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RESPECTFUL MATERNITY CARE
Translating Research into Action Project (TRAction) Emily Peca, MA, MPH Technical Advisor TRENDING TOPIC
WHAT IS TRACTION?
Translating Research into Action (TRAction) Project is funded by the U.S. Agency for International Development (USAID) and is based at University Research Co. LLC.
Through implementation research, the TRAction Project addresses “know-do” gaps largely in the area of MNCH.
Our work generates evidence and facilitates conversations around:
How do we assess the implementation of interventions (implementation research)?
How can we improve intervention implementation? What works/doesn’t & why?
How can we share this information across settings?
How can we Influence policy and practice?
RESPECTFUL MATERNITY CARE (RMC): HOW DID THIS WORK BEGIN?
This work started out with this question:
How do we increase uptake of skilled, facility-based childbirth care?
What are women’s experiences?
0
10
20
30
40
50
60
70
80
90
100
Low Income Middle Income High Income
Skilled Birth Attendant Coverage Countries Categorized by Income
(WHO 2012)
% SBA Coverage
EVIDENCE ON DISRESPECT & ABUSE IN MATERNAL CARE
A landscape analysis report was commission by TRAction and the Harvard School of Public Health
Reviewed the evidence around disrespect and abuse (D&A) in facility-based childbirth
CATEGORIES OF DISRESPECT AND ABUSE
• Physical Abuse
• Non-Dignified Care
• Non-Consented Care
• Non-Confidential Care
• Discrimination
• Abandonment or
Withholding of Care
• Detention in Facilities
-Bower and Hill (2010)
ELIMINATION OF DISRESPECT & ABUSE AND PROMOTION OF RESPECTFUL CARE
TRAction’s focus is on generating evidence to improve measurement of D&A, test approaches to promote RMC and contribute to policy and advocacy:
Population Council: Implementation Research on Tackling Disrespect and Abuse in Facility-based Childbirth in Kenya (Heshima Project)
AMDD, Columbia University: Research on Tackling Disrespect and Abuse in Facility-based childbirth in Tanzania (The Staha Project)
Implementation assessment of care-seeking for childbirth services in Ixil, Guatemala (TRAction Guatemala)
HOW PREVALENT IS THE PROBLEM OF DISRESPECT AND ABUSE
RELATED TO MATERNITY CARE?
Measuring the problem
AMDD, COLUMBIA UNIVERSITY: THE STAHA PROJECT (TANZANIA)
0.2%
3.4%
5.1%
6.2%
15.5%
18.9%
28.2%
0.2%
1.9%
2.9%
5.2%
8.5%
12.9%
19.5%
0% 5% 10% 15% 20% 25% 30%
Non-consented
Demands for payment
Physical abuse
Non-confidential
Abandoned
Non-dignified
Any D&A
Facility Exit (n=1,761) Community Follow-up (n=592)
POPULATION COUNCIL: HESHIMA PROJECT (KENYA)
TRACTION GUATEMALA (IXIL, GUATEMALA)
Perception/ experiences of D&A Facility Birth n=136
Abandonment 13%
Non-dignified care 4%
Single item disrespect and abuse 7%
Which women had a higher probability of reporting
disrespect and abuse?
indigenous, poor, high parity, illiterate/no education
13% of women who did NOT give birth in a health facility think women in
health facilities are abandoned/neglected when giving birth there…
Non-dignified Care
Scolding, yelling, use of angry/mean tone, making fun of patients/humiliation,
threats
Lack of Privacy/ Confidentiality
Forced to undress in front of others, lack of space/privacy, lack of
confidentiality/discretion, perception that providers unnecessarily view women’s
intimate parts
Abandonment/ Neglect
Neglected when needed help (gave birth alone), providers attend to needs when
they “feel like it,” women are left alone in rooms
Discrimination
Discriminated against for having many children, for being poor, for arriving at
facilities without bathing/smelling bad, for not understanding (language), for being
from certain municipalities; providers discriminate against comadronas
TRAction Guatemala (Ixil, Guatemala): Qualitative Findings
Unfair requests for payment
Families required to buy the following: brand new baby clothes (even
if they brought clothes from home), disposable diapers, food (when
not provided)
Physical abuse
Perceptions that women are hit, rumors of rape in another district,
pushing/being rough with women and companions
Non-consented care
Laying patients down without asking for permission, taking off clothing
without asking permission, administering blood transfusion without
communicating the costs up front
TRAction Guatemala (Ixil, Guatemala): Qualitative Findings
WHAT CAN WE DO ABOUT IT? Promising Approaches
POPULATION COUNCIL: HESHIMA PROJECT (KENYA)
COLUMBIA/AMDD: STAHA PROJECT (TANZANIA)
NEED FOR EVIDENCE AROUND IMPLEMENTATION
We are not sure what works—only have “promising approaches” to date; need to avoid “doing harm”
Pushing for evidence, generation, and sharing of lessons learned dialogue (WRA Sub-committee on evidence-informed approaches to RMC)
Can learn from humanization, obstetric violence movements, Mother Baby Friendly Hospital Initiative
Stand-alone? Integrated
approaches?
THIS ISSUE IS CATCHING Recent developments…
FITTING IN THE FRAMEWORK FOR QUALITY
65 studies
were
included
from 34
countries
REVISED TYPOLOGY
GROWING BODY OF KNOWLEDGE
In general, the literature is expanding rapidly…
Sources of information:
TRAction website (RMC)
White Ribbon Alliance
Maternal Health Task Force
World Health Organization
In the news
WHY THIS SHOULD BE MORE THAN A TREND
By 2030, reduce the global maternal mortality ratio to less than 70
per 100,000 live births
By 2030, end preventable deaths of newborns and children under 5
years of age, with all countries aiming to reduce neonatal mortality to at
least as low as 12 per 1,000 live births and under-5 mortality to at least
as low as 25 per 1,000 live births
Despite overall declines in maternal mortality in the majority
of developing countries, women in rural areas are still up to
three times more likely to die while giving birth than women
living in urban centres
The need for family planning is slowly being met for more
women, but demand is increasing at a rapid pace
WHY THIS SHOULD BE MORE THAN A TREND
1. Universal right to healthcare—and more specifically healthcare services that
are available , accessible, acceptable, and of high quality.*
*The General Comment No. 14 (2000) put forth by the United Nations committee on Economic, Social and Cultural Rights declared the
2. Disrespect & abuse can damage the continuum of care: ANC, PNC…
3. For users of care: disrespect & abuse can lead to poorer compliance with
treatment, worse health outcomes…other negative externalities??
4. For non-users of care: perceptions of disrespect & abuse and unacceptable
service provision keeps them away, reinforces mistrust in the health system
Because what is happening to women and families is unconscionable
and we cannot allow it to continue. All care should be respectful.
