A core component of high quality health care is ensuring that services are people-centered—that providers incorporate the “preferences and aspirations of individual service users and the culture of their community.” The World Health Organization’s “Standards for improving quality of maternal and newborn care in health facilities” released in 2016 recommend that practitioners participate in regular in-service trainings to improve their interpersonal communication, counseling skills and cultural competence to encourage the provision of respectful maternity care. Organizations such as the Joint Commission, the National Institutes of Health, the International Confederation of Midwives and the International Federation of Gynecology and Obstetrics have also emphasized the importance of cultivating cultural competence in health care and offered practical guidance.
How have program implementers, clinicians and researchers approached the issue of providing culturally-appropriate maternity care, and what challenges have they encountered?
A recent paper in BMC Pregnancy and Childbirth aimed to answer these questions. This paper was a secondary analysis of a previous systematic review that the authors published in 2014 as part of the MHTF-PLOS Collection, “Integrating Health Care to Meet the Needs of the Mother-Infant Pair.” The authors reviewed 15 studies to examine how interventions to provide culturally-appropriate maternal health services—specifically related to patients’ ethnicity, language and religion—affected utilization of skilled antenatal, intrapartum and postnatal care.
Ten of the 15 studies found that the intervention had positive effects on skilled maternity care utilization, especially antenatal care attendance.
Keys to success
The following four themes illustrate barriers and facilitators to ensuring that women receive culturally-appropriate maternity care:
Researchers noted that financial and geographic barriers often inhibit women of certain cultural groups from seeking maternal health services, even if those services are culturally-appropriate. In some settings, gender-based restrictions on travel, low levels of education or literacy, limited knowledge of health services and a lack of social support or child care were also barriers to access. Facility-based interventions cannot be effective if the target population cannot access services.
Creating mutual respect through coordination and communication among health workers and communities was essential for the success of interventions. Some program implementers highlighted the importance of establishing community ownership over interventions. Community-based participatory research is a promising approach that involves communities in program design from the beginning.
Poor interactions between patients and providers was a common issue, with many women reporting caretakers’ unfriendliness, discrimination and negative attitudes. These experiences of disrespect and abuse decreased women’s self-worth and caused feelings of anxiety and shame. The most common strategy to combat these issues was employing staff with similar cultural or linguistic backgrounds to those of the women seeking care.
Continuum of care
Several interventions focused on a specific aspect of maternity care such as antenatal visits, but addressing issues of cultural appropriateness across the entire continuum of care was an important success factor. Collaboration among different care providers was essential to ensuring culturally-appropriate services to women at every encounter with health workers during pregnancy, delivery and postpartum.
The stakes are high
Respectful maternity care is a human right, and failing to guarantee culturally-appropriate care has serious implications. For example, women who do not receive respectful and culturally sensitive care at a health facility are less likely to seek facility-based maternity care in the future, which can have long-term consequences for both mother and baby.
It is important to note that the 15 studies included in this review were conducted in Australia, Peru, the United States and the United Kingdom. Given how critical local contexts are in evaluating interventions to provide culturally-appropriate care, further research in other regions is needed to ensure that no woman is left behind.
Read the full, open access paper, “Interventions to provide culturally-appropriate maternity care services: Factors affecting implementation.”
Learn more about respectful maternity care.
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