Episode 03
Where There Are No Curtains: The Importance of Privacy During Childbirth
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Too often, treating women with respect is seen as a luxury. It is not. Violations of human rights during childbirth are all too common in labor wards, hurting women’s chances of surviving pregnancy and childbirth.

This episode of White Ribbon Alliance’s Brave Voices, Bold Actions podcast explores Article 3 of the Respectful Maternity Care Charter, and the human right to privacy and confidentiality during pregnancy and childbirth.

We hear from Rose Mlay, a midwife from Tanzania, who shares the all too common experience of women forced to give birth without the chance for personal privacy, and how that lack of protection harms women and their newborns, and from White Ribbon Alliance Zimbabwe’s Dr. Christina Rawdon, a midwife and educator who is credited with bringing Respectful Maternity Care to Zimbabwe. Together, we have the power to destroy the structures that harm women during pregnancy and childbirth!

Topics
  • Why do women’s rights in childbirth include the right to physical privacy and to the right to confidentiality?
  • How can the RMC Charter be used by health professionals to ensure women and newborns receive the respectful, dignified care they need during childbirth?
Resources

Diana Copeland (00:03): Too often treating women with respect is seen as a luxury. It is not. Respectful care and a life free from abuse is due to every woman and every health system around the world, no matter what. Not only is respectful care a right, it is also vitally important to improving women's chances of surviving pregnancy and childbirth. On White Ribbon Alliance's Brave Voices, Bold Actions podcast we're taking a close look, episode by episode, at the 10 basic rights women and newborns are due in childbirth. Every episode, we'll dive into each one of the 10 articles exploring what respectful care really looks like.

Diana Copeland (00:40): My name is Diana Copeland and I work with White Ribbon Alliance, a locally led, globally connected, grassroots movement advocating for the health and rights of women and newborns. In each episode of the Brave Voices, Bold Actions podcast, I'll be joined by White Ribbon Alliance colleagues from around the world, global human rights advocates, and community leaders creating real change. Together we'll show you how to advocate successfully for yourself and for others, wherever you are.

Diana Copeland (01:08): Today we're examining article three of the Respectful Maternity Care Charter and the rights of physical and informational privacy and confidentiality with Dr. Christina Rawdon, as well as chatting with human rights lawyer, and our resident expert on respectful care, Elena Ateva. But first, what happens when the rights of privacy and confidentiality is ignored?

Rose Mlay (01:30): My name is Rose Mlay. I'm a Tanzanian living in the city in Dar es Salaam.

Diana Copeland (01:38): Rose is a midwife who has dedicated her life to helping mothers and newborns. But the abuses she saw women suffer through during pregnancy and childbirth led her to found a White Ribbon Alliance Chapter in Tanzania to bring respectful and dignified care to health facilities across the country. Once in a labor ward in Tanzania, Rose saw a young woman giving birth for the first time.

Rose Mlay (01:59): The labor ward was like a hole where each woman would see what was happening to her, to her peers in the next bed, or at the far end of the ward. This young woman who was giving birth and it was her first time and she has not been like you're naked in everybody's presence and so she was quite scared to be told to open her legs so that she can give birth.

Diana Copeland (02:29): She had to give birth while completely naked, in front of an open hall full of people cleaning, senior doctors, nurses, students, and laboratory technicians - absolute strangers who stared at her in her most vulnerable state.

Rose Mlay (02:43): The medical attendant instructed the woman to open her legs because she was due to push, but the young woman held her legs closely, tightly in a panic. The medical attendant shouted, "Open your legs just as you did when you were conceiving." In tears, the woman closed legs even tighter, and the midwives slapped her face so hard.

Diana Copeland (03:14): Instead of offering some privacy and consolation to the mother, the medical attendant thought they needed to use physical force. This sort of abuse is not uncommon and is often excused with, "This ignorant girl doesn't know she needs to open her legs to give birth." But when you imagine giving birth, are you picturing 10 to 20 strangers in the room with you, including other laboring mothers, all looking at you while you are completely, utterly naked.

