Respectful Maternity Care defined by the WHO as “care organized for and provided to all women in a manner that maintains their dignity, privacy and confidentiality, ensures freedom from harm and mistreatment, and enables informed choice and continuous support during labour and childbirth – is recommended”. IT is a critical component of maternal and new born care.

In developing countries, apart from the lack of resources inherent socio-economic and cultural inequalities play a part in the quality of medical care and respectful care that people receive.

This article examines some of the factors which effect respectful maternity care and some of the changes which can be brought about to improve it.

 

Many developing countries have fewer medical professionals for the population than recommended by the World Health Organisation (WHO). The WHO norms state that for a population of 1000 there needs to be a 44 doctor, yet in more than 45% of WHO member states report having less than one physician for a population of 1000.

 

The ratio for other health professionals such as trained nurses and midwives is also equally low. Such low ratios of health professionals to the population increase the work pressure on doctors and doesn’t allow them to spend adequate amount of time with patients. This high-pressure atmosphere is believed to be one of the contributing factors for providing poor quality of healthcare. While this maybe a reason one wonders why patients in these situations do not complain about the poor quality. A major reason for this is the inherent social inequalities which exist within a society.

 

Medical professionals tend to come from higher social classes in the society while their patients come from different strata’s and it maybe difficult for people from poorer and marginalised communities to complain about health professionals.

 

These issues become even more evident when dealing with women’s health. Even in developed countries it was found that health professionals took longer to care for women when they complained about pain. These were found to be more acute in the case of marginalised women in the communities.

 

A place where these issues are compounded are in labour rooms.

 

In India in many health facilities it Health professionals misbehaving with women, scolding them and in extreme cases even physically hitting them is a common occurrence. Rude behaviour by medical staff in these situations has been normalised to such an extent that most women do not complain about it and accept it as the proper form of care.

When women were asked later about their experience of childbirth it was found that if the child was healthy and had survived the women viewed the entire episode favourably and if the child had not survived, they were more likely to be critical of the facility. The irony of the situation is that research finds that when women give birth in a safe and enabling environment, they tend to have safer births.

 

The notion of what is good quality on aspects of hygiene and sanitation always be based on feedback from patients as patients from very poor households may sometimes live in unsanitary conditions themselves.

Even a dirty hospital for some is better than what they are used to and hence may not find a reason to complain.

 

There have been situations when my colleagues and I were visiting hospitals and have found rats running which even the patient could see. But when asked about the cleanliness of the place the patients said she they found the place very clean.

 

Behavioural changes towards patients need to be inculcated during the training of health professionals both in nursing and medical schools. Health professionals need to be educated on the inherent inequalities in societies while dealing with patients from different strata of society.

 

Things are changing. Initiatives such as the White Ribbon Alliance for Safe Motherhood, a global network of maternal health professionals across the world is working to improve the quality of Respectful maternal healthcare.

 

 

They recently released a charter on Universal right of child bearing women which lays down the essential components of respectful maternity care. The government of India has brought in the Laqshya guidelines to improve labour room practices and prioritising the provision of respectful maternity care.  The District hospital in Aurangabad India a public hospital, has built a model for providing respectful care in overcrowded Public hospitals. The initiative led by the team Dr. Srinivas Gaddappa may soon be used in other hospitals.

 

 

Inequalities in society effect the access that an individual has to resources. Access to Respectful Maternity care is also one such resource currently but through a conscious effort of policy makers and medical professionals this resource could be available to everyone.