Resource Library

AMDD’s Staha project systematically studies the types, prevalence, and root causes of disrespectful and abusive maternity care experiences and interventions to reduce D&A practices. Their website includes links to tools used in AMDD’s first study of disrespect and abuse (D&A) of women during facility birth. The tools have since been applied to research into the prevalence of D&A in other contexts.

In Mozambique, promoting respectful maternity care (RMC) has been a key priority for decreasing maternal and newborn mortality.1,2 The rollout of the ”Iniciativa Maternidade Modelo” (Model Maternity Initiative) had the dual purpose of improving quality of maternal and newborn care and integrating the tenants of RMC across the maternity care cascade.

Highlights

In this research brief, the objectives are to:

1. Take a mixed-methods approach to understanding birth companionship policies, statistics, and practices in Nampula Province, Mozambique, as reported by facilities, health care providers, parents of young children, and other stakeholders
2. Identify strategies to address gaps in current support for birth companionship in Mozambique

How to Use

The report is available in both English and Portuguese.

Summary

Born too soon: decade of action on preterm birth looks to the future, setting an ambitious agenda to reduce the burden of preterm birth by addressing factors outside of the health system that affect preterm birth; and, within health systems, by providing high-quality, respectful care for women and babies so that they can survive and thrive, no matter where they are born. 

Highlights

• Of every 10 babies born, 1 is preterm – and every 40 seconds, 1 of those babies dies
• Preterm birth rates have not changed in the past decade in any region of the world
• The impacts of conflict, climate change, COVID-19 are increasing risks for women and babies everywhere
• Action is needed urgently to improve the prevention of preterm birth, alongside better care for affected babies and their families

How to Use

This report is intended to inspire and support country-led action: politicians, policy-makers and leaders of all stakeholder groups are its primary audience. However, leadership “from the top” often emerges in response to a unified call to action by a broad-based coalition of committed advocates “from the bottom”.

Summary

Respectful care is of increasing interest within reproductive, maternal, newborn, child, and adolescent health (RMNCAH) care. Concurrently, there has been a call for health systems to be accountable to the populations they serve for delivering quality care. This package of materials focuses on the role of social accountability in enhancing respectful care across RMNCAH.

Highlights

• A technical report that examines the empirical evidence and theoretical basis of social accountability interventions’ influence on respectful care across RMNCAH;
• A companion technical brief on the use of social accountability approaches to improve respectful care in RMNCAH services; and
• A research brief that presents a conceptual framework with a theoretical pathway from social accountability to respectful care in RMNCAH.

How to Use

Implementers can use this conceptual framework to design local-level social accountability interventions that engender improvements in respectful care. The conceptual framework also reveals what elements along the causal pathway from social accountability to respectful care might need further attention in order for enhanced respectful care to be achieved as a result of social accountability efforts. Researchers and evaluators can use this conceptual framework to assess how changes in context or moderating factors influence the success of social accountability and to evaluate the effectiveness of the conceptual framework itself.

On March 30, 2022, the World Health Organization released guidance on maternal and newborn care for a positive postnatal experience. A total of 63 recommendations on maternal care, newborn care, health systems, and health promotion address individual patient care and service delivery.

The new guidelines respond to global trends in maternal-newborn morbidity and mortality. As death rates drop globally, the new guidelines place great emphasis on thinking beyond survival, and continue to provide guidance on essential interventions to continue reductions in maternal and newborn mortality.

Here is what’s new:

• The importance of family-centered care | The new guidelines address the importance of the home and whole family in the health of the mother-baby dyad, including specific guidelines for the inclusion of men in care plans, the use of home-based medical records, and assessment of the home environment prior to discharge.
• Increased focus on maternal well-being | Moving beyond survival for the mother, the new guidelines address maternal mental health and comfort, including specific guidelines for pain control following delivery, and universal screening and intervention for depression and anxiety.
• Thinking beyond survival for the newborn | Interventions during the hours, days, and weeks following birth can have long-lasting impact on the health and well-being of children. The new guidelines specifically address responsive care, early infant development, safe sleep, and screening for hearing and eye abnormalities.
• Tackling health system and workforce challenges | The new guidelines recommend several strategies for increasing the size and quality of the healthcare workforce needed for a positive postnatal experience, including specific recommendations about mobilizing a greater diversity of health workers, establishing midwife-led continuity of care models, and using digital tools to improve birth registration and health behaviors in the home. The new guidelines also recommend integration of complementary maternal-newborn services when possible (maternal mental health and early infant development) and routine screening and prevention of infectious diseases (de-worming, TB, HIV screening).

