Throughout my career, I’ve heard women say they don’t want to go to the hospital for delivery because they don’t feel welcome. When I hear this, I know we have failed them.
At Pathfinder, we recognize a woman’s human right to health care—and that means high-quality health care that fully meets her needs. This includes her right to high-quality maternity care—to deliver her baby in a safe and supportive environment, to not sacrifice her own life to bring new life into this world.
Significant investments have been made in honoring this right. Yet babies continue to arrive in this world in unsafe conditions to mothers who have suffered through painful, dangerous, and isolating birthing experiences.
Two new reports on quality of care—from the World Health Organization and The Lancet—emphasize that quality of care must be client-centered—that is, designed to be responsive to local needs from inception, and valued and trusted by the communities served.
Evidence That Respectful Maternity Care Works
As we continually strive to honor the right to high-quality maternity care, I would like to share another recent publication in BMC: Reproductive Health, which describes Pathfinder’s USAID-funded Strengthening Communities through Integrated Programming (SCIP) project. SCIP used a model of “respectful maternity care” in Mozambique’s Nampula Province that was responsive to the full spectrum of pregnant and delivering women’s needs.
The SCIP model:
- Engaged traditional birth attendants to support mothers and their partners in taking the decision to go to the health facility for delivery, transporting them to the facility, and providing support to nurses.
- Engaged local Community Leadership Councils—who traditionally address social issues—in safe motherhood by sensitizing them about the number of and causes of maternal mortalities and morbidities in their communities and encouraging them to support the traditional birth attendants.
- Facilitated quarterly joint meetings between the Community Leadership Council and health facility management teams to review the health status of the population and find solutions to challenges.
According to the article, use of the model resulted in almost all pregnant women in catchment areas surrounding the two health facilities on which the article focuses delivering at health facilities: 80% of live births in one catchment area and 100% of live births in the other catchment area. The article offers important evidence about what convinced women in Nampula Province to deliver at their closest health facilities.
SCIP’s model offered women the emotional and physical support they needed during pregnancy and childbirth—in the form of kindness, empathy, and warmth, as well as access to essential information and services. In this model, communities implemented part of the interventions, which resulted in a deeper, more meaningful engagement of a core set of community actors who can hold health systems accountable for respectful care.
We evaluated whether women who felt supported during pregnancy and at the health facility during delivery would have a more positive birthing experience. We wanted to know if they would share their stories and encourage other women in their communities to deliver at the health facility too.
Results included in the article suggest that the model did have a positive effect in increasing institutional delivery rates, even if health facility staff’s ability and willingness to offer respectful care varied. Community organizations demanded respectful care when facility staff failed to deliver it.
Meaningful Community Engagement
So, how does it work?
Traditional birth attendants, who work as part of an active community leadership team, were central to the model. Traditional birth attendants worked in a network supported by community leaders and maternal child health nurses at health facilities.
The traditional birth attendant coordinated and negotiated a woman’s transport to the facility for delivery. She attended to the needs of the woman as she was being transported and to her general level of comfort once at the facility. It was not uncommon for traditional birth attendants, for example, to prepare meals for a woman and help her initiate breastfeeding.
One mother recounted her experience with a traditional birth attendant:
“After giving birth the [traditional birth attendant] TBA looked after me, she washed me and gave a bath to my baby and put her on scale to weigh [her], and she took me by the hand and advised me…to try to sleep. After some time when I was still in bed she brought my child…and told me to breastfeed…and…she talked to me.”
A traditional birth attendant recounted her experience in a supportive role:
I say some sweet words to her, I moralize her so that she may feel motivated saying that…this child may save her life one day, be a governor, a teacher…I say all this to all women I take to hospital….in the past I did not…”
Community Leadership Councils supported traditional birth attendants’ role as facilitators in accessing care. They helped them find transport for the woman to the health facility and sensitized family members on the importance of institutional deliveries. They monitored data coming from communities, such as number of women currently pregnant in a village, and numbers delivering at home and facilities. Community leaders and traditional birth attendants sat on co-management committees with health facility staff to make joint, evidence-based decisions about how safe motherhood interventions can be introduced and utilized in their communities.
Maternal child health nurses served as mentors for the traditional birth attendants. They supported them to offer basic safe delivery (when necessary), antenatal and postnatal care information and services, and to track women from the time they were pregnant through delivery and postpartum.
A Community with Confidence and Trust
Our model didn’t simply engage and sensitize community actors. It meaningfully engaged and empowered them to influence the quality of care and emotional support offered to women in their communities, from the time they became pregnant, until they delivered.
The model offered women the emotional support they needed at a critical time in their lives. It empowered them to place trust in their communities and caregivers. The model offered community leaders and traditional birth attendants the chance to assume ownership over the care their community receives.
Women were able to more safely and confidently deliver their babies, and their caregivers were able to more confidently honor women’s human rights to respectful, high-quality maternity care.