This document discusses disrespect and abuse during facility-based childbirth, which is a global problem occurring in both low and high income countries. It identifies several categories of disrespect and abuse based on reports, including physical abuse, non-dignified care, non-consented care, and abandonment or denial of care. The document then provides several quotes from studies illustrating examples of these categories. It discusses how disrespect and abuse can negatively impact utilization of skilled birth care and efforts to reduce maternal mortality. Finally, it outlines goals and strategies for a multi-sectoral initiative to promote respectful maternity care through advocacy, developing consensus on a charter of universal rights for childbearing women, and aligning standards of care

1. Respectful Maternity Care:Tackling Disrespect & Abuse During Facility-Based Childbirth

2. Disrespect & Abuse in Childbirth: What We Know USAID Landscape Analysis (Bowser & Hill, 2010) Global problem, occurs all over the world in low, medium, and high income countries Many anecdotal reports, little formal research No normative standard for respectful care It is a violation of human rights

3. Categories of Disrespect and Abuse Physical Abuse Non-Dignified Care Non-Consented Care Non-Confidential Care Discrimination Abandonment or Withholding of Care Detention in Facilities Exploring Evidence for Disrespect and Abuse in Facility-Based Childbirth; USAID TRAction Project 2010

4. Physical Abuse “When a woman goes into the second stage of delivery, you don’t want her to close her legs, so you’re beating her.” (CRR and Federation of Women Lawyers, Kenya, 2007)

5. Non-Dignified Care “One nurse told me: ‘Lady, can’t you see that you are in the way? Go over there, you aren’t anything but an animal and talking to you is like talking to an animal” (S, Miller et al, 2002, DR)

6. Non-Consented Care “Providing explanations to less educated women (is) a not a good use of time as ‘they just can’t understand’” (S. Fonn et al, 2001, S. Africa)

7. Non-Confidential Care Numerous reports by interviewees from Latin America, the Caribbean, Eastern Europe, Africa and Asia of routine lack of privacy (including delivery in full public view), confidentiality, information sharing and consent protocols. (TRAction, 2010)

8. Lack of Privacy in Maternity Units

9. Discrimination “Everything that came out of her mouth was the color of my skin. She goes, ‘You’re the first dark person I’ve ever had.’ I sat there and had to deal with that. After that, I left and never went back.” (Amnesty International, 2010, USA)

10. Denial of Care “After the injection I gave birth. The doctor had left by then and the nurse said she would not help me until the head of the baby came out. I was assisted by one of the patients who was waiting to give birth. (The nurse) later came and took the baby…told me to get off the bed and wipe the bed.” (Kenya, Fed. Women Lawyers, 2007)

11. Abandonmentof Care “You just call (for the nurse) until you get tired and then you finally deliver by yourself and die. I have even witnessed it myself.” (FCI, The Skilled Care Initiative, 2005, Kenya)

12. Detention in Facilities “When I got the bill, the doctor said to me, ‘Since you have not paid, we will keep you here.’” (Human Rights Watch, 2010)

13. Impact on MDGs Growing evidence for the negative impact of disrespect and abuse during facility-based childbirth on skilled birth care utilization Reviewed studies suggest it may sometimes be a more powerful deterrent to the use of skilled birth care than geographic and financial obstacles

14. Discussion Is this a problem that you have seen or heard about in your maternity facilities? Are you aware of any studies, programs, policies, or advocacy initiatives in your area to address this issue? What works? What more is needed?

15. Promotion of Respectful Maternity Care

16. 2011: Promotion of Respectful Maternity Care Global focus: Convene a multi-sectoral advisory council bridging research, clinical, human rights, and advocacy Develop strategies to raise awareness and foster advocacy and policy initiatives to address this issue Country focus: Initiate a collective dialogue with NAs about this issue; share experiences, updates and promising practices Explore opportunities for activities in specific countries

17. 2012: Promotion of Respectful Maternity Care Global focus: Convene partners and launch multi-pronged campaign Recruit champions and seek out/create high-visibility opportunities for them to speak out on this issue Country focus: Support innovative advocacy and social watch activities among WRA NAs Provide opportunities for sharing of experiences and best practices

18. Advocacy Goals GOAL: Lift the “veil of silence” on this issue, raise awareness and voices Strategies: Produce and disseminate short advocacy film, promote collective dialogue, recruit champions and mobilize civil society to speak out

19. Outcomes of Multisectoral Process: GOAL: Build women’s sense of entitlement, align it with normative and clinical standards and provide a basis for accountability Strategies: Draft and build broad consensus among key stakeholder groups (global and national advocacy, rights, clinical/technical) on a charter of rights that each group can use as basis for action (advocacy, accountability, clinical quality improvement and quality assurance)

20. Draft Charter of theUniversal Rights of Childbearing Women OBJECTIVE: To raise awareness of the problem in a way that avoids blaming/shaming To show that the rights of childbearing women have already been recognized as human rights To provide a tool for advocacy at all levels and a basis for accountability approaches To provide a platform for aligning childbearing women’s sense of entitlement to quality maternity care with international human rights

21. The Proposed Rights Framework

23. Discussion What is the relationship between disrespect and abuse, and clinical quality of care? How do women’s experiences affect their perceptions of the healthcare system and utilization of services? Would the Respectful Care charter be useful to you, and how could you use it to address disrespect and abuse in your sector/setting?

24. Respectful Care Charter: The Universal Rights of Childbearing Women “Safe Motherhood” is more than the prevention of morbidity or mortality: It is respect for every woman’s autonomy, dignity, and her feelings, choices and preferences…