Mistreatment of pregnant women, adolescent girls and persons, as well as newborns is a pervasive problem around the globe. Anecdotal reports and research evidence collected in maternity care systems from the wealthiest to poorest nations worldwide, irrespective of the state of the health systems, paint a disturbing picture. In fact, mistreatment of persons seeking maternity care, whether subtle or overt, intentional or unintentional, is being recognized as an urgent problem and a growing global movement has been created that spans the domains of healthcare research, quality and education; human rights; and civil rights advocacy.

Aligned to the 2030 Agenda for Sustainable Development and the Every Woman Every Child Global Strategy for Women’s, Children’s, and Adolescents’ Health, the Quality, Equity and Dignity Initiative is committed to ensure that all women, children and adolescents have equal access to quality, affordable and respectful health care and services, in all settings, with the aim of promoting the values of Quality, Equity and Dignity in both the provision and patient experience of health care. The initiative provides an important platform for advocacy and programming, particularly in its effort to support the Quality of Care Network being led by the WHO and UNICEF, its work to support the development of costed national plans to achieve universal coverage of essential health services for women, children and adolescents and its promotion of respectful care in all settings. This document outlines what is needed for progress, and lays out these top line messages: 

1. Addressing issues of quality, equity and dignity in healthcare is critical to ensuring the health and wellbeing of women, children and adolescents. 
2. As a basic right, increased attention must be given not only to access of healthcare, but also to ensuring quality and respectful care, equitably. 
3. The time around birth is the most critical period for saving mothers and newborns, and preventing stillbirths, through universal and high-quality healthcare. 

The well-being of a woman and of her newborn are interconnected, and both can be marginalized in the process of childbirth and the ensuing months. Focusing on preventing maternal and newborn morbidity and mortality is not enough. Care during this period needs to encompass basic human rights, including the rights to respect, dignity, confidentiality, information and informed consent, the right to the highest attainable standard of health, and freedom from discrimination and from all forms of ill-treatment. A woman’s autonomy should be recognized and respected, as should her emotional well-being, choices and preferences—including the right to have a companion of choice during labor and childbirth. Respect and recognition of the woman can benefit the newborn, who also has rights and requires respect and recognition. Together, the woman with her partner and family should be supported to care for and make the best decisions for their newborn

Those who asked women and girls what they wanted sometimes found it difficult to move the conversation from the negatives to the positives. We know the negatives: lack of supplies, shortages of staff, high costs, long distances to health centers. Our goal was to hear what women and girls wanted most: dignity and respect, clean and equipped facilities that are within reach physically and financially, choices, information and much more. This campaign called on women to make a statement of hope about how each and every one of us believes that things should rightly be.

This resource, written by the IAWG Maternal and Newborn Health sub working group, outlines interventions implemented in stable settings that maternal and newborn health (MNH) providers and program managers in crisis-affected settings have identified as promising strategies for humanitarian settings. While respectful maternity care (RMC) is being incorporated in some humanitarian and fragile settings, more evidence around the implementation and effectiveness of these interventions for diverse populations including host communities, refugees, internally displaced persons, young mothers, and other vulnerable groups is needed. This brief can be used as a tool to improve and promote RMC in fragile and conflict-affected settings. 

Many women experience disrespectful and abusive treatment during childbirth in facilities worldwide. Such treatment not only violates the rights of women to respectful care, but can also threaten their rights to life, health, bodily integrity, and freedom from discrimination. This statement calls for greater action, dialogue, research and advocacy on this important public health and human rights issue.

Postpartum hemorrhage (PPH) occurs in approximately 5% of all births and despite concerted efforts, remains the leading cause of maternal mortality and morbidity worldwide. Many of these deaths are preventable with quality evidence-based care. In Tanzania, 29% of all maternal deaths are due to PPH, contributing to the high national maternal mortality ratio (556 deaths/100,000 live births). Unfortunately, this situation has remained largely unchanged for the past 10 years.