#EndDisrespect as a Maternal Health Innovation

The Maternal Health Task Force blog features an excellent piece today about the importance of addressing how health care providers treat women during pregnancy, childbirth, and postpartum care visits: 

Women’s health is affected by how they are treated during pregnancy, childbirth and after. South African women, for example, have described verbal abuse, including being ridiculed while pleading for assistance or pain relief, and being berated for “messing up” when they bled on the floor during labour. Many are later forced to clean up their own blood, the report states. “It’s become so normal some nurses don’t understand why it’s a problem to slap or shout at women in labour,” says Odhiambo. “Some say it’s necessary to get patients to follow directions, and it’s for their own good.” Health providers, especially midwives, nurses and obstetricians are held responsible for this situation, but in fact, it is the whole health system that allows the abuse and lack of care to take place.

I bolded that last sentence because it’s critical to the ways in which a solution is constructed to this problem. If we are to see this as a problem of the provider, we’re missing the bigger picture; and an opportunity to address how we transform the maternal health delivery system for the better instead. Providers, including midwives, need support and a transformation of the maternal health care delivery model so that patient-centered, high-quality care is the standard. 

As we note on our web site:

In Nairobi alone, over two-thirds of the city lives in low-income peri-urban areas where health conditions are poor and the availability of medical services is limited. Research by the African Population and Health Research Council has suggested a maternal mortality ratio of over 700 per 100,000 births in Nairobi’s slums, significantly higher than the national average.

Unfortunately, maternity centers in these low-resource areas in Nairobi are often dangerous, dirty and offer sub-standard care to the women who live near them. This makes it hard to encourage women to birth in a facility with a provider. When women are treated with disrespect, there is little incentive to visit a facility; even when there are skilled providers in attendance. This contributes to high maternal mortality rates. [For more on this, read the WHO’s consensus statement, ”Prevention and elimination of disrespect and abuse during childbirth” and follow #EndDisrespect on Twitter]. 

It’s why Jacaranda Health is building an innovative system that combines patient-centered care with high-quality and affordability; within our own health centers and to share with public and private facilities throughout Kenya and eventually East Africa. We aim to develop nurse midwife curricula that ensure a skilled health workforce, trained in quality and respectful care as well. It is only by engaging all levels of the health system that we will meet our own mission as well as the MDGs and post-MDGs to make pregnancy and childbirth safer for women and newborns.

Read more at the Maternal Health Task Force blog.

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