Rose Mlay (03:40): The majority of the women who give birth at home is issues like lack of privacy and things like that. So, because when you're at home, you are in your home with one person.

Diana Copeland (03:56): If the only option you have available in your community is this type of open facility, does it surprise you that there are countless women who instead choose to give birth at home, even without qualified care, in order to protect their physical privacy. Article three of the Respectful Maternity Care charter says you have a right to privacy and confidentiality. That means that your personal information, including yours and your newborn's health records should be kept confidential, but you also have a right to physical privacy that we cannot forget.

Diana Copeland (04:29): And now joining us from Harare, Zimbabwe, for our discussion on the human rights of privacy and confidentiality is the wonderful Dr. Christina Rawdon. Dr. Rawdon is a nurse midwife with over 35 years of experience and holds a PhD in advanced midwifery practice and sexual and reproductive health. She is the former Editor in Chief of the African Journal of Midwifery and Women's Health and a founding member of the White Ribbon Alliance for Safe Motherhood, Zimbabwe. She has received a Lugina African midwives research network, lifetime achievement award, and was critical in bringing respectful maternity care to Zimbabwe. Welcome, Christina.

Dr. Christina Rawdon (05:06): Thank you very much.

Diana Copeland (05:08): Not only are you a midwife, but you're also a lifelong advocate. I'd really like to know about how your career and midwifery influenced your advocacy efforts for women and girls.

Dr. Christina Rawdon (05:18): After understanding what midwifery is, the art and science of midwifery. What you can do for mothers and families and understanding their needs for quality care. You can end up with being an advocate because there are some areas where mothers and their families are voiceless. Their rights are violated. They cannot defend themselves. So you find yourself engaged in any policy development because you've got information at hand of what women want for services when they seek maternity services. So that advocacy is an important part of midwifery services and is an important part of meeting the needs of childbearing women and in speaking for the voiceless.

Diana Copeland (06:12): Now, as the former national coordinator for White Ribbon Alliance Zimbabwe, which is a true grassroots movement, how did that connection with these communities change your ideas on policy change for maternal healthcare?

Dr. Christina Rawdon (06:25): You, when you, when you are in the community, you begin to understand the community and exactly policy change and contribution to policy change must start from the community, because the community do know what they want for improvement with their own health. So I'm talking about bottom top approach instead of top bottom approach to policy change and the policy development. But recognizing that there are some areas like corporate, where you need the policy coming from the top. But most of the policies that come from the community bring in community ownership of projects that promote maternal and newborn health.

Dr. Christina Rawdon (07:11): Women are very valuable and their rights must be respected. Their rights to quality care must be respected. The rights are only respected when you bring the care providers to understanding the importance of the rights of women to care. We can only improve on maternity and newborn mortality and morbidity, if we focus the care on woman centered care and respecting the rights of the women. Those who provide care also understand the rights of the women and the environment in which is they're providing that care so that they can also be advocates for respective, for maternity care.

Diana Copeland (07:56): You're doing all this really great work in elevating the work that's happening with the women who've already been trained, the midwives and the health workers, but you're also working on the idea of privacy and confidentiality. I'd like to know more about how the lack of privacy and the sharing of patients' information hurts maternal health.

Dr. Christina Rawdon (08:18): The right to privacy is like a mirror, a mirror to quality respectful maternity care. When that right to privacy has been violated and the women have been hurt, when maybe their information has not been, it's been shared, maybe information they provided for research. It's been shared with the people who have nothing to do with that research. Their records are being shared with people who do not add anything to the girls, those women, it becomes difficult in the sense that when women are aware, there is no privacy. They will not, and I'm saying they will not with a underline. They will not give information that is adequate to make a full assessment of their own health and to provide them with the appropriate information for self care at home. It may even bar the women from coming to the clinics or to the facilities they may look for services elsewhere.

