By Hannah McCauley
A person who defends human rights is someone who, individually or with others, acts to promote or protect human rights (United Nations General Assembly, 1999). These rights include social, civil, economic, political and cultural rights, and, the right to health. The right of everyone to enjoy the highest attainable standard of physical and mental health is specified in the United Nation’s (UN’s) International Covenant on Social, Economic and Cultural Rights (UN, 1966). The UN’s Sustainable Development Goal 3 – to ensure healthy lives and promote wellbeing for all, at all ages – relates directly to maternal care and has specific goals to reduce maternal and neonatal mortality rates. Midwives play a crucial role in this. We have a duty to care for and support women during and after pregnancy. We are defenders of women’s rights!
Building quality relationships
In every country and community worldwide, pregnancy and childbirth are momentous events in the lives of women and families. Globally, childbearing is often considered an important ‘rite of passage’ which holds personal and cultural significance for a woman and her family. Safe motherhood currently focusses on the prevention of morbidity and mortality during and after pregnancy. There is now a strong international refocus on the need to encompass respect for women’s basic human rights, including respect for women’s autonomy, dignity, feelings, choices, and preferences during and after pregnancy. Issues related to gender equity and gender violence are at the core of maternity care.
Women’s experiences with maternity caregivers can empower and comfort them, or inflict lasting damage and emotional trauma. Physical abuse, lack of informed consent, lack of confidential and dignified care, discrimination, abandonment during care, and detention in facilities are some examples of the disrespect and abuse that women are experiencing (Kruk et al, 2014). There have been many interventions in low- and middle-income countries that aim to improve access to skilled birth care. This includes training healthcare providers to deliver competent birth care and have the ability to recognise and manage any complications. However, the quality of relationships with healthcare providers has until now received less attention. Fear of disrespect and abuse that women may encounter in healthcare facilities has been suggested to be a more powerful deterrent to the use of healthcare facilities for maternity care than commonly recognized barriers, such as cost or distance (Bohren et al, 2014).
Respectful maternity care
Women should never be denied access to maternity services and should not be disrespected or abused during or after pregnancy. The international community acknowledges these issues and recognises that all childbearing women need and deserve respectful care and protection of their autonomy and right to self‐determination. For example, The White Ribbon Alliance has developed a Respectful Maternity Care Charter which draws on relevant extracts from established human rights literature and demonstrates the legitimate place of maternal health rights within the broader context of human rights. It includes seven rights of childbearing women:
Midwives are best placed to advocate for women and these rights, and should be personally responsible for their own actions. They have a duty to ensure women have a positive pregnancy and birth experience. Globally, midwives are tackling the challenges outlined above to ensure gains are made in maternal health globally. Yet, the global shortage of midwives is creating a situation where women are not receiving quality care during and after pregnancy.
What can be done?
For midwives to continue to be defenders of women’s rights, governments must increase funding to train and hire midwives and other community health workers. Advocacy is also essential; communities must become aware of their needs and rights around access to pregnancy health services and demand quality services.
We must also continue to emphasise the importance of respectful maternity care. Midwives in the Centre for Maternal and Newborn Health, have conducted competency-based skills and drills training in antenatal and postnatal care, which includes respectful maternity care, in low- and middle-income countries. More than 200 healthcare providers have been trained across 5 low-and-middle-income-countries: Chad, Togo, Ghana, Afghanistan and Tanzania. One of the participants stated that:
“I learnt that respectful maternity care is an essential component of antenatal care and that psychosocial care in pregnancy is a key intervention for preventing maternal morbidity. I will ensure I provide respectful maternity care and discuss the importance of it with my colleagues.”
My colleague, Dr Mamuda Aminu has written a blog in BMC series about respectful maternity care: Respectful maternity care – the way forward.
Good quality maternal healthcare can be the difference between life and death. Trustworthy, competent, compassionate midwifery care empowers and encourages women to safely and positively welcome their newborn babies into the world. I am proud to be a midwife and a defender of women’s rights. Alongside other midwives and obstetricians in CMNH, I will continue to strive towards our vision of ending preventable maternal deaths, stillbirths and neonatal deaths and improve the health of mothers and babies in low- and middle-income countries.
About the author
Hannah McCauley is a midwife who has been practicing for more than 13 years in both high-income and low- and middle-income countries. She currently works in the Centre for Maternal and newborn health in LSTM as a Senior Research Associate and is undertaking research into what and how we can improve the care women receive during and after pregnancy.