Meternal Health, Respect Maternal care,

1. RESPECTFUL MATERNITY CARE
By A. Chipondeponde

2. OUTLINE OF PRESENTATIONS
• Definition
• Overview of maternal Health
• Major, Direct causes of maternal morbidity
and mortality
• Disrespect and Abuse
• Factors associated with Disrespect and Abuse
• Tackling Disrespect and Abuse: Seven Rights of
Childbearing Women
• Characteristics of Respectful Maternity care

3. Ct….
• Solutions for Disrespect and Abuse
• Conclusion
• Reference

4. DEFINITIONS
• RMC is an approach centered on the
individual, based on principles of ethics and
respect for human rights, and promotes
practices that recognize women’s preferences
and women’s and newborns’ needs
• It respects her rights and choices through
supportive communication, actions, and
attitudes.

5. DEFINITIONS ct…
• Respectful maternity care (RMC) is a universal
human right that is due to every childbearing
woman in every health system.
• RMC refers to the humane and dignified
treatment of a childbearing woman
throughout her pregnancy, birth, and the
period following childbirth.

6. Family Centered Approach

7. DEFINITIONS cont.
• “Respect” can be a specific feeling of regard
for the actual qualities of the one respected
(e.g., “I have great respect for her judgment”).
• “Undignified“ is lacking dignity or value for
someone.
• “Disrespect” is rude conduct and usually
considered to indicate a lack of respect.

8. Maternal health
• Maternal health refers to the health of women
during pregnancy, childbirth, and the
postpartum period.
• While motherhood is often a positive, fulfilling
experience but many women associate
motherhood with suffering, ill health, and
even death
• The notion of safe motherhood must be
expanded beyond the prevention of maternal
morbidity or mortality to encompass respect
for women’s basic human rights.

9. Overview of maternal health
• Evidence suggests that in countries with high
maternal mortality, the fear of disrespect and
abuse that women often encounter in facility-
based maternity care is a more powerful
• It is critical that all births be attended by
skilled health professionals who provide
competent life-saving interventions.
• Interventions need to focus on improving
quality of care during facility-based childbirth

10. Major, direct causes of maternal
morbidity and mortality
The major causes of maternal morbidity and
mortality include
• haemorrhage,
• infection/sepsis,
• pre-eclampsia /eclampsia,
• unsafe abortion,
• obstructed labour and
• ruptured uterus

11. Major, direct causes of maternal
morbidity and mortality cont.
• Most maternal deaths are avoidable, as the
health-care solutions to prevent or manage
complications are well known.
• All women need access to
– quality antenatal care,
– skilled care during childbirth,
– care and support in the weeks after childbirth,
– Access to fully functioning emergency obstetric
care.

12. Disrespect and abuse (D&A) globally
and regionally
• Across the world many women experience
disrespectful, abusive, or neglectful treatment
during childbirth in facilities.
• These practices violates women’s rights, deter
women from seeking and using maternal
health care services and can have implications
for their health and well-being.

13. Disrespect and abuse (D&A) globally
and regionally
• Because disrespectful and abusive behaviours
and environments degrade the quality of
maternity care, identifying and addressing
D&A is an important component of cultivating
RMC in health facilities.

14. Disrespect and Abuse cont.
Disrespect and abuse can include but are not
limited to:
• any kind of physical or verbal abuse or
humiliation
• discrimination
• Non-confidential and non-consented care
• detainment due to unpaid fees
• denial of access to a health facility
• abandonment of care

15. Other forms of Mistreatment
• Poor communication, failure to introduce
oneself as a caregiver,
• Long waits with little attention to the woman
or her family.
• Overcharging in the health facility.

16. Factors associated with disrespect and
abuse
A. Policy
• National policy: failure to enforce existing laws or to
apply policy or laws that address health rights.
• Institutional policy:
– client rights and RMC not reflected in institutional policy;
lack of, or
– failure to use, protocols, guidelines, and performance
standards related to RMC;
– ignorance of the existing laws related to pregnancy, labour,
and delivery care; norms that exclude fathers, family
members, friends, traditional birth attendants (TBAs), and
doulas from the labour and birth process.