Dr. Christina Rawdon (09:32): I'm not talking about private services. I'm talking about maybe delivering in their own, under the care of the traditional birth attendant, who is able to keep private issues to the family only. So it may harm in the sense that important information, that influence decision making in the care that women should receive, maybe detrimental to the health of the women, if the assessment is not adequately made and some information have been missed, which is of importance. So that's how it affects the women indirectly that they may not come. They may not give information that is relevant to decision making about their kid because they're scared. You can talk about their information. But when you look at in the room, there's privacy in the room, because it's only you and the traditional midwife. So between the two she may choose to deliver at home.

Diana Copeland (10:36): I think that makes total sense because why would you go to a place where kind of your trust has been violated and you don't feel secure, even if that means you might not be getting the best quality care that's possible.

Dr. Christina Rawdon (10:51): Yeah, you are right. Because when women do not trust the healthcare system, why would they come to the healthcare system, okay?

Diana Copeland (11:00): Why does the RMC Charter matter to the work that you do? Not only with WRA Zimbabwe, but with your career as a midwifery educator. Using the actual Respectful Maternity Care Charter, it seems like a really powerful tool.

Dr. Christina Rawdon (11:15): It is like a roadmap. It is a reference for quality improvement in any institution where maternity services is provided. And if you got the document in front of you and you're caring for women, you refer to it all the time. It's a reminder that there are some rights that need to be on at and that these rights are related to the care that you are giving to the woman and to the care that you are giving to the baby.

Dr. Christina Rawdon (11:47): So it is an important tool for education. It is an important tool that can be used in research. It is an important tool that can be used for auditing care in maternity unit, in the changing of how we provide care in maternity units. And it is a tool that can be adapted, but the principles will never change. A right is a right and the right will never change. Doesn't matter how you phrase the statements on the charter, but the principles remain the same and it is a tool that will be in a maternity unit for a very long, long time. I don't see it being put on the server and collecting dust. I see it as being a reference used in many areas.

Diana Copeland (12:43): Dr. Rawdon, how do you personally stay so positive and committed, amidst sometimes very daunting challenges?

Dr. Christina Rawdon (12:50): I am compassionate about the lives of women, the lives of babies. I love women to bring a baby into the world who is healthy and the health mother who can look after her own family. And I persevere and I am committed to the work that I do and not for money, but it's just work that I'm doing because someone is in need, change takes place when it's supported. Let's have midwives, all midwives trained in the respective maternity care. Let's have midwives adequate enough to provide care in a maternity. Let's improve the environment in which care is being provided. Let's monitor the care that we provide so that we can be rest assured we address the gaps that are hindrance to the implementation of respective maternity care is a model.

Diana Copeland (13:58): Listeners can find links to support White Ribbon Alliance Zimbabwe and learn more about Christina's work in this episode's show notes. Thank you so much for joining us, Dr. Rawdon, it was an incredible discussion on human rights in childbirth and it was absolutely wonderful to have you on this podcast.

Dr. Christina Rawdon (14:12): Thank you for inviting me, Diana.

Diana Copeland (14:17): And now we turn to Elena Ateva, a human rights lawyer and the convener of the Respectful Maternity Care Council to learn more about the human rights, privacy and confidentiality.

Elena Ateva (14:26): Hello, Diana, thanks for having me.

Diana Copeland (14:29): So we're talking about article three and everyone has the right to privacy and confidentiality. Could you tell us why that matters and what happens when this right is not upheld?

Elena Ateva (14:39): So the rights to privacy and confidentiality is really critical to respect for maternity care. The rights basically says that no one is allowed to share your or your newborn personal or medical information, including all records and images without your consent. And that you and your numerous privacy must be protected, except of course, when it is necessary for health care providers to convey information for continuity of care. So that's from one healthcare provider to another so that they can care for you or for your baby.

Elena Ateva (15:13): And as Dr. Rawdon said during the interview, the right to privacy is really a mirror to quality and respectful care because when you have, when you don't have that, right, and lack of privacy is missing, or where there's lack of confidentiality, this violates the trust between women and providers. Women will withhold information that's relevant to their health or the health of their newborn. They might decide to deliver at home. They might resist interventions because they don't have privacy. So they don't want to be exposed as was illustrated in, in the opening segment from Tanzania. So this right is really, really critical.

