Disrespect and abuse during childbirth has been observed and recorded all around the world. In addition to being a human rights violation, disrespect and abuse during childbirth discourages women who experience it from seeking health care in the future and ultimately results in poor health outcomes. As a result, a number of organizations, including the World Health Organization (WHO), have called for improved measurement, programs and advocacy addressing this global issue. With support from The John and Katie Hansen Foundation and the Bill & Melinda Gates Foundation, the Maternal Health Task Force (MHTF) established a research project to measure the prevalence of disrespect and abuse during childbirth in Tanzania and Ethiopia and to develop effective interventions.
In a recent study published in Reproductive Health as a part of the MHTF’s work with Management and Development for Health, Ratcliffe and colleagues examined the effects of two interventions designed to promote respectful maternity care in Tanzania: the first was an educational program for pregnant women—Open Birth Days (OBD), and the second was a workshop series for healthcare providers—Respectful Maternity Care Workshop (RMC Workshop). Both interventions were implemented in the same large, referral hospital in Dar es Salaam, Tanzania over the course of seven months. After evaluating both programs through pre and post-tests, direct observation and interviews with patients and providers, the researchers found numerous positive outcomes.
The RMC Workshop, which was adapted from the WHO’s Health Workers for Change curriculum, was designed to give providers an opportunity to revisit ethical principles of clinical work, think about the background and preferences of patients and reflect on interpersonal and structural barriers impeding respectful maternity care. Compared to baseline, after participating in the RMC Workshop a greater number of providers:
- Stated that “disrespect and abuse during maternity care is a human rights violation”
- Reported having a good understanding of their patients’ backgrounds
- Disagreed that it was “safer to withhold information from less educated women”
- Said that they could empathize with their patients
- Felt able to identify and solve problems at work
The OBD program was designed as a supplement to regular antenatal care services to facilitate patient-provider communication and mutual accountability, prepare women for delivery and empower women to advocate for themselves and their patient rights. Compared to baseline, after participating in the OBD program a greater number of patients:
- Knew about their right to consent to procedures
- Knew about their right to be free from physical abuse during labor
- Knew about their right to privacy
- Knew where to check in when arriving at the facility in labor
- Agreed that moving around during labor is best
- Felt more comfortable about their upcoming delivery
- Were more satisfied with the services they received
The researchers also conducted follow-up interviews with women four to six weeks after they delivered at the facility and saw substantial reductions in the prevalence of types of disrespect and abuse including having experienced slapping, shouting, scolding, being uncovered during delivery or examination and being abandoned during labor and delivery.
The results of this study illustrate that reducing disrespect and abuse during childbirth through effective interventions is possible. However, there is still a shortage of interventions that have been designed, implemented and evaluated—both in Tanzania and around the world. Continued investment in training, measurement and programming is crucial to improve women’s birthing experiences globally.
Access more information about respectful maternity care.
Learn more about the 2013 “Measuring Advocacy for Policy Change: The case for respectful maternity care” technical meeting hosted by the MHTF in partnership with USAID’s Translating Research into Action (TRAction) Project.
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