been learned from the past ineffective strategic approaches 3. One lesson learned is the importance of respectful maternal health as a key strategic effort in reducing maternal morbidity and mortality. A large proportion of maternal and perinatal deaths are avoidable, with most deaths occurring due to poor service provision by healthcare providers, as well as lack of access to and use of these services. 6
Furthermore, for a long time, the concept of “safe motherhood” has been restricted only to physical safety; forgetting that childbearing is also an important rite of passage, with deep personal and cultural significance for a birthing person and their family. Most maternal health programs are directed towards ensuring adequate supplies and necessary skills to perform obstetric procedures to save lives. On the other hand, less investment is directed towards building the necessary principles for respectful maternity care, in which essential supplies and skilled midwives form only a small portion. 1 As part of social justice, safe motherhood should be expanded beyond the prevention of morbidity or mortality. When designing maternal healthcare interventions as a midwife, respectful maternity care has always been the guiding principle to a successful program. This should be done in order to encompass respect for birthing people’s basic human rights, which includes respect for their autonomy, dignity, feelings, choices, and preferences such as choosing their companion during maternity care.
Anthropological ethnographies reveal that birthing people in every culture are confronted with the same fears and obstacles during the birthing experience, reporting that “there is no privacy, no informed consent for most procedures done to us while in labor, we’re not given a chance to participate in our own healthcare, healthcare workers insult us, we are not allowed to stay with our companions.” 2 These practices perpetuate gender violence and inequality in every culture. One study looked at birthing people who gave birth in 12 countries in the WHO European region in 2020 and 2021. It found that 62% of birthing people were not allowed a companion of choice, nearly 24% felt they were not treated with dignity and 12.5% suffered abuse. 7 Undignified care, aggressive interactions, and lack of privacy and consent by healthcare professionals during childbirth must stop. We must work to end the unsafe and undignified treatment of people, especially during a time so precious, vulnerable and defining as the birth of a child.
1. WHO (2018). WHO Recommendations: Intrapartum Care for a Positive Childbirth Experience. Geneva: World Health Organization.; 2018. http://apps.who.int/iris/bitstream/handle/10665/260178/9789241550215-eng.pdf;jsessionid=7E800B590A164DC7FC879E73B480D6FC?sequence=1. Licence: CC BY-NC-SA 3.0 IGO
2. Robbie Davis-Floyd, Debra Pascali-Bonaro, Rae Davies, Rodolfo Gomez Ponce de Leon (2010). The International MotherBaby Childbirth Initiative: A Human Rights Approach to Optimal Maternity Care • Midwifery Today. Midwifery Today, Issue 94. Accessed May 18, 2022. https://www.midwiferytoday.com/mt-articles/imbci/
3. Futures Group Global. (n.d.). Respectful Maternity Care. The Health Policy Project. http://www.healthpolicyproject.com/index.cfm?ID=topics-RMC
4. WHO (2006). Making a Difference in Countries: Strategic Approach to Improving Maternal and Newborn Survival and Health.; https://www.who.int/maternal_child_adolescent/documents/wa3102006ma/en/. WHO reference number: WA 310 2006MA
5. Allen J, Gibbons K, Beckmann M, et al. Does model of maternity care make a difference to birth outcomes for young women? A retrospective cohort study. Int J Nurs Stud. 2015 Aug;52(8):1332-42. doi: 10.1016/j.ijnurstu.2015.04.011. PMID: 25952336.
6. White Ribbon Alliance (2011). Respectful Maternity Care: The Universal Rights of Childbearing Women .; . https://www.whiteribbonalliance.org/wp-content/uploads/2017/11/Final_RMC_Charter.pd
7. Lazzerini M, Covi B, Mariani I, Drglin Z, Arendt M, Nedberg IH, Elden H, Costa R, Drandić D, Radetić J, Otelea MR, Miani C, Brigidi S, Rozée V, Ponikvar BM, Tasch B, Kongslien S, Linden K, Barata C, Kurbanović M, Ružičić J, Batram-Zantvoort S, Castañeda LM, Rochebrochard E, Bohinec A, Vik ES, Zaigham M, Santos T, Wandschneider L, Viver AC, Ćerimagić A, Sacks E, Valente EP; IMAgiNE EURO study group. Quality of facility-based maternal and newborn care around the time of childbirth during the COVID-19 pandemic: online survey investigating maternal perspectives in 12 countries of the WHO European Region. Lancet Reg Health Eur. 2022 Feb;13:100268. doi: 10.1016/j.lanepe.2021.100268.
8. World Health Organization. (n.d.). Learning from women’s experiences during childbirth to improve quality of care. World Health Organization. https://www.who.int/news/item/23-03-2022-learning-from-women-s-experiences-during-childbirth-to-improve-quality-of-care
9. Talvacchia, T. (2017, April 28). It’s time to Download respectful maternity care! Healthy Newborn Network.from https://www.healthynewbornnetwork.org/blog/time-download-respectful-maternity-care/
10. Marshall Sackey 2022, photograph
