Respectful Maternity Care

• Resources
• The Role of the MHTF

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 more holistic 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), founded 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:

1. Physical abuse
2. Sexual abuse
3. Verbal abuse
4. Stigma and discrimination
5. Failure to meet professional standards of care
6. Poor rapport between women and providers
7. 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 socioeconomic status, parity, age and the partner’s race. Being multiparous has been found to be a protective factor, which may suggest that past experience helps patients avoid disrespectful treatment, or that disrespectful treatment is normalized by past experiences among certain groups, such as women of color, young women, and those with economic, social or health challenges.

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 healthcare facilities, which included an increased focus on respect and preservation of dignity. In addition to the eight domains of quality of care, the framework also includes six strategic areas to help build a systematic, evidence-based approach for providing quality care:

1. Clinical guidelines
2. Standards of care
3. Effective interventions
4. Quality measures, and
5. Relevant research and capability building

While a number of interventions have aimed to address this issue, many women around the world 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.