Significant progress has been made globally in reducing maternal and neonatal morbidity and mortality. Despite these improvements, access to quality services is not guaranteed for many, especially in developing countries.1Even when services are available, care may be compromised by social, ethical and cultural barriers, an unwelcoming reception at the health care facility, lack of privacy and information for the client, and disrespect and abuse.2 These barriers affect service utilization as women often avoid seeking care in health facilities because of mistreatment.
In recent years, women giving birth and a number of doctors, midwives and nurses have joined forces in various countries around the world to promote more respectful maternity care, emphasizing the importance of underlying professional ethics and psycho-socio-cultural aspects of health care delivery as essential elements of care.3 This movement for Respectful Maternity Care (RMC), sometimes referred to as “Humanization of Childbirth,” calls for an approach centered on the individual, based on principles of ethics and respect for human rights, and promoting high-impact, evidence-based practices that recognize women’s preferences and the needs of women and newborns.
Recognizing the importance of RMC, Jhpiego has been a leader in integrating key RMC principles and practices into its maternal and newborn health (MNH) programs worldwide. One notable example is from Mozambique, a country committed to creatinga progressive culture of respectful maternity care in its health services. The Mozambique Ministry of Health (MOH), with support from the U.S. Agency for International Development (USAID) and Jhpiego, has been incorporating the principles of humanization of care into national strategies and national technical guidelines.Since 2007, Jhpiego has worked collaboratively with the MOH in the development and implementation of a National Plan to Improve the Quality and Humanization of Reproductive Health and MNH Services.
The National Plan is based on the Standards-Based Management and Recognition (SBM-R®) approach to performance and quality improvement pioneered by Jhpiego, in which aspects of respectful care were incorporated with performance standards. The first phase of implementing the National Plan included 18 health facilities across the country, all demonstrating improved adherence to the RMC performance standards.
Building on the experiences and lessons learned from these 18 facilities, the Mozambique MOH, with support from USAID and the Maternal and Child Health Integrated Program (MCHIP) led by Jhpiego, launched a national “Model Maternity Initiative” (MMI) in 2009. Under this initiative, the quality and humanization improvement process using the SBM-R approach was expanded to the 34 largest hospitals in the country (MISAU, 2009 and 2010).
MMI is based on principles of quality and respectful maternity care to create facilities that serve as models for quality maternity care, as well as clinical training sites. MMI promotes birthing practices that recognize women’s preferences and needs, and the scaling-up of high-impact interventions. Specifically included are: respect for beliefs, traditions and culture; the right to information and privacy; choice of a companion; freedom of movement and position; skin-to-skin contact and early breastfeeding; appropriate use of technology and effective lifesaving interventions; and prevention of violence and disrespect.
As one Mozambican woman who had her first child under respectful care, accompanied by her partner, said, “This movement is so important. We women must speak up to fight for our rights.”
Over time, the culture of promoting respectful maternity care has become more widespread in Mozambique, with increasing involvement of pre-service and in-service training institutions, professional associations (ob/gyn, pediatric and nursing) and civil society. The MOH, with the support of MCHIP and other partners, is now working to scale up the MMI to include up to 122 health facilities by 2014.
Jhpiego continues to provide leadership in the promotion of RMC, focusing on disseminating various program experiences, developing program tools and templates to support countries interested in strengthening RMC programming, and supporting global advocacy efforts.
1Countdown to 2015 for maternal, newborn, and child survival: The 2008 report on tracking coverage of interventions. 2008. The Lancet, 371: 1247–1258.
2Bowser D and Hill K. 2010. “Exploring Evidence and Action for Respectful Care at Birth.” USAID, TRAction Project.
3Davis-Floyd RE, Barclay L, Daviss B and Tritten J. (eds). 2009. Birth Models That Work. University of California Press; Davis-Floyd R and Cheyney M. 2009. Birth and the big bad wolf: An evolutionary perspective. In Childbirth across Cultures: Ideas and Practices of Pregnancy, Childbirth, and the Postpartum, pp. 1–22.