“Women are not dying because of untreatable diseases. They are dying because societies have yet to make the decision that their lives are worth saving. We have not yet valued women’s lives and health highly enough.” —Professor Mahmoud Fathalla, 2006UN Secretary General Ban Ki-moon made this quote famous by including it in his high-level remarks in 2013. The words remain true today.

How do disrespect and abuse cause maternal deaths? Disrespect and abuse during childbirth reflect this lack of value and remain a largely under-acknowledged, systemic barrier to safe motherhood, as well as a violation of human rights.

Prevalence rates for violence against women are notoriously difficult to determine.

There are three deadly delays a woman can face during labor:

1. not recognizing the signs of an emergency and seeking care
2. not identifying and reaching a medical facility
3. not receiving adequate and appropriate treatment

Disrespect and abuse contribute to delays #1 and #3. Improving access to health facilities will not save women if they aren’t willing or allowed to go facilities or forced to endure abuse if they do.

Two years ago, when I volunteered as a registered nurse-midwife at a health center in the Philippines, I witnessed terrible abuses firsthand. After absorbing the immediate shock, I began to question the reasons behind the disrespect and abuse.

I knew it was complicated. I knew that most clinicians didn’t go to work seeking to shame and neglect women. But I also knew that gender norms and power dynamics have a profound influence on people everywhere—including hospital staff.  And many health workers are expected to work in poor conditions that exacerbate this behavior. If a woman does not feel safe and respected when she first visits a maternity center, she is less likely to attend her antenatal care appointments or come to a health facility when in labor, which increases her risk of both pregnancy-related morbidity and mortality. And if she does make it to a facility for delivery but receives poor care, she and her child remain at risk.

Abuse occurs in all societies.

Disrespect and abuse can include but are not limited to:

• any kind of physical or verbal abuse or humiliation
• discrimination
• nonconfidential or nonconsensual care
• detainment due to unpaid fees
• denial of access to a health facility
• abandonment of care

It occurs in all societies, but is particularly prevalent in low- and middle-income countries where there is only minimal accountability in the health systems and health facilities are poorly resourced.

Prevalence rates for any kind of violence against women are notoriously difficult to determine due to a lack of documentation and societal norms that tolerate abuse against women.

For example, the World Health Organization estimated that 35% of women worldwide have experienced physical and/or sexual intimate partner violence or non-partner sexual violence at some point in their lives.

That is one in every three women.

All women have a universal human right to be respected and cared for during pregnancy, childbirth, and thereafter.

How can we protect women from disrespect and abuse in maternity care?

As a proud health worker, I want to effect meaningful change at the source of the problem.

I was lucky to be awarded a fellowship at IntraHealth International this summer to finally do something about the type of abuse I witnessed in the Philippines, which also happens all over the world.

IntraHealth strengthens health systems and empowers health workers to better serve communities in need around the world. My fellowship focused on reviewing the small but growing research on disrespect and abuse in maternity care and synthesizing qualitative findings IntraHealth has collected from its own programs into a forthcoming advocacy brief. 

Respectful maternity care is necessary. And achievable.

There are a multitude of factors that lead to disrespect and abuse of this kind. Gender norms and values, power and status relationships, lack of motivation to practice respectful maternity care, poor workplace environments, perceptions of health workers in society and the media, inadequate training opportunities, and a pervasive lack of accountability for disrespect at both the local and national levels all influence this behavior and affect how fast and how well changes can be made.

Health systems in crisis need support to effectively implement and sustain respectful maternity care practices, and this includes addressing the rights and needs of both clients and health workers. Health workers, women, and their families need to know the rights of a woman seeking maternity care. And health sectors must address the needs of their health workforces.

To sustain respectful maternity care, health sectors should provide health workers with:

• safe working conditions and reasonable working hours
• policies that mandate health workers are treated with respect by other staff and clients
• support from their managers and ministries of health
• training on cultural sensitivity and continual education on evidence-based practices
• mentors who model respectful maternal care 
• adequately resourced facilities 
• physical and psychosocial support to combat stress and fatigue 

Respectful maternity care is necessary. It is achievable. And it’s everybody’s responsibility.

Respectful maternity care is a human right. Learn the facts here:

• Respectful Maternity Care: The universal rights of childbearing women
• Break the Silence: Respectful Maternity Care (White Ribbon Alliance)
• The Right to Respectful Maternity Care Video (White Ribbon Alliance)
• Respectful care: a tool for healthcare workers (White Ribbon Alliance)
• Respectful Maternity Care (Maternal Health Task Force)
• Prevention and elimination of disrespect and abuse during childbirth (World Health Organization)

AdvocateUse Facebook, Twitter, Tumblr, Instagram, Storify, and more for good. Sample messages you can share include:

• Every woman has the right to the highest attainable standard of #health, which includes dignified, respectful care. #EndDisrespect
• Let’s prevent and eliminate disrespect and abuse during facility-based childbirth: http://bit.ly/1psAWei #EndDisrespect #Commit2Deliver

Follow these Twitter handles:

• @IntraHealth
• @WHO
• @UNFPA
• @USAIDGH
• @HRPresearch
• @MHTF
• @genderhealth
• @familycareintl
• @PMNCH
• @MCSPglobal
• @urcchs
• @AMDD_Program
• @Pop_Council
• @WRAGlobal

Use these hashtags:

• #EndDisrespect
• #VAW
• #EndGBV
• #HumanRightsDay
• #RespectfulCare
• #Commit2Deliver
• #16days

Donate and support a health worker today.

IntraHealth is working hard to improve health systems and the conditions of health workers everywhere. Want to make a sustainable, cost-effective contribution that will improve the lives of the women they care for? Invest in health workers, especially those on the front lines of care. Together we’ll save lives and build a healthier, more productive world. Donate today.