Midwife Connection

by Angeline Fujioka, CNM, ACNM Technical Advisor, Department of Global Outreach

Pervasive and dangerously silent human rights violations against women often occur during one of the most vulnerable times in a woman’s life: childbirth.

Around the world this violation continues, irrespective of socio-economic boundaries, education levels of providers, religious and cultural values, and rural or urban borders. Many women have reported being yelled at, neglected, humiliated, beaten, slapped and dehumanized during childbirth. Others report abuse of power, procedures performed without consent, and information withheld.

Not only does this silent violation cause suffering, but in countries with high maternal and infant mortality, disrespectful care in childbirth is an identified barrier to women utilizing facilities with skilled birth attendants. Access to a skilled attendant at birth reduces maternal and infant mortality and is an indicator for the United Nations Millennium Development Goal #5: Reduce by 75% the maternal mortality ratio by 2015.

Awareness and advocacy around disrespect and abuse in childbirth has been building. Latin America has led the way since 2002 when the first International Conference on Humanization of Childbirth was held in Brazil. A compelling and key document in advancing the knowledge-base of this problem was the USAID-commissioned landscape analysis “Exploring Evidence for Disrespect and Abuse in Facility-based Childbirth.” The analysis examined the evidence on disrespect and abuse of women in childbirth, reviewed contributing factors, and identified potential interventions effective in combating this silent problem. Diana Bower and Kathleen Hill of USAID’s Health Research Program called TRAction conducted the analysis, which provides a framework to more clearly define and document abuses so that the prevalence of the problem can be accurately measured.

The contributing factors are complex and varied, but a critical gap is the lack of impact studies relative to specific interventions. As a result of this analysis, USAID has provided grants through the TRAction project to the Population Council and Columbia University Mailman School of Public Health’s Averting Maternal Death and Disability Program (AMDD) to conduct baseline assessments of disrespect and abuse in facility-based childbirth. Results of the baseline assessments will inform future interventions to reduce disrespectful care and abuse in childbirth.

The White Ribbon Alliance (WRA) is working closely with the TRAction project to provide advocacy and support in an effort to improve respectful care of women during childbirth. WRA’s “Respectful Maternity Care” project provides resources for policymakers, advocacy groups, and governments to improve respectful care in childbirth.

As we move closer to 2015 and the expectations held by the Millennium Development Goals, it is a perfect time to understand and address this silent and pervasive violator of women worldwide.