Episode 04

Dignity and Respect During Childbirth: It’s What Women Want

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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 4 of the Respectful Maternity Care Charter, and the human right to be treated with dignity & respect during pregnancy and childbirth.

We hear from Mercyline Ongachi, a young mother from Kenya, who bravely shares her story of mistreatment and disrespect during the birth of her twins, and from White Ribbon Alliance India’s Dr. Aparajita Gogoi, co-chair of the What Women Want campaign, which started in India, and which went on to give voice to 1.2 million women and girls across 114 countries on their demands for quality healthcare. Together, we have the power to destroy the structures that harm women during pregnancy and childbirth!

Topics
  • Why is treating women and newborns with respect and dignity critical to saving lives during pregnancy and childbirth?
    How can the What Women Want campaign show us the impact disrespect and abuse in childbirth has on where and how women seek treatment during childbirth?
  • How does the Respectful Maternity Care Charter help women and girls advocate successfully for their rights to be upheld during pregnancy and childbirth?
Resources

Diana Copeland (00:05): 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 in every health system around the world, no matter what. Not only is respectful care a right, but it's 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 will dive into each one of the 10 articles exploring what respectful care really looks like.

Diana Copeland (00:41): 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. Today, we are examining Article Four of the Respectful Maternity Care Charter and the right to be treated with dignity and respect with Dr. Aparajita Gogoi, as well as chatting with human rights lawyer and our resident expert on respectful care, Elena Ateva. But first, what happens when the human rights to be treated with dignity and respect during childbirth is ignored?

Mercyline Ongachi (01:29): I'm Mercyline Ongachi, 21 years old. Yeah, I come from Mukuru kwa Reuben. It's a slum located in Embakasi South.

Diana Copeland (01:44): In 2019, Mercyline went to Mama Lucy Kibaki Hospital in Nairobi, Kenya to give birth.

Mercyline Ongachi (01:48): I was left unattended for a long period of time and unfortunately lost my two babies due to what I believe was medical negligence.

Diana Copeland (01:56): Alone and waiting for help, Mercyline�s first baby was born.

Mercyline Ongachi (02:00): All this while, one health worker was close by attending to another mother. Eventually he responded to my persistent cries of pain. He picked the first baby from the bed and told me that my baby was too young to survive. The second baby was delivered alive, however, the health worker picked my baby again and told me, "You think this one too can survive? This one cannot survive." He performed a physical examination on my two babies before throwing them into a box as I watched helplessly. The health worker organized for the babies to be taken to the morgue and did not make any attempt to save their life.

Diana Copeland (02:37): Mercyline shared her story with us to inspire others to fight for their and their baby's human right to dignity and respect, and to ensure that other mothers never have to suffer through the same sort of terrible trauma.

Mercyline Ongachi (02:51): They should never keep quiet whenever they're assaulted in these hospitals. Yeah, they should let people know what is happening inside the labor room. They should never keep quiet, yeah.

Diana Copeland (03:05): Article Four of the Respectful Maternity Care Charter says that everyone is their own person from the moment of birth, they deserve respect. No one is allowed to humiliate, verbally abuse, speak about or touch you or your newborn in a degrading or disrespectful manner. Mercyline and her babies deserved to be treated with respect and compassion, they were not. How can we make sure that other women are not treated in the same way?

Diana Copeland (03:33): Joining us in our discussion on the impact disrespect and abuse has in childbirth on where and how women seek treatment, is Dr. Aparajita Gogoi. Aparajita is the national coordinator of White Ribbon Alliance India and the executive director of the NGO C3; the Centre for Catalyzing Change. She's a political scientist with 25 years� experience in programming and has led White Ribbon Alliance India's Safe Motherhood advocacy efforts for the last 19 years. The Guardian newspaper once named Aparajita as one of the world's most inspiring women. Welcome, Aparajita.

Dr. Aparajita Gogoi (04:07): Thank you, Diana. Good to speak to you.