Diana Copeland (16:01): Well, what can the average person do to make sure that their rights are upheld?

Elena Ateva (16:05): For everybody... I think it's really important to have access to the Respectful Maternity Care charter. And you can find this charter at our website, www.whiteribbonalliance.org/rmcresources. And it's really a tool for you to use within your community to disseminate, share with your family, share with your friends, share with your neighbors. And most importantly, share with your providers. That charter is available in English, Spanish, French, Russian, and Arabic. And if you want to make the charter available in your local language, if that's not available already, you can let us know by contacting us at info@whiteribbonalliance.org. We also want to make sure that providers can use the charter and utilize it. So if you're a provider, what you can do is print a copy of the RMC Charter and start a conversation with your colleagues, discuss what is it that you need, yourself as providers, to be able to provide respectful maternity care and to uphold the rights, respect, and dignity, because this is, you need to be supported, you need to be supported to provide that type of care.

Diana Copeland (17:38): Thank you so much for joining.

Elena Ateva (17:40): Thank you, Diana.

Diana Copeland (17:45): Special thanks to Dr. Christina Rawdon and Rose Mlay. This episode of Brave Voices, Bold Actions was produced by Diana Copeland, Elena Ateva, Stephanie Bowen, Marissa Ware, Amanda Livingstone, Nina Garcia Wright, Kendra Hanna, with support from White Ribbon Alliance Tanzania, White Ribbon Alliance Zimbabwe and the entire White Ribbon Alliance team.

Diana Copeland (18:06): Our theme song is called "Mama" by Eric Wainaina can be found on White Ribbon Alliance's "Advocacy in Audio." Learn more about the Respectful Maternity Care Charter, the What Women Want Action Agenda, and find links to more resources at www.whiteribbonalliance.org/BraveVoicesPodcast.

Episode Team: This episode produced by Diana Copeland, Elena Ateva, Stephanie Bowen, Marissa Ware, Amanda Livingstone, Nina Garcia Wright, Kendra Hanna, with support from the entire WRA team. Special thanks to White Ribbon Alliance Tanzania and White Ribbon Alliance Zimbabwe.

HOST

Diana Copeland

Senior Communications Officer

Diana Copeland joined White Ribbon Alliance in 2016 as the Communication Coordinator, working to strengthen and disseminate the organization’s message on its website and social media platforms, and was promoted in 2018 to Senior Communications Officer in order to oversee and grow White Ribbon Alliance’s digital and offline presence.
GUEST
Rt. Hon Helen Clark

Dr Christina Rawdon

Dr Christina Rawdon is a nurse midwife with over 35 years of experience, and holds a PHD in advanced midwifery practice and sexual and reproductive health. She is the former Editor-in-chief of the African Journal of Midwifery and Women’s Health, and a founding member of the White Ribbon Alliance for Safe Motherhood Zimbabwe. She has received a Lugina African midwives research network lifetime achievement award, and was critical in bringing respectful maternity care to Zimbabwe. Follow White Ribbon Alliance Zimbabwe on Twitter at @WRAZW1.

CONTRIBUTOR

Elena Ateva

Advocacy Manager

Elena Ateva is the Advocacy Manager at White Ribbon Alliance and the Maternal Health lead for the USAID/Health Policy Plus Project. She is responsible for facilitating the work of the Global Respectful Maternity Care Council, leading global advocacy efforts to strengthen the midwifery workforce and providing assistance to WRA National Alliances that campaign to improve reproductive, maternal and newborn health and rights. Elena is an attorney and a human rights advocate who has been involved in the movement for respectful care in her home country, Bulgaria, and throughout Eastern Europe. Prior to joining WRA, Ateva was the Eastern Europe Legal Advocacy Coordinator for the international non-profit Human Rights in Childbirth and later served on the board of the organization. Her work has also focused on prevention of other forms of violence against women, including domestic violence and trafficking in Bulgaria and the United States.

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