In low resource countries like Rwanda, disrespect and abuse during maternity care is often linked to poor status and working conditions of health workers. As primary care providers for childbearing women, midwives are uniquely positioned to play a key role in promotion and provision of respectful maternity care.
The White Ribbon Alliance for Safe Motherhood (WRA), through the Health Policy Project, is developing a collection of dynamic first person narratives to compile and document midwives’ perspectives on provision of respectful care and amplify their voices regarding challenges in their work environment that may make it difficult for them to provide quality care.
On March 21-22, WRA staff talked to midwifery students, tutors and practicing midwives in Rwanda to hear their views on provision of respectful maternity care in their settings. Non-consented care and lack of privacy were named as main factors affecting provision of respectful care in Rwanda’s maternity wards. In addition, a shortage of midwives and lack of motivation were also named as contributing to the problem of disrespect and abuse in many of maternity wards in Rwanda:
Midwives do not give women enough explanation about labor… we just tell them what to do…so at the end they are like objects or robots, we make them do things without their consent.
Sometimes we expose women and it affects them psychologically…it is not good.
Sometimes midwives have five women in labor. This affects the type of care that midwives provide. We still need to train more midwives here in Rwanda because they are not enough.
However, the midwives also had much to say about the potential for change:
In order to ensure respect during delivery, midwives and everyone in the health profession need to be educated about women’s rights. When educated, we will do well.
Through its global and national level campaigns, WRA is advocating for promotion of respectful maternity care as a human right. It is crucial for midwives to understand women’s right to respectful maternity care and why it is so important for women’s rights to be respected during birth. Disrespect and abuse during childbirth cannot be eliminated without engagement of midwives.
In collaboration with the International Confederation of Midwives (ICM), midwifery associations in WRA National Alliance countries and other partners, WRA conducts advocacy training for midwifery students and midwives with a focus on promotion of respectful maternity care. When engaged, midwives can play a crucial role in demanding and providing respectful care in their health facilities.