Diana Copeland (04:10): Well, you really have done absolutely incredible things, and I'll just say that one of White Ribbon Alliance India's great gifts to the world has been the recent What Women Want campaign, which originated in India and which then went on to give voice to 1.2 million women and girls across 114 countries on their demands for quality healthcare. Could you share how it got started and why you thought it was so important to lead this campaign?

Dr. Aparajita Gogoi (04:32): All of us are aware that very, very important health policies are made for the wellbeing of women. These are made by people who are in positions which enable them to do so. I have to say that these people and the policies are all well-intended, there's no bad intentions behind these policies, but often, more often than not, the women for whom we make these policies are not part of the process. We have meet women who have just given birth or they're about to give birth, we hear a lot of stories, and some of the stories that we hear are really, really heartrending. One story which I'll always remember is this woman who was lying uncovered in the labor table, and when I asked her, "Why have you not asked or demanded that you be covered up?" She said that, although she was ashamed, "I don't want to ask because I feel that if I complain or ask, I would not be treated here and they will refer me to another facility." There's this other case where the women told us that her legs were tied with a rope, she was unable to move.

Diana Copeland (05:43): Oh, my goodness.

Dr. Aparajita Gogoi (05:45): She was hit many times. Her thighs were cut and she showed us a scar on her thigh. So these are the experiences of women while giving birth. It's not with every woman who's giving birth, but with many, many of the women. They go through such experiences. Half the time, women do not really know that they have the right to demand respectful care, that they have the right to speak up, that they have the right to take it up as a grievance. Childbirth normally is seen as a time for rejoicing, for warmth, and for caring, where women get empathy, trust, and support. But unfortunately, many women really kind of experience the reverse.

Diana Copeland (06:30): What I found really interesting about this campaign was the fact that it was open-ended survey, so there wasn't an ABC option. You truly allowed women to say exactly what they wanted. Why was that important to you?

Dr. Aparajita Gogoi (06:45): Actually, Diana, when we started designing the process of, "How do we reach out to women," we realized that women's perceptions of what they feel is the quality of care matters a lot about their health seeking behavior. We didn't want to color the judgment of women, and we didn't want to give them like, "Tick the option ABCD or none of the above." We really wanted women to think about what is their... that prime most, that very, very important aspiration which is really, really dear to them. That's the reason we thought that we will leave it open-ended. So when we started the conversation with women, most of the conversations started by women telling us what she did not get or what she heard that her sister or her neighbor did not get. It took a while to get women to really talk about what do they want.

Diana Copeland (07:42): It's such an easy thing that you did, but it was also so difficult to actually have this conversation with people instead of just assuming that you knew what everyone wanted and what was best. I really hope that more public health efforts and all decision making will continue down this path. But I'd really like to know, what did women want in India?

Dr. Aparajita Gogoi (08:03): In the first phase of the campaign, women in India really, really talked about wanting equity, respect, and dignity. Then they wanted no discrimination based on their education level, on their class, caste, or religion. They said that, "We do not want any physical and verbal abuse." So a large part of what women asked for was really respectful maternity care, their entitlement to respect. The second large chunk of what women wanted was, really, access to services, access to supplies, and access to providers. They said that, "All of us know that childbirth doesn't happen between 9:00 to 5:00 PM." So the second very large chunk that women asked for was access to 24/7 health facilities, services, supplies, et cetera. The third largest thing that people really asked for was clean and hygienic health facilities.

Diana Copeland (09:02): Let's go into that actually, because once you found out what women want in India, how did you use that information?

Dr. Aparajita Gogoi (09:09): We had to do subsequent research to understand why is disrespect happening? What is the typology of this? How can we support health workers to kind of reduce instances of disrespect and abuse? How can health system incorporate some of this? So we'd spend almost a year really, really figuring out the reasons; structural reasons, behavioral reasons. Is it happening because women are poor? Is it happening because of this complete normalization of, "The woman was lying on that table," that, "she's helpless and we can do what we want." Based on our findings, we started also implementing certain protocols, certain guidelines. For example, we signed an memorandum of understanding with the government health facility, where we tried to see that the accepted standards of respectful maternity care, can they actually be put into practice in crowded facilities? You'll be very happy to know that, yes, this is a facility which has about almost 19,000 childbirths every year, and we've just done the end line and it shows that respectful maternity care can be integrated in service delivery even if it's extremely kind of a stress-related environment with less workers, less infrastructure, and many women.

