By CARE Canada’s Rebecca Davidson
Becoming a mom for the first time is a journey filled with excitement and wonder; I know this as a mom to Leo, 5, and Sadie, 2. It can also be a time filled with anxiety and fear, as I also know very well experiencing complications in both my deliveries. Yet, in some parts of the world, it can be a disempowering and traumatic experience.
Every day over 800 women die in pregnancy and childbirth, 99 per cent of these are in the developing world. Many of these deaths could be prevented if women had access to quality sexual, reproductive and maternal health services.
As Program Manager for CARE’s TAMANI project in Tanzania, I work with our partners in one of the country’s poorest regions to help make sure quality health care is available and that women and girls can access it. Improving availability of health care is challenging but straightforward at the same time - we know what will save the most lives in childbirth based on evidence and experience. Improving access to health care is a bit trickier. We must understand the local context that prevents women and girls from seeking and receiving the care they need.
On my recent visit to Tanzania, I was struck by the stories of fear and mistreatment at health facilities - especially for young mothers, who because of their age, are at risk for serious complications.
One 16-year-old girl told us:
I saw a woman being mistreated by the health care providers. They were insulting her after she had given birth on the floor because the nurse was late to attend to her. The woman had called this nurse several times but there was no response. The nurse insulted the woman, telling her that she poured her dirt on the floor. I think this treatment scares girls and they do not want to give birth at the health facility because they think that they may have a similar experience.
This young woman is now unlikely to seek care at a health facility should she need it, in a region where over 43 per cent of girls between the ages 15 to19 are pregnant or are already mothers – the highest rate of teenage pregnancy in Tanzania.
CARE believes every woman has the right to a safe journey into motherhood for herself and her baby. On April 11th, the International Day for Maternal Health and Rights, we stand in solidarity with women and girls and demand that the Universal Rights of Childbearing Women be respected.
The Respectful Maternity Care Charter developed through global consultations by White Ribbon Alliance, is a rights-based framework that draws upon existing declarations, international treaties, national laws, and patient charters to serve as the basis for securing policy commitments and undertaking global and grassroots advocacy.
Central to the Respectful Maternity Care Charter is the right to be free from harm and ill treatment. We have heard from 45 women who reported physical abuse during delivery, and nearly 100 women have shared stories of verbal abuse. How many more women will hear about this mistreatment and fear seeking skilled care when it is their turn to deliver?
We cannot minimize the challenges health care workers face. In Tanzania, roughly 50 per cent of health care positions remain unfilled and labour and delivery rooms are often small, crowded and under-resourced. Local gender and power dynamics negatively affect female health care workers. Access to broader reproductive health care, including family planning is essential – especially for adolescent girls. These complicated issues deserve our support and attention.
Within the TAMANI project, we are working to improve health care workers' conditions and skills and reinforce the importance of respectful care for all through coaching and mentoring so that young girls are not delivering alone on the floor. We are working with the community to address unequal gender dynamics. We are working to make it easier for women and girls to access health care and family planning.
Today on International Day for Maternal Health and Rights, I look at Leo and Sadie and I am grateful at how fortunate we were to receive skilled care that also respected my rights as a childbearing woman. I had a birth companion of my choice, I was told what was happening, and I provided consent when decisions were made about my care. Every woman deserves to realize her right to skilled and respectful care.
Today, we recognize that women and girls’ experiences are an essential piece of the puzzle in reducing maternal and newborn mortality. For all the advances we have made in making childbirth safer, if women and girls fear the providers of this care, we will never achieve what we need to save lives. This is why it is essential to include what women want in maternal and reproductive health programming, and to reinforce the rights of all women and girls to make the journey into motherhood safely with dignity and respect.