Why Respectful Maternity Care Should Be the Right of All Women

Loise* first met midwife Kathy at a Jacaranda Health mobile antenatal outreach clinic in 2012. This was her second pregnancy, and she was surprised to find a maternity provider who would bring services into her area, on the outskirts of Nairobi, Kenya, rather than expecting her to go to them. Kathy saw patients in the back of a community hall, and carried all the necessary equipment and documentation with her. Despite the rather makeshift nature of the space, Loise felt cared for, respected, listened to and supported. In fact, she built such a bond with Kathy that when she finally delivered at Jacaranda Health’s maternity hospital in Ruiru, a peri-urban area near Nairobi, she asked for Kathy to be there – not as her midwife but as her birth partner.


We at Jacaranda Health are proud to be able to say that Loise is just one of many women who have attended Jacaranda Maternity Hospitals (we have two hospitals, outside of Nairobi) for antenatal care, and built such a rapport with their caregivers that they have asked for them to be at the delivery as a birth partner. We are prouder still that our midwives, time after time, come in on their off days, stay after hours, and make themselves available to support their patients in this way.

To mark International Day for Maternal Health & Rights (IDMHR), on April 11, 2015, Jacaranda Health is happy to be participating in this blog carnival because we strongly believe that mothers around the world should have access not only to quality care, but care that is individualised, respectful and cognizant of their autonomy, dignity, choices and preference.

As the White Ribbon Alliance, one of the partners for IDMHR notes, “Every woman needs access to skilled health care if she is to be safe during childbirth – but the quality of that care is crucial. Women’s memories of their childbearing experiences stay with them for a lifetime.”

It’s not only critical then that women receive high-quality maternity care with skilled providers but also that those providers offer the respect and compassion that all women deserve before, during, and after childbirth. There is evidence that women sometimes do not seek care at facilities, even if those facilities are accessible, for fear of being disrespected and even abused. This is unacceptable.

Here are five ways Jacaranda Health advocates for respectful care for our patients:

1)    Patient rights charter

At the entrance to every Jacaranda Maternity is our patient rights charter in English and Kiswahili, outlining the rights and the type of care every woman should expect to receive at Jacaranda. Our patient base is primarily low income women, and most rarely receive recognition as autonomous decision makers, particularly in healthcare settings. We hope that  displaying the patient rights charter in a public area educates our patients as to the care they deserve, encourages them  to speak up if they feel otherwise, and holds all our staff accountable to uphold those patient right standards.

2)    Right to information, informed consent and refusal

Providing timely, appropriate, and culturally relevant information, counselling and education n is vitally important for healthcare, particularly maternity and child care. At Jacaranda Health, patients are counselled about the care they are about to receive and asked to sign an informed consent form prior to any consultation or treatment. They are encouraged to ask questions about their care as they receive it, and are made aware of the right of refusal.

3)    Respect for choices and preferences

Education is at the core of what we do, ensuring that our patients have the information they need to make informed decisions about their bodies, their pregnancies, and their families. Jacaranda patients receive extensive counselling and education in their antenatal visits, including detailed birth planning. This provides them the time and the information to make informed choices about their care, including the birth companion of choice. Of course, we are always thrilled whent that birth companion is a Jacaranda staff member!

4)    Patient Satisfaction

We measure our success on the satisfaction of our patients. Patients complete satisfaction surveys as the end of every consultation, whether inpatient or outpatient, and the data from this drives all our service-delivery decisions. Our measure of whether we have achieved in providing valuable care and advocating in the best interests of our patients is whether our patients will refer another pregnant mother to our facility – and 97% of them report they will.

5)    Quality of Care

Quality of care is a major factor influencing a woman’s decision to use facility-based maternity care – but is nevertheless underemphasized by many public and private service providers. Jacaranda’s emphasis on quality extends to everything we do, from nurse training to patient meals. Our commitment to quality has been recognized with a SafeCare accreditation rating of 3 – the highest so far awarded in Kenya. We use human-centered design principles to better understand the barriers that our clients face and develop programs that address these barriers, such as the need for more effective savings tools for birth planning, Caesarean section capacity, and the ability to accept National Health Insurance Fund (NHIF) insurance. These initiatives have resulted in the percentage of our antenatal clients who end of delivering at Jacaranda more than doubling from 2013 to 2015.

We hope you’ll join Jacaranda Health and all of the organizations in support of the International Day for Maternal Health & Rights to ensure respectful maternity care for all women.

*Name changed to protect patient privacy. 

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