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Respectful Maternity Care:Tackling Disrespect & Abuse
During Facility-Based Childbirth
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
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
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)
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)
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)
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)
Lack of Privacy in Maternity Units
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)
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)
Abandonment of 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)
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)
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
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?
Promotion of Respectful Maternity Care
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
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
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
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)
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
The Proposed Rights FrameworkCategory of Disrespect & Abuse
Corresponding Rights
Physical abuse (1) Freedom from harm and ill treatment
Non-consented care (2) Informed consent, right of refusal, respect for patient choice and preferences
Non-confidential care (3) Confidentiality, privacyNon-dignified care (4) Dignity, respectDiscrimination based on specific attributes
(5) Equality, freedom from discrimination, equitable care
Abandonment or denial of care
(6) Right to health care and to the highest attainable level of health
Detention in facilities (7) Liberty, autonomy, self-determination, and freedom from coercion
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?
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…