EXECUTIVE SUMMARY
Respectful maternity care (RMC) — the right of every woman to dignified, respectful treatment during pregnancy and childbirth — has emerged as a critical quality dimension in maternal health. Evidence from LMICs documents widespread disrespect and abuse in maternity facilities: physical abuse (slapping, restraining), verbal abuse (shouting, shaming), discrimination (based on ethnicity, poverty, HIV status, age), non-consented procedures (episiotomy, C-section), abandonment during labour, and denial of cultural practices. These experiences deter facility delivery, undermine trust in health systems, and constitute violations of women's human rights.
UNFPA has integrated RMC into its maternal health programming, recognising that increasing skilled birth attendance and facility delivery — core goals of the maternal health strategy — must be accompanied by improvements in the quality and dignity of care women receive. A woman who delivers in a facility where she is mistreated may not return for her next pregnancy, and her experience may discourage other women in her community from seeking facility care.
The White Ribbon Alliance's Respectful Maternity Care Charter (2011), WHO's Quality of Care Framework (2015), and the Lancet Maternal Health Series have all contributed to elevating RMC as a global priority. UNFPA supports RMC through: health worker training on communication and rights-based care, facility-level quality improvement, community feedback mechanisms, and advocacy for national RMC standards.
KEY FACTS
- Prevalence of mistreatment: A 2019 multi-country WHO study found that approximately 42% of women observed during childbirth in Ghana, Guinea, Myanmar, and Nigeria experienced some form of mistreatment
- Types of mistreatment: Physical abuse, verbal abuse, stigma/discrimination, failure to meet professional standards, poor rapport, and health system conditions/constraints (Bohren et al. typology)
- Impact on facility delivery: Women who experience mistreatment are less likely to return for subsequent deliveries; community awareness of mistreatment deters facility use
- White Ribbon Alliance Charter (2011): Defined 7 rights of childbearing women: freedom from harm, information/consent, privacy/confidentiality, dignity/respect, equality/non-discrimination, right to healthcare, and liberty/autonomy
- WHO Quality of Care Framework (2015): Includes both provision of care (evidence-based practices) and experience of care (communication, respect, emotional support) as essential quality dimensions
- WHO recommendations on intrapartum care (2018): Include companion of choice during labour, mobility and position of choice, informed consent for all procedures, and respectful care
- Risk factors for mistreatment: Young age, poverty, ethnic minority status, HIV-positive status, unmarried status, and prior C-section
- Health worker perspective: Mistreatment often reflects health worker burnout, understaffing, poor working conditions, and lack of training — not solely individual attitudes
DETAIL
UNFPA's RMC work focuses on training health workers (midwives, nurses, physicians) in respectful communication, informed consent, pain management, companion of choice, and cultural sensitivity. Facility-level interventions include quality improvement collaboratives, client feedback mechanisms, and standards-based audits.
An important dimension is recognising that disrespectful care often reflects systemic problems — understaffing, overwork, inadequate supplies, poor infrastructure — rather than individual malice. A midwife managing 10 simultaneous labours in a facility without running water may resort to harsh communication under extreme stress. Addressing RMC therefore requires both individual training and systemic investment in maternity facility conditions.
Community engagement is also critical: empowering women to know their rights during childbirth, establishing feedback mechanisms, and involving community leaders in facility oversight.
SOURCES
- Bohren, M.A. et al.: "How women are treated during facility-based childbirth in four countries" (Lancet, 2019)
- White Ribbon Alliance: "Respectful Maternity Care Charter" (2011)
- WHO: "Standards for Improving Quality of Maternal and Newborn Care in Health Facilities" (2016)
- WHO: "WHO recommendations: intrapartum care for a positive childbirth experience" (2018)
- Freedman, L.P. et al.: "Defining disrespect and abuse of women in childbirth" (Bulletin of WHO, 2014)
RELATED DOCUMENTS
- UNFPA-W-01 (Maternal Health)
- UNFPA-W-09 (Midwifery)
- UNFPA-W-14 (EmONC)
- UNFPA-H-02 (CEDAW)
- UNFPA-W-17 (Gender Equality)