Respectful maternity care, a right

An eight months pregnant woman was forced to carry her dead foetus for 19 hours in her womb in Gurgaon near Delhi. Doctors at the government hospital where she went declared the baby dead, but they refused to operate upon her because she had gone to the hospital alone (without any female attendant).

She was also reportedly slapped by the hospital staff and went through severe physical and emotional pain during that time. Finally, she was operated upon in a private hospital in the city with the help of the police.

Incidents such as this compel us to wonder if institutional births have any advantage over home care. The poorer one is and the more remote your village is, the more likely you are near the burden of expensive transportation costs. Other factors like high service fees for ca-re, illiteracy and a lack of awareness, all act as barriers to service access and receiving quality maternal healthcare. There is clea-rly a need to improve provider’s attitude, communication skills and building in cultural sensitivity in maternity care.

Each, year, over five lakh women worldwide die during pregnancy, delivery or in the postpartum period. India’s Maternal Mortality Rate (MMR), according to the National Sample Survey Organisation is reported to be 167 per 1,00,000 live births, thus contributing to about 15% of global maternal deaths. While many interventions aim to improve access to skilled birth care, the quality of relationships with caregivers during maternity care has received less attention.

The mistreatment of women during childbirth in health facilities is a growing area of research and public attention. Across the world, many women experience disrespectful, abusive, or neglectful treatment during childbirth in facilities. These practices can violate women’s rights, deter women from seeking and using maternal healthcare services and can have implications for their health and well-being.

In 2011, a groundbreaking consensus document, the Respectful Maternity Care Charter: The Universal Rights of Childbearing Women, was drafted which demonstrates the legitimate place of maternal health rights in the broader context of human rights. This charter was developed collaboratively by a multi‐stakeholder group with expertise bridging research, educational, clinical, human rights, and advocacy perspectives. However, it is yet to be accepted and implemented as a policy at the government level.

This year marks an end of Millennium Development Goals (MDGs) and a humble beginning for Sustainable Development Goals (SDGs) to achieve the development agenda over the next 15 years. It is an opportune moment to establish frameworks to accelerate action on maternal, newborn and child health.

Within these frameworks, global and national accountability systems which both monitor and drive the delivery of promises on women’s and children’s health, should be put in place to support targets on maternal, newborn and child health. Such accountability mechanisms must include the direct engagement of citizens and low cost interventions to help expectant mothers ease the delivery process.

Long-term policy changes

Government health systems must establish long-term policy changes at the village, district and country level to promote respectful maternity care and put an end to the disrespect and ab-use of pregnant women seeking care. This can be achieved thro-ugh proper enforcement of the ‘Respectable Maternity Charter’.

Addressing issues related to staffing and facilities for maternal health needs are important.  The use of institutions and quality services will not only decre-ase the MMR and reduce maternal morbidity but also instil confidence amongst end users thereby increasing utilisation of health services and inculcating better health behaviours. We need to improve the quality of care and comfort of stay for in-patients in public hospitals especially at the secondary level, through clean toilets, fresh lin-en, and a friendly environment.

A plateauing of institutional services and maternal mortality rates in the past year reflects the shifting priority of women’s health needs in the country. Guaranteed provision of quality services show the efforts taken to value women and are a crucial step towards making motherhood safer.

All women are entitled to maternal healthcare when they need it; regardless of where they live, their income, their caste or tribe. But as long as formal safeguards and policies against discriminatory and abusive practices remain absent, women will continue to be particularly vulnerable to avoidable morbidity and at risk of human rights abuses in healthcare settings.

(The writer is Executive Director, Centre for Catalyzing Change)