A growing body of evidence shows that the mistreatment of women in maternal healthcare is a reality worldwide. For several years, the World Health Organization (WHO) and HRP (the UNDP/UNFPA/UNICEF/WHO/World Bank Special Program of Research, Development and Research Training in Human Reproduction) have been documenting this human rights violation, and its impact on health and wellbeing.
HRP and WHO authors and collaborators have now published a special series of five papers in the journal PLOS Global Public Health exploring a range of strategies on different themes to end mistreatment of women during childbirth and improve respectful care.
The first of these papers looks at theories of interventions to reduce physical and verbal abuse. In this paper two themes emerge: first, that violence is normalized in society, particularly against “othered” groups; and second, the belief that mistreatment of women is necessary to reduce clinical harm.
The second article looks at strategies to reduce stigma and discrimination, an important part of the mistreatment experienced by women. Whilst much research has been done to describe stigma and discrimination experienced by women in sexual and reproductive healthcare settings, more needs to be done to better understand how to end it.
The third article in the series, which has just been published, looks at communication strategies to improve interpersonal communication to reduce mistreatment of women. Two main approaches were identified: the training of health workers and using communications tools. Whilst most interventions uncovered focus on providing information, incorporating other communication goals – such as building a relationship, including women and their partners in making decisions – could further improve the experience of care for women, their partners and their families.
The fourth article in the series looks at how factors relating to organizations and working environments can affect mistreatment in low- and middle-income countries. There is growing evidence on how health systems staff shortages and other barriers can affect respectful maternal care, but this paper identifies and addresses significant gaps in research relating to multiple work and organizational factors. This includes key organizational challenges related to high workload; unbalanced division of work; lack of professional autonomy; low pay; inadequate training; poor feedback and supervision; and workplace violence – all of which are differentially influenced by shortages of resources.
The fifth paper was a “Critical Interpretive Synthesis”, which aims to increase understanding of the drivers of power-related mistreatment of women. It did this by exploring and consolidating literature from across different fields of study, to advance theory and practice on this theme.
These findings will help inform a new WHO knowledge translation companion for respectful maternal and newborn care, planned to be published in 2024, which will aim to support lasting positive change in health systems.
