Respectful Maternity Care
In every country and community in the world, pregnancy and childbirth are events of great significance in the lives of women and families, and also a time 
of intense vulnerability. The relationship with maternity caregivers and the maternity care system during this time is incredibly important.
In addition to bringing vital, potentially lifesaving health services, women's experiences with maternity caregivers have the impact to empower and comfort... or to inflict lasting damage and emotional trauma. Either way, women's memories of their childbearing experiences stay with them for a lifetime.
Imagine the relationship any of us would want for ourselves, or a woman we love, with the maternity care provider entrusted to give this care...
In addition to good judgment and clinical competence, we imagine a relationship that is characterized by caring, empathy, support, trust, confidence, empowerment, and gentle, respectful, effective communication.
We are shocked to learn that in maternity care systems all around the world, from the richest to the poorest nations, too many women experience care that does not match this image. A "veil of silence" has obscured the humiliation and abuse suffered by women seeking care during childbirth, a time of intense vulnerability for women worldwide.
We might be inclined to think that such traumatic experiences during maternity care occur only in "other countries"; however this is a problem of global scope. The growing body of reports and studies on this topic come from every continent and from countries all around the world, including our own.
There is a growing body of anecdotal and research evidence that paints a different and disturbing picture. A recent review of the evidence identifies seven categories of disrespect and abuse in childbirth, in addition to withholding or denial of care. Available reports document numerous painful examples of disrespect and abuse during maternity care occurring around the world, in each of the seven categories. These are just a few:
Non-consented Care "Providing explanations to less educated women (is) a not a good use of time as 'they just can't understand'"
— South Africa (Fonn et al., 2001)
Non-dignified Care "One nurse told me: 'Lady, can't you see that you are in the way? Go over there, you aren't anything but an animal and talking to you is like talking to an animal.'"
— Dominican Republic (Miller et al., 2002)
Physical Abuse "When a woman goes into the second stage of delivery, you don't want her to close her legs, so you're beating her."
— Kenya (Ogangah, Slattery, and Mehta Soon, 2007)
Discrimination "Everything that came out of her mouth was the color of my skin. She goes, 'You're the first dark person I've ever had.' I sat there and had to deal with that. After that, I left and never went back."
— USA (Amnesty International, 2010)
Abandonment of Care "You just call (for the nurse) until you get tired and then you finally deliver by yourself and die. I have even witnessed it myself."
— Kenya (Family Care International, The Skilled Care Initiative, 2005)
Detention in Facilities "When I got the bill, the doctor said to me, 'Since you have not paid, we will keep you here.'"
— Burundi (Human Rights Watch, 2010)
Non-confidential care "...I was assisted by one of the patients who was waiting to give birth. The nurse later came and took the baby…then told me to get up and wipe the bed."
— Kenya (Ogangah, Slattery, and Mehta Soon, 2007)
Interpersonal care before, during, and after birth that is disrespectful and abusive to women is upsetting and appalling. It strikes a deep chord within us as a violation of women's basic human rights. Disrespect and abuse during maternity care is also of great significance because it can deter women from accessing the maternity care system for vital care and treatment.
The contributors to disrespect and abuse are complex and multi-factorial. But no matter what contributes to it, a growing number of maternal health stakeholders agree that disrespect and abuse in facility-based childbirth cause significant numbers of women to suffer and violate their human rights, and also represent an important quality of care problem that acts as a barrier to skilled care utilization, a key MGD-5 indicator.
This is a problem that is reaching a tipping point of urgency and creating a growing community of concern that spans across the domains of health care research, quality and education; human rights; advocacy and civil society. We need the number of people who know and care about disrespect and abuse during maternity care to keep on growing, until it can no longer be ignored.
