B!RTH Blog: Hannah McCauley RGN RM, Centre for Maternal and Newborn Health, LSTM
Respectful maternity care and the importance of empowering women (both HCPs and pregnant women)
What are the main birth inequalities that you’ve seen through your work?
Women do not lose their basic human rights once they become pregnant. And yet, across the globe, women’s human rights are compromised and violated around childbirth. This is unacceptable and totally avoidable.
What single action or change would make the largest contribution towards women surviving and thriving?
Gender equality! When women have equal access to education, health services and employment, they become autonomous individuals with the ability to seek and advocate for services for themselves and their children. Achieving gender equality is a key strategy to improving the health of women and children, but we must first empower women to recognise their worth in society. This would have the greatest impact on the global population.
What is meant by ‘respectful maternity care’ and why is it needed?
Respectful maternity care is care that is 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 labour and childbirth. The recognition that women faced disrespect and abuse during childbirth inspired a childbirth activism movement in the 1990’s, leading to the formation of the ‘Network for the Humanization of Labour and Birth’ in Brazil in 1993. At the time, it was being noted that even with the implementation of recognised interventions to improve care for women during and after pregnancy, women were not accessing this care mainly due to the way they were being treated by healthcare providers.
Following this, the Respectful Maternity Care charter was developed by the White Ribbon Alliance which outlined the universal rights of childbearing women. After the development of the RMC charter, the World Health Organization released a statement in 2014 demonstrating their commitment to promoting respectful maternity care; “Every woman has the right to the highest attainable standard of health, including the right to dignified, respectful care during pregnancy and childbirth.” Respectful care is now at the forefront of the global agenda but there is much work to do.
What is the role of the midwife, and how can they provide respectful maternity care?
Midwives are the healthcare providers who provide all the care that women and their newborns need during and after pregnancy. Evidence shows that being respectful towards women is identified by pregnant women as one of the most important attributes for a midwife to have. Researchers in LSTM undertook some research in Sub Saharan Africa regarding how women were treated around the time of birth. A woman stated that ‘I thought they were going to handle me like a queen, but they didn't’. Having a caring behaviour and environment as well as companionship is what women want and deserve at the time of birth. Midwives are best placed to provide this care and many midwives across the world are indeed providing this care in often challenging circumstances. However, across the globe midwives are often not held with the value in society that they deserve; they may have low salaries and work in very challenging environments with a chronic lack of resources. How can midwives be agents of change and empower women, if they themselves are disempowered and lack agency? If midwives are to be defenders of women’s rights, they must themselves be empowered. They are heros!
What are the consequences for women when there is a lack of respectful maternity care in place?
Evidence suggests that in countries where maternal mortality is highest, women associate disrespect and abuse with facility-based maternity services. Consequently, across the globe, a woman’s experience of poor quality care can be a powerful determinant of whether she will, and if so, how she will access health services for herself and her baby. During and after pregnancy, women face stigma for their socioeconomic status, HIV status and age at the hands of healthcare providers. In addition, there are narratives of women being denied access to postnatal care due to having delivered at home as punishment for not delivering in facilities. Power imbalances seem to underpin the disrespect and abuse women during and after pregnancy. The evidence shows respectful maternity care and/or disrespect and abuse all play a part in influencing women’s perceptions of and interactions with maternity services. If women suffer disrespect and abuse during maternity care this will negatively influence women’s perceptions of care.
How important is it to empower women to take decisions about their own birth? How might this impact on outcomes for mother and baby?
It is a woman’s right to make an informed choice regarding where she wishes to give birth. Globally, it is recommended that women’s individual health needs should be taken into consideration when designing and implementing maternity services and that women should be offered more choice. Women make choices throughout pregnancy and childbirth and interactions with healthcare providers are integral to the journey. Healthcare providers have the potential to advise, influence and support women in their choices as to where to give birth. If healthcare providers have a lack of belief in women's ability to make appropriate choices, this negates principles of choice and consent. We should adopt a human rights-based approach which is about the entirety of health, not just isolated pathologies, and focuses on empowering women, and not merely avoiding maternal morbidity or mortality during and after childbirth. Once women become pregnant, they don’t suddenly lose their ability to make informed decisions about their health – we should support and empower them, not dictate they care we think they should receive.