When I volunteered in a maternity ward in the Philippines in September 2013, I had about 18 months of experience under my belt as a midwife and a couple more years as a nurse. I had also volunteered in Papua New Guinea and was eager to return to a low-resource setting to sharpen my skills and develop my clinical thinking.
I hoped I would be of some help to the local frontline health workers. Perhaps I could lighten their load slightly, give them a chance to breathe by providing an extra set of hands. Within a day I realized this was not going to be the experience I had hoped.
What troubled me most was the way the women were treated.
My public health instincts had me imagining the creation of new patient services flow charts or moving the dumping ground of rubbish and broken hospital equipment away from the wind tunnel that blew directly into the TB ward, where fragile patients tried to heal.
These were simple problems, though, compared to what I saw from the corner of the labor room, where I was instructed to “just watch.” What did I see? Women verbally abused, humiliated, mocked, shamed, and abandoned.
Of course, the nurses and doctors I worked with in the Philippines did not wake up every day with the desire to mistreat the women in their care. Many of the types of problems I saw are the result of failures within the health system. Short staffing, for instance, can lead health workers to take dangerous shortcuts, become exhausted and burn out, leading to terrible consequences. According to the World Health Organization, there’s a shortage of 7.2 million doctors, nurses, and midwives worldwide.
Women Abused, Humiliated, and Abandoned
I witnessed more than one woman give birth by herself while the nurses gossiped behind the desk. A few times I provided support to laboring women when I wasn’t delivering the baby myself, but when I did this the woman whose hand I held or whose baby I placed on her chest was chided for embarrassing herself or given an “obstetric slap” for not “being strong like a good Filipina woman.”
But it wasn’t just the physical and verbal abuse; even the care the women received reflected the staff’s contempt and disregard.
I saw a doctor use the same syringe and needle on five different women as she administered medication, while storing the other sterile needle kits—which each woman brought at her own cost—for later use.
I saw another doctor use the same instrument to break two women’s amniotic sacs, merely rinsing the tool under the tap in between.
I was left with one woman for nearly an hour as she lay, slowly bleeding from a deep tear during childbirth, while the doctor suturing her left to see another client and the other on-call doctor slept behind the nurses’ desk. The nurses didn’t want to wake him and I was not yet confident in my suturing skills. All I could do was attend to her observations, increase her IV fluids, and watch for possible hemorrhage or shock.
Respectful Maternity Care Is Everyone’s Responsibility
Mistreatment during childbirth is not unique to this facility in the Philippines. According to a new report published in PLOS Medicine, many women around the world experience these and other abuses when giving birth.
“They are slapped and pinched during labor, yelled at, denied pain medicine, neglected and forced to share beds with other women who just gave birth,” reports the New York Times. “And that is just a partial list of the abuses and humiliations inflicted on women around the world as their babies are born.”
If a woman can’t be protected and cared for at the exact moment she brings life into this world, when can she expect it?
In addition to greater support and investment in the health system and workforce, health workers need strong role models. They need colleagues who not only demonstrate compassionate care but who demand accountability when women are mistreated under their watch. Respectful maternity care is everyone’s responsibility.
In nursing school, I found my purpose in Millennium Development Goal 5: to improve maternal health. I learned that between 1990 and 2013, the maternal mortality rate dropped by almost half, but that 289,000 women still die every year because of pregnancy or childbirth. Twenty times that will experience an acute or chronic disability.
This is the equivalent of three out of every four people in my hometown of Canberra, Australia, dropping off the face of the planet in just one year.
I remember the looks the women gave me when they were mocked and shamed and abused; their eyes told me they knew they deserved better. I silently begged them to forgive me for not being able to help more, for doing little more than witnessing their trauma. Two years on, I am still trying to help. Now instead of acting as a witness, I act as an advocate.
What I saw in the Philippines occurs throughout the world. As the report in PLOS Medicine points out, women from lower- and middle-income countries, from stigmatized backgrounds and those who live within health systems in crisis all face greater risk of disrespect and abuse in childbirth.
By building stronger health systems, helping countries better support their health workforce and advocating for equality for women and girls, we can end women’s trauma. And we can give mothers and babies the chance they deserve to thrive.
This post has been lightly edited and originally appeared on the Frontline Health Workers Coalition Blog.