Diana Copeland (10:33): It's absolutely incredible. I mean, you're really leading the way in India. What I would really like to know is how did the policymakers react when you told them that disrespect and abuse was such a huge problem?

Dr. Aparajita Gogoi (10:47): We did not come across a single person who said that it's not important, but what everybody asked us, "What can we do?" Because often, respect, behavior are kind of marked as not tangible aspects which cannot be measured. But I think the research that we did really helped us to kind of highlight, "Okay, these are the seven things that you can integrate. For example, making a birth companion mandatory, telling the woman she has the right to decide what birthing position she wants, ensuring that no one is really kind of abusing her, put a poster about do's and don'ts in the labor room." So I think there was extreme amount of acceptance. We also received support from health professionals who were extremely willing to engage, to acknowledge that this is something which has been normalized for long, and this is time that we really, really look at quality and go beyond just looking at quantity as in numbers of women who are delivering in facilities.

Diana Copeland (11:58): Now that the advocacy agendas are being created for the What Women Want campaign and it's being dispersed through other governments; other governments are going to be seeing what women have said, just like India, what would you tell governments and funders about why they should care about respectful care?

Dr. Aparajita Gogoi (12:14): Well, I think the first thing is that respectful maternity care or respectful care for women is a fundamental right, literally. It's a violation of your human rights if you are abused or discriminated because you're poor, or you're not literate, you are not educated, or you belong to a different caste or a class. The other thing that we would really like to speak to important stakeholders about is that respectful maternity care is an extremely important component of quality of care. If you see the WHO's framework on quality of care, respectful care features as one of the eight components. So I think what we need to do right now is that really ensure that maternal-health-related policies and programs, sexual and reproductive health policies and programs, really have to incorporate respectful care. This is the watch that we need to kind of keep doing. I think even starting with the endorsement of the Respectful Maternity Care Charter, really kind of reaffirms people's commitment to maternal health rights as a basic human right, and it should be grounded in international, national policies and programs.

Diana Copeland (13:34): Other than actually endorsing the Respectful Maternity Care Charter, which I recommend every listener do at home, what can advocates at home do to ensure that women's rights are upheld in their community during childbirth and beyond? What's a really tangible thing that they could take home?

Dr. Aparajita Gogoi (13:49): When we started the What Women Want campaign, when respectful maternity care emerged as something really, really important, something that matters to women, something which is really dear to women, initially the general perception was it's only poorer women who's facing this. But as we kind of ramped up our campaign, we reached out to women through social media, we asked women to kind of tell us what were their kind of birthing experiences. And social media in India really means women who are well-off, women who are educated, middle class, women who can speak/understand English, has access to internet, et cetera. We were very surprised that women like us also came back to us with their experiences of disrespect, which really told us that there is, all over the world, there is enough, kind of, normalization of disrespect. What really touched us was that a lot of women said that, "I didn't really realize at that time that that was disrespect or that was violation of my rights."

Diana Copeland (15:04): It's become so normalized.

Dr. Aparajita Gogoi (15:07): So normalized. Even providers said, "This is what I've seen my seniors doing. When I was doing my house job, this is what I saw. So, I never even for a moment thought that not asking a woman her name, for example, is a sign of disrespect." So I think there's something that all of us can do, even advocates at home, women, women's groups, women's movements. I think, really, we can start by sharing experiences, by speaking up, by amplifying the voices, by supporting women who speak up, and really, from all corners to ramp up the discourse, which is demanding respect from maternity care.

Diana Copeland (15:53): I just want to say thank you so much. It was absolutely wonderful to have you on the podcast. You are absolutely, truly leading the way in ensuring that the women of India and around the world receive the respectful care that they deserve during pregnancy and childbirth. Thanks so much for joining.

Dr. Aparajita Gogoi (16:08): Thank you, Diana, and I would like to also thank everybody who's listening in, everybody who's speaking out for respectful maternity care. We need to keep this going, so more power to you all.

