Respectful Maternity Care at MSI
When a woman comes into an MSI maternity center, we want her to have a positive experience. Our new Respectful Maternity Care training helps ensure that happens, giving providers a new perspective on preventing obstetric violence.
What is obstetric violence?
The term “obstetric violence” covers a wide range of experiences which take choice and autonomy away from the laboring woman. This can include everything from dismissive attitudes to aggressive behaviors by health care providers. But it also includes practices such as unnecessary episiotomies or unnecessary separation of mother and baby.
Obstetric violence includes:
- Exams or procedures without consent
- Bullying into procedures such as C-Sections
- Disrespectful treatment or mocking
- Lack of privacy during labor and birth
Unfortunately, this kind of experience is sometimes deeply rooted in routine practices, and it’s more common than you might think. One study by the WHO followed over 2000 women pre- and post-childbirth in Ghana, Nigeria and Guinea. It concluded that four out of ten women experienced discrimination or verbal or physical abuse, such as slapping, mocking, and unnecessary medication or cesarean sections.
By contrast, respectful maternity care is care organized for and provided to all women in a manner that maintains and respects her dignity, privacy, and confidentiality. It ensures freedom from harm and mistreatment and enables informed choice and continuous support during prenatal care, labor, childbirth and postpartum. For example, it might include allowing birth companions; avoiding unnecessary episiotomy; or humanized Caesarean sections.
Negative birthing experiences deny women their bodily autonomy: Their fundamental right to decide what happens to their body, the right to informed consent, the right to privacy, and the right to equal treatment. This can have a lasting impact on women’s health, including higher incidence of postpartum depression, breastfeeding and bonding issues.
Turning resources into practice
MSI operates high-quality maternity centers in 7 countries, including Ethiopia, Bangladesh and Madagascar. MSI maternities offer the full range of services including vaginal, assisted births, and C-Sections, antenatal and postnatal care, comprehensive abortion care, as well as gynecologic surgeries.
MSI’s staff were already committed to providing a safe experience for women, and were already using clinical guidelines and tools created by the World Health Organization to support respectful maternity care. But we wanted to do more, changing the beliefs and attitudes that can lead healthcare providers to fall short. We created a unique new Respectful Maternity Care training that encourages medical providers to put themselves in clients’ shoes.
What we found
Using exercises inspired by Values Clarification and Attitudes Transformation workshops, long used by abortion activists, the training helps providers think about what would give them a positive experience through role play, case scenarios, and other exercises. By exploring the provider’s underlying beliefs and attitudes, these trainings encourage lasting change.
MSI launched Respectful Maternity Care training earlier this year, and the feedback from providers has been overwhelmingly positive. After a recent training in Nairobi, Kenya, providers from across MSI’s maternity programs came away surprised and inspired by the way the exercises made them think critically about their own practices. Since then, the training has been made available in other countries as an online course followed by an in-person workshop including role plays and group activities.
“In addition to feeling safe, we want women to have a positive, compassionate and respectful experience throughout her pregnancy, labor, delivery and postnatal period,” Patricia Lledo Weber, Head of Clinical Services, told us. “We must respect her dignity and privacy and enable informed choices about how she wants to deliver.”
Improved experience for maternity clients
Following the training, more clients described that they were encouraged to move during labor (from 67% to 95%). More also reported they were encouraged to have a birth companion (from 75% to 95%).
Last year, MSI’s maternity centers saw more than 16,000 deliveries. They also saw 112,000 pre- and post-natal visits, primarily to women in urban areas. In addition to helping reduce maternal mortality, the centers also play a crucial role in our advocacy work. By offering maternity services, we help destigmatize MSI’s work offering post-abortion care and safe abortion services. Governments and insurance providers who might hesitate to speak to an abortion provider are far more willing to talk to us when we also offer safe delivery.
Our maternity centers show that offering high-quality, respectful maternity care can be a crucial part of women’s health, not just at the moment of delivery but throughout a woman’s life. We’re committed to serving women “from menstruation to menopause,” giving women the support and tools they need to control their own bodies and futures.
