Respectful Maternal Care

Emerging evidence indicates that, all too often, women face humiliating and undignified conditions in health facilities. These negative patient experiences contribute to poor health outcomes and reinforce mistrust of institutional care. Women and families may delay or avoid seeking care in health facilities--even at the risk of their own health and that of their newborn. Our aspiration is to decrease--and eventually eliminate--disrespect and abuse during facility-based childbirth.

In 2010 the USAID|Translating Research into Action (TRAction) Project commissioned Bowser and Hill to conduct a review of literature called "Exploring Evidence for Disrespect and Abuse in Facility-Based Childbirth: Report of a Landscape Analysis." This report classified these experiences into seven categories: physical abuse, non-confidential care, non-consented care, non-dignified care, abandonment/neglect, discrimination, and unfair requests for payment. This was the first step toward systematically investigating disrespect and abuse related to facility-based childbirth.

Since the release of a landscape analysis, TRAction has supported studies that describe and quantify disrespectful and abusive care related to facility-based childbirth in three countries: Tanzania, Kenya and Guatemala. TRAction along with its partner organizations has worked toward better defining, describing, addressing, and advocating for improved facility-based childbirth services and infrastructure.

TRAction supports efforts to promote respectful maternal care in the following areas. Click on the links to learn more:

TRAction contributed to the development of the WHO statement entitled “The Prevention and Elimination of Disrespect and Abuse during Childbirth,” which includes the experience of care along with the provision of care as an integral component of quality of care and health outcomes. In 2016 the WHO developed recommendations on antenatal care for a positive pregnancy experience (access the report here).

A brief of TRAction's RMC work can be found here.

Key Results

Following the landscape analysis, TRAction’s current research studies in Kenya, Tanzania, and Guatemala have produced promising results to address the issue.

The Heshima (Kiswahili for “respect”) study in Kenya was designed to investigate the effects of an array of complementary facility and community interventions for reducing disrespect and abuse during facility-based childbirth in Kenya. The intervention period was associated with an overall 7% reduction in disrespect and abuse reported by postnatal women after their discharges from maternity units, from 20% to 13%.

The Staha (Kiswahili for “dignity”) study in Tanzania provides an important early example of an approach to reducing disrespect and abuse and increasing respectful maternity care. In the Tanzania study, the results of the interventions within the facilities and communities have shown the potential to reduce the occurrence of disrespect and abuse and to possibly improve maternal and neonatal outcomes. The implementation research revealed that stakeholders, implementers and community members alike found the interventions to be acceptable and feasible as a means to promote respectful care.

The TRAction Guatemala project revealed that 18% of women who gave birth in a health facility reported at least one of the three examples of disrespect and abuse, while 9% of women who gave birth at home perceived that women are abandoned in health facilities and must pay or give something for better care.

All three studies uncovered factors contributing to disrespect and abuse including societal factors such as historical marginalization of certain populations to institutional factors and a lack of accountability, substandard infrastructure, limited resources, stressful working conditions, and poor health worker supervision.

Our Partners

Columbia University's Averting Death and Disability (AMDD) program
Ifakara Health Institute
Population Council
Federation of Women's Lawyers in Kenya (FIDA)
National Nurses Association of Kenya (NNAK)
Cooperativa Todos Somos Nebajenses (COTONEB)

Events

Publications Featuring TRAction Research

Collaborative Efforts

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Addressing Disrespect and Abuse in Kenya

Photo of Kenyan woman carrying water, Photoshare

Addressing Disrespect and Abuse in Kenya

An award was made to Population Council in February 2011 to fund implementation research on disrespect and abuse during facility-based childbirth in Kenya. The purpose of the research was to document the manifestations and prevalence of disrespect and abuse in facilities and to design, test and evaluate an approach for reducing the problem. The research aimed to promote respectful maternal care (the converse of disrespectful and abusive care) so demand for skilled delivery care increases and the quality of services rendered improves.

Addressing Disrespect and Abuse in Tanzania

Photo of Mothers and babies at Kibaoni Health Center, Photoshare

Addressing Disrespect and Abuse in Tanzania

An award was made in February 2011 to fund implementation research on disrespect and abuse during facility-based childbirth in Tanzania. The purpose of the research is to document the manifestations and prevalence of disrespect and abuse in facilities and to design, test and evaluate an approach for reducing the problem. The research aims to promote respectful maternal care (the converse of disrespectful and abusive care) so demand for skilled delivery care increases and the quality of services rendered improves.

Exploring Disrespect and Abuse in Guatemala

Photo of Indigenous midwives in Guatemala, Photoshare

Exploring Disrespect and Abuse in Guatemala

While socioeconomic status and place of residence are considered the main factors for underutilization of modern health care in Guatemala, some argue these two factors alone do not fully explain ethnic disparities in women’s use of maternal health services. In order to explain some of these differences, disrespect and abuse in the exchanges between health care providers and patients among the indigenous population in Guatemala is a recent issue that demands to be further explored.

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Respectful Maternal Care

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