Respectful Maternity Care-Promoting a positive birth experience

Respectful maternity care focuses on the need for maintaining the dignity and respect of woman and promotes a positive birthing experience

1. Respectful Maternity Care “Promoting Positive Birth Experience" D.KOTESWARAMMA TUTOR COLLEGE OF NURSING ALL INDIA INSTITUTE OF MEDICAL SCIENCES PATNA

2. Verbatims… “ हमें नहीं पता , लेती रहो.बार-बार मत बुलाओ” "परेशान करा हुआ है तुम्हारे रिश्ते-दारो ने , ऐसे करेंगे तो इलाज नहीं होगा तुम्हारा यहाँ" “इतना मत चिल्लाओ मत ये रानी , ​​ सर दर्द हो रहा है” "अगर जोर नहीं लगेगी तो बच्चे की धड़कन ख़राब हो जाएगी और बच्चा ख़तम हो जाएगा“ "बच्चा तुम्हारा है , तो दर्द भी तो तुम्हें बर्दाश्त करना पड़ेगा" "अब तुम्हारे बच्चे का इलाज करे या तुम्हारे सवालों का जवाब दे"

3. Key concepts…. Disrespect and Abuse in childbirth Categories of Disrespect and Abuse Impact on safe motherhood Respectful maternity care(RMC): Concept The universal rights of childbearing women Barriers in implementing RMC RMC standards

4. Disrespect and Abuse in childbirth: what we know A global problem Occurs 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

5. Research shows…. Disrespect and Abuse leading to: Non-preference for institutional delivery Opting for caesarean section Fear and low self esteem due to humiliation

6. Categories of Disrespectful Care (Browser and HILL’ 2010) Physical abuse Non-consented care Non-confidential care Non-dignified care Discrimination Abandonment or denial of care Detention in facilities

7. Impact on safe motherhood “providers attitude” mattered more than cost, distance and lack of availability of transport for choosing facility based childbirths (Kruk et al,2009,Tanzania)

8. Respectful Maternity Care: General Concept RMC is an approach that: Focuses on the interpersonal aspect of maternity care Emphasizes the fundamental rights of the mother, newborn and families Respects the autonomy and dignity of woman giving birth, engages her active participation and decision making Recognizes that all women need and deserve respectful care and protection of the women’s rights.

9. RESPECTFUL MATERNITY CARE (RMC): HOW DID THIS WORK BEGIN? This work started out with this question: How do we increase uptake of skilled, facility-based childbirth care? What are women’s experiences during child birth? Percentage of births attended by a skilled birth attendant by UNICEF region, historical trends (2000-2022)

10. Respectful Maternity Care Movement RMC, sometimes known as “Humanization of Childbirth”, is a movement advancing progressively in several countries. Some landmarks in this movement are: The birth of the Humanizing Childbirth movement (Brazil 1975); WHO conference on appropriate technology for birth (Brazil 1985); the first International Conference on Humanizing Childbirth in Fortaleza (Brazil 2000); USAID supported Landscape Analysis on abuse and disrespect in childbirth care ( Bowser&Hill 2010); the RMC charter (WRA 2011 – with support of MCHIP, TRAction and others).

11. Respectful Maternity Care Movement Organizations and networks supporting this movement include: JICA (Japan International Cooperation Agency), RELACAHUPAN (Latin American and Caribbean Network for the Humanization of Childbirth), USAID (U.S. Agency for International Development), MCHIP (Maternal and Child Health Integrated Program), WRA (White Ribbon Alliance), TRAction and IMBCO (International Mother Baby Childbirth Organization) The RMC movement takes in consideration the categories of disrespect and abuse and the corresponding rights Maternity Care.