Diana Copeland (16:21): 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 right to be treated with dignity and respect.

Elena Ateva (16:30): Hello, Diana.

Diana Copeland (16:53): Thanks so much for coming on. We're going to be talking about Article Four; everyone is their own person from the moment of birth and has the right to be treated with dignity and respect. Why is that, and what happens when this right is not upheld?

Elena Ateva (16:44): So Article Four talks about the right to be treated with dignity and respect, and really, that right begins with birth. What it says is that no one is allowed to humiliate, verbally abuse, speak about you or touch you or your newborn in a degrading or disrespectful manner. You and your newborn baby must be cared for with respect and compassion. When it comes to respect for women's rights and access to quality care, women want the same thing no matter where they live. We heard that from Dr. Gogoi's interview. Respect and dignity are fundamental human rights, and they're also central to our shared humanity. This is how we distinguish ourselves as humans. Respect and dignity are also critical to newborns. If you think about it, if anyone is disrespected, that impacts the quality of care they receive. Dr. Gogoi also showed us that change is possible even in systems that face a lot of stressors, and that it is truly a matter of leadership and perseverance. There really is no quality care without respectful care.

Diana Copeland (18:03): What can the person listening at home do if their rights are being disrespected?

Elena Ateva (18:09): If you're a family member, if you're a friend, a supporter, a provider, and you're in a position to advocate for women; for women within your community, for your sisters, for your friends, your relatives, what you can do is ask your government to adopt the Respectful Maternity Care Charter starting from your local government or even the administrators within your facility. Advocate with them to adopt the Charter, to formally adopt the RMC Charter and to say that they will abide by those rights. This would make it easier for women then to have their rights respected and also make it safer for providers to provide respectful maternity care. If you're a provider, administrator, or policy maker, you have to incorporate within your programs, within your policies, women's requests for their own health. You need to ask women what they want and what do respect and dignity mean to them, because that would be different from place to place. You have to use this information to improve services and to continue asking these questions to ensure then that the care has been improved in practice.

Diana Copeland (19:34): Thank you so much for joining.

Elena Ateva (19:37): Thank you, Diana.

Diana Copeland (19:42): Special thanks to Dr. Aparajita Gogoi and Mercyline Ongachi. This episode of Brave Voices, Bold Actions was produced by Diana Copeland, Elena Ateva, Stephanie Bowen, Amanda Livingstone, Sandra Mwarania, Nina Garcia Wright, Kendra Hanna, and support from White Ribbon Alliance Kenya, White Ribbon Alliance India, and the entire White Ribbon Alliance team. Our theme song is called "Mama" by Eric Wainaina and 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 whiteribbonalliance.org/bravevoicespodcast.

Episode Team: This episode produced by Diana Copeland, Elena Ateva, Stephanie Bowen, Amanda Livingstone, Sandra Mwarania, Nina Garcia Wright, Kendra Hanna, with support from the entire WRA team. Special thanks to White Ribbon Alliance Kenya, C3, the Center for Catalyzing Change and White Ribbon Alliance India.

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. Aparajita Gogoi

National Coordinator, WRA India

Dr. Aparajita Gogoi is the National Coordinator of WRA India. She is the executive director of the NGO Center for Catalyzing Change (C3, formerly CEDPA India). Aparajita is a political scientist with 25 years of experience in programming, advocacy and defining strategies for policy issues, especially on young people’s health and rights. She is passionate about women’s health issues and has been an advocate for safe motherhood, firmly believing that surviving childbirth is a fundamental right of every woman.  Aparajita has been leading WRA India’s advocacy for safe motherhood for the last 16 years. She has also been involved in safe motherhood advocacy in Bangladesh, Indonesia and the Philippines.  She has received recognition for her work in various forums, including by The Guardian, which in 2011 named Aparajita as one of the world’s 100 most inspiring women. She holds a PhD (International Politics), from Jawaharlal Nehru University, New Delhi and a Post graduate diploma in Journalism. Follow White Ribbon Alliance India on Twitter at @WRAIndia.

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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