Respectful care essential to saving women’s lives

Growing evidence suggests disrespect by health care providers is part of women’s experience of labour and delivery in many countries

Written by Rebecca Davidson, Global Health Program Manager for CARE Canada, and Catherine Savoie, Global Health Coordinator for the Society of Obstetricians and Gynecologists of Canada (SOGC)

This month in Canada we celebrate mothers, while our friends in the UK are buzzing about a royal baby.

Certainly this leaves many women looking back fondly on their own birth story. If you are like us, two women who gave birth in Quebec and Ontario, you probably had a choice to be followed by a midwife, family doctor or obstetrician throughout your pregnancy.

Your pre-natal visits involved time for questions and concerns, and your consent on what interventions would, or would not take place.

You may have had a birth plan (even if it went straight out the window when you went into labour), and once those contractions started, you were likely able to choose where to deliver your child.

You also likely had a partner or friend to provide moral support, and you probably had privacy from other birthing women while in active labour.

This may not be the case for all women in Canada, particularly Indigenous women. And this definitely is not the birth story for too many women in developing countries.

The reasons why are often attributed to far-flung and poorly-equipped medical clinics. But a growing body of evidence also suggests that disrespect and abuse by health care providers is part of women’s experience of labour and delivery in many countries.

In Tanzania, one of our authors met a woman who arrived to a health facility where she was unattended to, and gave birth alone to a stillborn baby.

CARE’s field workers also met a young woman who was scolded while in labour by health care workers, and shamed for giving birth out of wedlock. Other women recounted stories of delivering their babies on the floor of a crowded maternity ward, usually on a tarp and with no companion.

Research in Tanzania suggests that up to 28 per cent of women surveyed experienced abuse while in labour and delivery. Other surveys in Tanzania suggest women will travel twice as long to access respectful care (often bypassing their local health facility) if they have previously been mistreated.

"While we know that health care providers in rural and remote settings face many challenges, the way they engage with women, especially in pregnancy and delivery, can set the stage for whether she seeks life-saving care."

With the support of the Government of Canada, CARE and the Society of Obstetricians and Gynecologists of Canada (SOGC) are working together on a project in the Tabora region of Tanzania, an area with high rates of maternal mortality. Our team has found that 78 per cent of women did not feel informed about the delivery care process, and 93 per cent said they were not given time to answer questions and give their opinion.

While we know that health care providers in rural and remote settings face many challenges, the way they engage with women, especially in pregnancy and delivery, can set the stage for whether she seeks life-saving care for herself and her child in the future.

What were once assumed as simply barriers of cost or transport, are emerging as women quietly voting with their feet in search of kind treatment.

This is why our organizations are working with health care providers to ensure women receive respectful care. Together with local partners, and drawing upon SOGC’s expertise in promoting optimal, culturally-safe health care for women across Canada and around the world, we are experimenting with different approaches to support compassionate, patient-centered care. For example, we train coaches and mentors who then model this behaviour and encourage their peers to treat women with respect.

And we are starting to see some promising results.

Data from our last household survey found a decrease in the number of women who reported being physically hurt, coerced, or called names during delivery.

We also saw increases in the number of women who said they were able to choose their birth companion. More women also said their questions during labour and delivery were answered in a respectful way.

And we were really excited to hear that more women had time to give their opinions on what they wanted and felt they could ask questions.

The drivers of disrespectful care are complex. Unequal gender norms and power dynamics that privilege some groups over others are replicated at the health care facility. This is why, in addition to working with health care providers, we also dig into these issues with the broader community.

Shifting attitudes and transforming patient-provider relationships takes time and reflection. But this work can no longer be considered optional. We know it is an integral component of clinical training if we want to save lives.

While we may not all receive royal treatment, women everywhere deserve to be accompanied into motherhood with dignity and respect.


Learn more about the TAMANI project in Tanzania