12. Respectful maternity care WHO defines good quality maternal and newborn care as- care that is ‘safe, effective, timely, efficient, equitable and people-centred’ One of the very important yet overlooked aspect of maternity care is respect,dignity and emotional support using effective communication Good quality of care has also been recognized as an important factor in promoting institutional deliveries, improved birth oiutcomes and in determining patient and her family’s health seeking behaviour

13. The universal rights of child bearing women Freedom from harm and ill treatment Informed consent, information and refusal Confidentiality, privacy Dignity and respect Equality, freedom from discrimination and equitable care Timely health care Liberty, autonomy and self determination

14. Disrespect and abuse-corresponding rights

15. Freedom from harm and ill treatment Women will not be abused physically by anyone. All types of physical contact with pregnant women should be gentle, comforting and supportive as possible

16. Right to information and informed consent Woman should not be forced to do anything without information or informed consent Explanation of proposed procedure or treatment in understandable language is necessary to make them to give their consent or refuse

17. Right to confidentiality and privacy Health care personnel must protect the confidentiality and privacy of the woman and their information during examinations, clinical procedures, and while handling records and information

18. Right to dignity and respect Pregnant women should not be humiliated and verbally abused by anyone care providers must ensure patients as comfortable as possible during procedures. Every women must be treated with respect and concern. They should be encouraged to express their idea feeling freely and provide feedback to the service providers .

19. Right to equality, freedom from discrimination and equitable care No one can discriminate because of something they do not like about pregnant women. All women are equal and must be treated with respectful care regardless of their ethic background, culture, social standing, educational level and economic status.

20. Right to timely health care and to the highest attainable level of health No one can prevent the women from getting the needed maternity care. Women who is going to give birth should never be left alone however sometimes they are neglected and left to deliver by themselves. Women should have companion of their choice throughout labour and birth for continuous support

21. Right to liberty, autonomy, self determination and freedom from coercion No one can detain the child bearing women or her baby without legal authority; some health facilities have been known to prevent women from leaving with their babies, because they can not pay their bills. This is usually only for a day or two, but there are reports of patients being held for weeks and months. Even women whose babies died have been detained because they could not pay their bills.

22. Benefits of RMC Respect for belief, traditions and cultures. Empowerment of women and her families to become active participants in health care. Continuous support during labor. Choice of companion during labor and birth. The right to information and privacy. Freedom of movement during labor. Choice of position during birth. Good communication between client and providers.

23. Barriers in implementing RMC Policy and management Infrastructure, resources and work condition Knowledge, skills and heath worker motivation Ethical, gender, economic and socio-cultural aspects Interpersonal relations and community factors

24. Key action points – focus of strategies or interventions to promote RMC Service delivery (management, infrastructures, and communications) Community participation Research Education and training Legal approaches Advocacy

25. WHO recommendation on respectful maternity care during labour and childbirth

26. RMC performance standards

27. Let’s think about the action plan at your workplace

28. CONCLUSION When a woman experiences disrespect and abuse during facility-based care, her rights are being violated. Often when this happens, more than one of her seven rights are being violated at the same time. Around the world, in both wealthy and poor communities and countries, women have been, and are, experiencing disrespect and abuse. All women deserve respectful and dignified care during pregnancy and childbirth. When we speak out and demand respectful care, we make it safe for women everywhere to do so.

29. References WHO recommendation on respectful maternity care during labor and childbirth. The WHO Reproductive Health Library. 018. Abuya T, Sripad P, Ritter J, Ndwiga C, Warren CE. Measuring mistreatment of women throughout the birthing process: implications for quality of care assessments. Reproductive health matters. 2018;26(53):48-61. Afulani PA, Phillips B, Aborigo RA, Moyer CA. Person- centred maternity care in low-income and middle-income countries: analysis of data from Kenya, Ghana, and India. The Lancet Global Health. 2019;7(1):e96-e109. E Shakibazadeh , M Namadian , MA Bohren , JP Vogel, A Rashidian , V Nogueira Pileggi, et al. Respectful care during childbirth in health facilities globally: a qualitative evidence synthesis. An international journal of obstetrics and gynecology. 017. 37

30. 5. Sen G, Reddy B, Iyer A, Heidari S. Addressing disrespect and abuse during childbirth in facilities. Taylor & Francis; 2018. 6. Siraj A, Teka W, Hebo H. Prevalence of disrespect and abuse during facility based child birth and associated factors, Jimma University Medical Center, Southwest Ethiopia. BMC pregnancy and childbirth. 2019;19(1):185. 7. Solnes Miltenburg A, van Pelt S, Meguid T, Sundby J. Disrespect and abuse in maternity care: individual consequences of structural violence. Reproductive health matters. 2018;26(53):88-106. 38

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