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Maternity services: women want respect and dignity above all else, finds global survey

Jun 7, 2019 | News

BRITISH MEDICAL JOURNAL

By Zosia Kmietowicz

A survey of 1.2 million women from more than half (114) of the world’s countries has found that the thing they most wanted from reproductive and maternal health services was to be treated with respect and dignity.1

After that requirement, the women, who were asked an open ended question about their health needs, said that they would like clean water, sanitation, hygiene, and adequate medicines and supplies.

Kirsty Kade, deputy executive director of the White Ribbon Alliance, a US based international coalition of organisations aimed at decreasing maternal and newborn mortality, and co-chair of the What Women Want campaign, which conducted the survey, said that the emphasis on respectful and dignified care was a surprise to the research team. She said it showed a disparity between what non-governmental organisations and experts in global health thought women needed—such as health facilities, more drugs, and more healthcare workers—and what they actually prioritised.

“What is apparent is that women are not currently having a positive experience [of maternal health services]. Women told us that they want to be listened to, that they want an interpersonal relationship with their provider, and that they want compassion, not to be talked down to,” Kade said at a press briefing to launch the report at the Women Deliver 2019 conference on gender equality this week in Vancouver.

“Now we must ask: how do we start shifting and putting more emphasis on the interpersonal dynamic? A lot of this is to do with the wider attitudes about women and girls and not about the clinical knowledge of doctors.”

Another surprising finding was the basic need for security that many women called for, such as lights in health facilities and security guards on clinic doors. Other respondents mentioned food, disabled toilet facilities, and sanitary towels.

For many of the survey respondents it was the first time they were asked for their opinions on healthcare, and many were at first reluctant to speak up. The briefing heard that in Pakistan, where women face violence or the threat of violence for speaking up about such issues, a quarter of a million women took part in the survey. Mobilisers often went to remote communities to win women’s trust to share their experiences.

Samina Naeem Khalid, a doctor and executive committee member of White Ribbon Alliance Pakistan, said that many doctors lacked the social skills that women were asking for. She said, “We need these women’s voices to be heard in political corridors. These are basic necessities that they are calling for, and we must work together to provide them.”

The researchers now plan to analyse in more detail the data from individual countries with significant numbers of responses, including India, Kenya, Pakistan, Malawi, Mexico, Nigeria, Uganda, and Tanzania, and create specific implementation plans for them.

Kade said, “We promised them their words would mean something. If we want them to continue raising their voices, we cannot abuse their trust. We must act to meet their needs and systematically place their voiced priorities at the centre of health policies, programmes, and practices.”

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Cite this as: BMJ 2019;365:l4107

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