BLOG: Dignity and Respect are a Key Part of Humanistic Care

This posting from Sheena Currie, Maternal Health Specialist (MCHIP/Jhpiego), describes MCHIP’s “model maternities initiative” and training programs that emphasize humanistic care to ensure childbearing women’s dignity and rights are respected.  Jhpiego, a global health non-profit organization and affiliate of Johns Hopkins University leads the MCHIP project. MCHIP stands for the Maternal and Child Health Integrated Program, USAID’s flagship global maternal and child health program that operates in more than 30 countries.

Elizabeth Mpunga, a nurse midwife in Tanzania trained in "humanistic" care.  Credit: Jhpiego/Kate Holt

From Afghanistan to Tanzania, a push to encourage women to give birth in a health facility with skilled care has saved countless lives in the developing world. But it comes with a cost – women have little influence over the environment in which they give birth. They often must share a bed with another woman or succumb to the orders of staff that are caring for too many patients. As a midwife who has worked around the world, I have seen this all too often. That’s why educating midwives and doctors on humanizing care for pregnant women is so important.

Article 4 of the Universal Rights of Childbearing Women states: “Every woman has the right to be treated with dignity and respect.” In trainings on emergency obstetric and newborn care, I explain that “humanistic” care combines the highest quality of clinical care with respect for a woman’s human dignity. That includes everything from sharing information and ensuring a woman’s privacy to respecting her choice of birth position and birthing partner. It means talking gently with a woman, respecting her cultural, traditional or religious beliefs, and something as simple as encouraging her freedom of movement so she can walk around during labor and not be confined to a bed, and promoting a continuum of care and skin-to-skin contact between mom and her newborn.

To reinforce this approach during their training, health providers are guided to introduce themselves to a client, sit at eye-level with her, drape for privacy during procedures, and use language that is respectful and understandable. These sessions in simulated settings with a manikin reflect clinical care as closely as possible to ensure that these behaviors are an integral part of skills development.

In concept, respectful care is understandably the right thing to do. But in practice, I find that I have to frequently remind trainees on the basics: Tell her what you are going to do.  Tell her what you’ve found. Answer questions. Explain to her that you are going to give her some medication because her blood pressure is too high.

During a supervisory visit to a Tanzania hospital, I saw a pregnant woman in labor, kneeling on a bed, her preferred way to give birth. If I wasn’t there, I think they would have said, ‘No, you have to lie on your back.’ But that woman’s choices and preferences during her care were respected and she delivered on her knees. Providers need to see women treated with dignity and support in the clinical setting. Supportive supervision and monitoring can reinforce respectful care and empower providers to offer this care.  

From Brazil to Mozambique, Jhpiego has seen the benefits of governments adopting a “model maternities initiative” to ensure women’s rights and humanistic care in maternal and newborn health in this most personal time in a woman’s life.  In 34 hospitals in Mozambique where this initiative was first introduced, facilities substantially improved the quality of their services for women. A 2010 conference in Brasilia on this mother-centered approach drew 2000 participants from 25 countries.

We still have a huge amount of work to do on this. We believe that humanistic care begins with pre-service education and provider training at all levels and that it benefits both the pregnant woman and the health provider. When midwives feel they are respecting women’s human rights and meeting their clinical needs, they have greater job satisfaction.

Click the image below to see all seven articles of the Respectful Maternity Care Charter: The Universal Rights for Childbearing Women.