The Question of Quality: Comprehensive, Respectful, and Rights-Based Maternal Health

Imagine that you’re a young, pregnant woman. Imagine that you have to walk five miles to even get to the doctor. You arrive at the clinic, only to sit in a small, hot, overcrowded waiting room for four or more hours. When you finally do get to see a nurse, she mocks your accent, or your clothes. She scolds you for not coming in sooner, and makes you feel ashamed. Your understanding was that it was a free exam, but then you are asked to go to the pharmacy to buy gloves for the nurse. The nurse pricks your finger and says she’s testing you for a disease. You think you’ve heard of this disease, and you heard it kills people. You’re scared of it, but she doesn’t say more – doesn’t say if she thinks you might have it or if it will hurt your baby. You’re given a confusing mix of pills that are bitter tasting, and told that the clinic is out of some. The nurse says you should come back next week to get these, and that you should come back for another exam in 2 months.

Would you return to the health facility?

For many women in the developing world, this example closely resembles their experience. Each year, over 300,000 women die in pregnancy and childbirth, 99 percent of them in the developing world. For every woman who dies of pregnancy-related complications, 20 to 30 more suffer from related on-going conditions which may permanently affect their normal functioning –additional 6 to 9 million women per year. Maternal health advocates, researchers, and providers are committed to ending human rights abuses and promoting skilled and dignified care. Together, we can make comprehensive, respectful, and rights-based maternal health care available to all.

Maternal mortality and morbidity are the tragic result of a myriad of compounding factors. 75% of maternal deaths are caused by severe bleeding, infections, high blood pressure during pregnancy, complications from delivery, and unsafe abortion. Other deaths are often caused by or associated with other diseases such as malaria or AIDS. Delivering at a medical facility with a skilled health care worker present is critical should these complications arise, but often they can be avoided altogether if a woman attends antenatal care visits. However, only 40% of women in low-income countries complete the recommended number of antenatal care visits.

As the example above illustrates, accessing care for some women can not only be difficult, it can be intimidating, humiliating, and scary. Unsurprisingly, receiving poor care makes women less likely seek health care out in the future. This is why it’s crucial to not only provide access (by making healthcare close and affordable), to educate women, their families, and their communities about the importance of maternal health care, but also to work with health clinics and health workers to ensure quality of care – the respectful, comprehensive, and competent care that every human deserves.

At PfD, we deliver integrated programs that address the nuanced reality on the ground. In Nigeria, we not only provide education to women, their families, and communities and engage with key community leaders to change behavior. We also work with health care providers to ensure that they have the knowledge and resources to provide quality care. PfD worked to deliver improved maternal, newborn, and child health services through the training and mentoring of health care personnel, including nurses and midwives, community health extension workers, and community based healthcare volunteers. PfD trained nurses and midwives on quality of care and trained health care workers on Balanced Counseling Strategy which improves client-provider interactions and client satisfaction. The results of this project speak for themselves – In the first year of the project, 15,562 women attended at least one session of antenatal care during pregnancy – by the end of the project over 44,000 did. This represents an increase of over 280%.

Through the Scale-up of Prevention of Mother-to-Child Transmission and Pediatric HIV/AIDS services in Delta State, Nigeria, PfD built the capacity of health facilities, training health workers to provide quality HIV testing and counseling, integrating Prevention of Mother-to-Child Transmission and HIV care into antenatal care services, and upgrading and equipping a laboratory to service as a comprehensive treatment hub. PfD trained health care workers and pregnant women received HIV testing and counseling. PfD also facilitated testing of pregnant women for HIV.

PfD is committed to the idea that no woman should be in danger because she gives birth, which is why we’re joining the global community in calling on the UN Secretary General to recognize April 11th as the International Day for Maternal Health and Rights. Together with the UN community we can make comprehensive, respectful, and rights-based maternal health care available to all. To sign the petition,click here. Follow the discussion at #IntlMHDay and through PfD’s social media updates. To learn more about our work to promote maternal health and healthy communities, click here.

April 6th, 2016, by Katie Baczewski, PfD Program Officer