Every woman around the world has a right to receive respectful maternity care. The concept of “respectful maternity care” has evolved and expanded over the past few decades to include diverse perspectives and frameworks. In November 2000, the International Conference on the Humanization of Childbirth was held in Brazil, largely as a response to the trend of medicalized birth, exemplified by the global cesarean section epidemic, as well as growing concerns over obstetric violence. Advocates emphasized the need to humanize birth, taking a woman-centered approach.
The concept of “obstetric violence” gained momentum in the global maternal health community during the childbirth activism movement in Latin America in the 1990s. The Network for the Humanization of Labour and Birth (ReHuNa) was founded in Brazil in 1993, followed by the Latin American and Caribbean Network for the Humanization of Childbirth (RELACAHUPAN) during the 2000 conference. In 2007, Venezuela formally defined “obstetric violence” as the appropriation of women’s body and reproductive processes by health personnel, which is expressed by a dehumanizing treatment, an abuse of medicalization and pathologization of natural processes, resulting in a loss of autonomy and ability to decide freely about their bodies and sexuality, negatively impacting their quality of life.
Disrespect and abuse (D&A), a concept closely related to obstetric violence, has been documented in many different countries across the globe. In a 2010 landscape analysis, Bowser and Hill described 7 categories of disrespectful and abusive care during childbirth: physical abuse, non-consented clinical care, non-confidential care, non-dignified care, discrimination, abandonment and detention in health facilities. A 2015 systematic review updated this framework to include:
- Physical abuse
- Sexual abuse
- Verbal abuse
- Stigma and discrimination
- Failure to meet professional standards of care
- Poor rapport between women and providers
- Health system conditions and constraints
Some evidence suggests that ethnic minorities are at greater risk of experiencing D&A during facility-based childbirth. Other factors that might influence a woman’s risk include parity, age and marital status. Women who have experienced or expect mistreatment from health workers may be less likely to deliver in a facility and to seek care in the future.
Respectful maternity care (RMC) is not only a crucial component of quality of care; it is a human right. In 2014, WHO released a statement calling for the prevention and elimination of disrespect and abuse during childbirth, stating that “every woman has the right to the highest attainable standard of health, including the right to dignified, respectful care during pregnancy and childbirth.” WHO also called for the mobilization of governments, programmers, researchers, advocates and communities to support RMC. In 2016, WHO published new guidelines for improving quality of care for mothers and newborns in health facilities, which included an increased focus on respect and preservation of dignity.
While a number of interventions have aimed to address this issue, many women around the world, including those living in high-income countries, continue to experience aspects of disrespectful and abusive care during childbirth. As facility-based birth and the use of skilled birth attendants continue to rise, a focus on quality and RMC remains critical for improving global maternal health.
- WHO Statement on Prevention and elimination of disrespect and abuse during childbirth
World Health Organization | 2015
- Respectful Maternity Care: The Universal Rights of Childbearing Women
White Ribbon Alliance | October 2011
- Exploring evidence for disrespect and abuse in facility-based childbirth: Report of a landscape analysis
USAID-TRAction Project | September 2010
- Defining disrespect and abuse of women in childbirth: A research, policy and rights agenda
World Health Organization | October 2014
- The mistreatment of women during childbirth in health facilities globally: A mixed-methods systematic review
PLOS Medicine | June 2015
- Disrespectful intrapartum care during facility-based delivery in sub-Saharan Africa: A qualitative systematic review and thematic synthesis of women’s perceptions and experiences
Social Science & Medicine | November 2016
- International human rights and the mistreatment of women during childbirth
Health and Human Rights Journal | November 2016
- Moving beyond disrespect and abuse: Addressing the structural dimensions of obstetric violence
Reproductive Health Matters | May 2016
- Facilitators and barriers to facility-based delivery in low- and middle-income countries: A qualitative evidence synthesis
Reproductive Health | September 2014
- Beyond too little, too late and too much, too soon: A pathway towards evidence-based, respectful maternity care worldwide
The Lancet | October 2016
- Failure to deliver: Violations of women’s human rights in Kenyan health facilities
Center for Reproductive Rights | 2007
- Disrespect and abuse of women in childbirth: Challenging the global quality and accountability agendas
The Lancet | June 2014
- Why do nurses abuse patients? Reflections from South African obstetric services
Social Science & Medicine | December 1998
- Exploring the prevalence of disrespect and abuse during childbirth in Kenya
PLOS One | April 2015
- The prevalence of disrespect and abuse during facility-based childbirth in urban Tanzania
BMC Pregnancy and Childbirth | August 2016
The MHTF, along with more than 70 partner organizations, endorsed the World Health Organization’s first statement on preventing and eliminating disrespect and abuse during childbirth released in 2015.
In partnership withe the White Ribbon Alliance, the MHTF played a role in the formation of the “Evidence-Informed Approaches to RMC” subcommittee of the RMC Global Council and in the creation of the RMC wiki database.
The MHTF measured the prevalence of disrespect and abuse and tested interventions to promote RMC in urban Tanzania in partnership with colleagues at Management and Development for Health, and conducted similar research in rural Ethiopia in partnership with colleagues from Addis Ababa University and the Last Ten Kilometers Project of John Snow, Inc.
Meetings & Events
In partnership with USAID’s Translating Research into Action (TRAction) project, the MHTF convened a technical meeting in 2013 to engage discussion around evaluating RMC advocacy for policy change from the global to the local level.
In May 2013, as a part of the Advancing Dialogue on Maternal Health Series, the MHTF hosted a panel discussion at the Woodrow Wilson Center to discuss widespread disrespect and abuse during childbirth around the world.
Blog Series: Respectful Maternity Care