Promoting Respectful Maternity Care at Ethiopian Health Facilities

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By: Susan Moffson, MCSP Senior Program Officer

The MHTF has relaunched our Respectful Maternity Care blog series in response to the inaugural International Day for Maternal Health and Rights, which sparked many questions: How can women’s health rights take priority before, during, and after childbirth? What does women-centered healthcare look like in the post-2015 agenda? How can a woman-centered approach strengthen health systems and achieve universal health coverage? 

Makia Tukey, mother of three, delivered her third child at an MCHIP-supported health center. Photo courtesy of Jhpiego

Makia Tukey, mother of three, was amazed at the improved conditions at the health facility where she delivered her third child, a healthy baby boy. “They were friendlier this time and treated me like a sister,” she said. “I labored in a room with comfortable beds and, after the delivery, I went back to the room to rest.”

Since the birth of her second child, the quality of care provided at the health facility near her village in the Oromia region of Ethiopia has dramatically improved. Better facilities mean more women like Makia will come to a health center to deliver, increasing both their own odds of survival and that of their newborns. Increasing facility births is crucial since only about 10% of women in Ethiopia give birth in facilities and too many women are dying of preventable causes during childbirth, giving the country one of the highest maternal death rates in Africa (676/100,000 live births) and putting them far behind their Millennium Development Goal target of 267 per 100,000 live births by 2015.

The facility where Makia gave birth—Kore Health Center—is one of 118 facilities benefiting from the government of Ethiopia’s commitment to improving the quality of maternal and newborn care, with key support from USAID’s flagship Maternal and Child Health Integrated Program (MCHIP). To encourage facility births, MCHIP partnered with the government in 2010 to better conditions at 107 health centers and 12 hospitals in four regions. Together, MCHIP and the Ethiopian government are striving to ensure that women who go to health centers receive high-quality care.

Central to these quality improvement efforts is the promotion of respectful maternity care (RMC). Alarmingly, a number of women prefer to give birth at home with unskilled traditional birth attendants or alone, in part because they are concerned about the poor quality of care at facilities. They fear that health care providers, such as doctors and midwives, will treat them disrespectfully. In many resource poor countries like Ethiopia, providers may be overworked, understaffed, and ill equipped. As a result, women may experience verbal abuse or a lack of caring or empathy when they give birth at a facility.

Increasing Awareness of Patients’ Rights

In addition, many providers also lack awareness about patients’ rights to be treated with dignity during birth, or to receive RMC. In consequence, many clinics in Ethiopia do not allow family members or friends in the delivery room, leaving the mother to birth alone. RMC is a philosophy of maternal care that gives priority to the wishes and needs of the mother with an emphasis on the importance of informed choices, like birth position or whether to have a companion during childbirth. Through training and role-play, MCHIP is showing midwives that mothers feel more at ease when they have a birth companion present.

Providing Privacy

Another principle of RMC is allowing women adequate privacy while awaiting and receiving healthcare. Depending on the rural clinic or hospital, mothers often give birth in the same room and can see each other. In the MCHIP facilities, curtains were installed to provide privacy.

Respecting Culture and Traditions

RMC also holds that women’s beliefs, culture and traditions should be respected. For instance, a deep-rooted Ethiopian tradition is the coffee ceremony, which marks significant occasions, including births. In response to community engagement facilitated by MCHIP, the community constructed a traditional coffee hut at the Morsito health center. The hut serves as a place for family members to wait in anticipation of the birth and to prepare the coffee and porridge for the woman after she has given birth. By helping the community incorporate such cultural practices and improve patients’ experiences, MCHIP is encouraging more facility births.

Improving Health Systems

Despite these improvements, there are still many challenges to changing the attitudes of providers and women regarding RMC. Jhpiego/Ethiopia Country Director Hannah Gibson admits that “people find it difficult to see what RMC looks like. It is not just coffee and a midwife treating a woman like a sister.” To address this, the MCHIP team created useful guides and job aids to educate both MCHIP and facility staff about RMC.

RMC is a central component of the quality improvements at the 119 MCHIP-supported facilities, where staff are trained and later evaluated on how to provide RMC. For example, MCHIP staff teach providers the importance of greeting women and their families with respect and kindness, providing explanations of care provided, and asking for consent before they perform a procedure. There is evidence that key components of RMC—such as involving women in their care–makes the birth experience go more smoothly for both women and health care providers.

Lastly, MCHIP is improving facility conditions based on patient experiences. In response to numerous women’s complaints of being cold during childbirth, MCHIP provided blankets for warmth and pajamas to avoid getting blood on women’s clothing. This donation has been a huge success and a step in the right direction toward improving the birth experience. “The women are very pleased that they are not getting their own clothes dirty when they give birth and they stay warm,” Gibson said.

Thanks to these combined initiatives, the number of women going to the facility to deliver has more than doubled at MCHIP facilities since project inception. Greater demand for health care services at these facilities reflects a growing culture of RMC in which women are able to make informed choices about the care they receive during one of the most important events in their lives.

If you would like to submit a post to the Respectful Maternity Care blog series, please contact Katie Millar.