17. • Weak leadership and governance for
respectful and non-abusive care
• Insufficient funding for maternal health care

18. Factors associated with disrespect and
abuse cont.
• Cross-cutting
issues(national/institutional/community):
women and communities
– unaware of women’s rights in policy, or of laws
that protect them;
– health care providers do not respect norms or
rules and so work in an undisciplined way.

19. B. Facility infrastructure, physical resources,
and commodities
• Lack of adequate infrastructure (physical
space and environment).
– Lack of essential supplies and equipment.
– Poor facility conditions including extreme
overcrowding with patient sharing beds,
– Poor sanitation.

20. • Inadequate infrastructure leading to poor
working environment
• Staff shortages leading to high stress
• Poor supervision
• Lack of professional support
• Lack of understanding of clients’ rights
• Weak implementation of standards and quality
of care guidelines

21. Ct…
• Lack of resources for facilitating normal birth,
e.g., birth stools, birth balls; lack of
– informational materials related to respectful
maternity care.
– Few or no supplies for community midwives who
work in rural/remote sites

22. Factors associated with disrespect and
abuse cont.
• “Providers themselves may be
– treated poorly
– be underpaid
– face harassment
– difficult working conditions
– overcrowding,
– understaffing
so we need to address RMC holistically and look at how
to create more supportive work environments.”

23. • lack of empowerment by the clients which
makes it difficult for victims to seek justice
• Lack of understanding of women’s health
rights

24. Tackling Disrespect and Abuse: Seven
Rights of Childbearing Women
CATEGORY OF DISRESPECT AND ABUSE
1. Physical abuse
2. Non‐consented care
3. Non‐confidential care
4. Non‐dignified care (including verbal
abuse)
5. Discrimination based on specific
attributes
6. Abandonment or denial of care
7. Detention in facilities
• CORRESPONDING RIGHT
1. Freedom from harm and ill
treatment
2. Right to information, informed
consent and refusal, and respect for
choices and preferences, including
the right to companionship of
choice wherever possible
3. Confidentiality, privacy
4. Dignity, respect
5. Equality, freedom from
discrimination, equitable care
6. Right to timely health care and to
the highest attainable level of
health
7. Liberty, autonomy,
self‐determination, and freedom
from coercion

25. CHARACTARISTIC OF RESPECTFUL
CARE
• During childbirth, providers should be
characterized by a
– caring attitude,
– empathy,
– Support and trust,
– confidence
– empowerment,

26. CHARACTARISTIC OF RESPECTFUL
CARE Cont.
– gentle,
– respectful,
– and effective communication to enable informed
decision-making.
• But this may not be the case for most women.
Many women experience disrespect and
abuse (D&A)during childbirth.

27. Solutions for D&A
• This should include respect for women’s
autonomy, dignity, feelings, choices, and
preferences, including companionship during
maternity care.
• Health workers, women, and their families
need to know the rights of a woman seeking
maternity care.

28. Solutions for D&A cont
• Health sectors must address the needs of their
health workforces.
• Health sectors should provide health workers
with:
– Safe working conditions and reasonable working
hours

29. Solutions for D&A cont
– Policies that mandate health workers are treated
with respect by other staff and clients
– Support from their managers and ministries of
health
– Training on cultural sensitivity and continual
education on evidence-based practices

30. Solutions for D&A cont.
– Mentors who model respectful maternal care
– Adequately resourced facilities
– Physical and psychosocial support to combat
stress and fatigue

31. CONCLUSION
• When women choose not to give birth in
health facilities, due to fears of being treated
poorly, their chances of having a clean and
safe birth are reduced, and maternal and
newborn health (MNH) outcomes are
threatened

32. CONCLUSION cont.
• Addressing health system factors, as well as
professional behaviour, are compelling health
priorities, since D&A care is one of the top
reasons women cite for not seeking care from
skilled health care providers.
• Respectful maternity care is necessary. It is
achievable. And it’s everybody’s responsibility.

33. Reference
• - See more at:
http://www.intrahealth.org/blog/respectful-
maternity-care-everyone%E2%80%99s-
responsibility#.V16vJ_l97IU
• Carasciuc. L.,(2015). Mistreatment has a
solution, White Ribbon Alliance