On May 30th, 2018, HHL Co-Director Neil Prose spoke at the University of Amsterdam in a multidisciplinary roundtable on the topic of Respectful Maternity Care.
The last decade there has been a gradual, partial shift in the field of global maternal health: from a focus on reducing maternal deaths to fostering respectful maternity care. A growing body of literature documents various forms of ‘disrespect and abuse’ occurring in labour wards around the world, seemingly especially pronounced in low and middle income countries. Declarations regarding the rights of childbearing women have been formulated by the WHO and international organisations, typologies of abuse (e.g. verbal abuse; physical abuse) have been developed, and interventions are being rolled out. However, not much is known yet about how to best promote respectful care. Few studies have hithereto studied RMC interventions. What works, for whom, under what circumstances? What are the potential unintended consequences? And, to what extent do generic ‘rules’ regarding respectful care fit local realities on the ground, and how do they translate in the various social, economic and political contexts? We seek to reflect on such questions in this roundtable, which seeks to bring together social scientists, medical practitioners and public health specialists.
Dr. Neil Prose was joined by Dr. Bredje de Kok, assistant professor, Anthropology/Amsterdam Institute for Social Science Research, University of Amsterdam.
Empathic Communication and Respectful Maternity Care
Neil S Prose MD
In the past decade, disrespect and abuse during pregnancy and childbirth has been the subject of extensive study in a number of low and middle income countries in Africa and Latin America. Research teams have documented varying degrees of physical and verbal abuse, stigma and discrimination In many cases, women were not afforded privacy during the labor and birth process, nor allowed to have a family member or other companion present during delivery.
In this brief talk, I will describe two interventions designed to increase the level of empathic and respectful maternity care. The first is a learning session for midwives and health extension workers, which has been presented throughout Ethiopia as part of a national project on maternal and child health. The second is a communications skills seminar for midwifery students at the University of Aysen, in Chilean Patagonia. In each case, I will touch on some basic linguistic and cultural challenges, an overall philosophy of empathic communication, and the ways in which the power of the individual story, as portrayed in testimonial videos of women who encountered obstetric violence, can create the foundation for a powerful learning experience.
Translating respectful maternity care in Malawi: Mind the gap.
Bregje de Kok
When Napier University, Edinburgh and the Association of Malawi Midwives (AMAMI), developed a Respectful Maternity Care intervention, early formative survey research led to some puzzling findings. Whilst high percentages of women reported to have experienced high levels of ‘disrespect & abuse’(e.g being shouted at, slapped), an equally high percentage reported to be satisfied with their care. There clearly was a need for more in-depth, qualitative ethnographic research into the meanings of ‘good’ care and respect. In this team-ethnography, we conducted observations in labour wards in facilities in central Malawi. In addition, in interviews and focus groups we discussed experiences of care and perceptions of respectful care with midwives, women who recently gave birth and their guardians, that is, relatives who accompany women to the facility and provide basic care. Our discussions point to various translation issues and misunderstandings, and a disconnect between midwives and women. Equally, some of the universal respectful care principles seem to jar with local possibilities, priorities and local notions of good care. In this presentation I will present our preliminary findings and reflect on what this may mean for respectful maternity care interventions and research.