Promoting Evidence & Action for Respectful Care at Birth
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Source: Ann Tornkvist/AFP |
Recent analysis of global maternal mortality data indicated that fewer women die each year from complications during pregnancy. A recent report found that an estimated 358,000 women died during pregnancy or childbirth in 2008, mostly in poor countries of sub-Saharan Africa and South Asia. This represents a 34 percent decline from previous international estimates of more than 500,000 maternal deaths annually. While the world has focused on overcoming financial and geographic obstacles to connecting women with lifesaving childbirth care, little attention has been paid to documenting and tackling the significant barriers posed by disrespect and abuse of women giving birth in facilities. A “veil of silence” has obscured widespread humiliation and abuse of women during childbirth, a time of intense vulnerability for women worldwide.
Now a recently published USAID-funded report, Exploring Evidence and Action for Respectful Care at Birth, by Diana Bowser, Harvard School of Public Health, and Kathleen Hill, University Research Corporation, presents the evidence on manifestations of disrespect and abuse in facility-based childbirth,contributors to the problem,the negative impact on skilled care utilization, and approaches to tackle this human rights, ethical and quality-of-care problem. USAID will support future efforts to further document, confront, and tackle abuse during childbirth.
USAID has been one of the largest donors with sustained investments and programming in both maternal health and family planning. USAID programs have consistently invested in approaches to promote evidence-based, lifesaving interventions and strengthen key elements of health systems, from quality assurance methods to drug management and logistic systems to performance-based financing. In countries with high mortality rates and weak health systems, reducing mortality requires bringing a basic set of high-impact services as close as possible to the people who need those services. For this reason, USAID’s programs have supported community-based approaches such as family planning, iron folate supplementation, misoprostol to prevent postpartum hemorrhage in home deliveries, and behavior change programs to promote breastfeeding. These approaches are often developed through partnerships with NGOs but need to be taken to scale as components of national health sector programs. USAID programs also take a community mobilization approach to ensure women’s access to appropriate care is not restricted. Health services and commodities can be provided through trained community outreach health workers. These programs reach out to women by making commodities and services such as condoms, contraceptives, and other medications more easily accessible through local pharmacies, kiosks, or even beauty salons. USAID also supports facility-based maternal health care. The focus has been on provision of high-impact interventions such as Active Management of the Third Stage of Labor to prevent postpartum hemorrhage and provision of magnesium sulfate to treat severe preeclamsis/eclampsia to address two of the major killers of women during pregnancy and childbirth. USAID has a robust program of quality improvement that includes Quality Improvement Collaboratives and Standards Based Management and supports competency-based training programs in Lifesaving Skills and Emergency Obstetric Care, including fistula repair.
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