A social justice approach to maternity care

World leaders have committed to 17 Sustainable Development Goals aimed at ending poverty, fighting inequality, protecting the planet and ensuring prosperity, peace and justice.  UN Women has identified that achieving gender equality and women’s empowerment is integral to each of the 17 goals. Only by ensuring the rights of women and girls across all the goals will we get to justice and inclusion, economies that work for all, and improve access to health care including maternity care.

A positive childbirth experience is more than the prevention of death and disability.  It is also respect for every woman’s basic human rights: autonomy, dignity, feelings, choices, and preferences.  Cultural, emotional, social, psychological and spiritual safety, inform a positive birth experience.

 In spite of the considerable debates and research that have been ongoing for several years, the concept of “normality” in labour and childbirth is not universal or standardized. There has been a substantial increase over the last two decades in the application of a range of labour practices to initiate, accelerate, terminate, regulate or monitor the physiological process of labour, with the aim of improving outcomes for women and babies. This increasing medicalization of childbirth processes tends to undermine the woman’s own capability to give birth and negatively impacts her childbirth experience. In addition, the increasing use of labour interventions in the absence of clear indications continues to widen the health equity gap between high- and low-resource settings*.

The value of a positive childbirth experience for health

Research indicates that a positive birth experience can be an important mechanism for creating greater health equity.  The WHO recommendations Intrapartum care for a positive childbirth experience are focussed on ensuring that women and children thrive and achieve their full potential for health and well-being*.

The value of a positive childbirth experience for the global community

We need women to be more than simply alive; we need them to be well physically, emotionally and culturally.  A healthy, strong and confident mother gives a baby the best start at birth, influencing the long-term wellness of herself and her child and our community.  By outlining a new model of intrapartum care that is adaptable to individual country contexts, the WHO guideline – intrapartum care for a positive childbirth experience enables substantial cost-savings through reduction in unnecessary interventions during labour and childbirth.

The right to a positive childbirth experience

Irrespective of the socioeconomic setting all pregnant women and their babies during pregnancy, childbirth and the postnatal period have a right to a woman-centred care that optimizes the quality of maternity care, through a holistic, human rights-based approach that provides a positive birth experience.

The right to a positive birth extends beyond the idea of choice: social protection and support measures are needed to empower women and families with the knowledge and resources needed to realise their right to a positive birth.  We also need to consider the linkages between an individual’s reproductive self-determination and the conditions in their own communities such as health professional use of best practice and accountability to the woman and community.

Supporting positive childbirth for all

Pregnancy and birth is a normal physiological life event.  When women are supported and validated, their innate strength is enhanced.  Health workers need a faith in the ability of the women to achieve a good outcome.  We need to challenge cultural classifications of birth so as achieve a positive birth experience.  Giving birth is uncertain but not dangerous for the majority of women.

Pregnancy is not an illness.  Pregnancy is a fundamental human capability, which requires a societal context that is robustly supportive of pregnant women enabling women to lead full healthy lives.  Outcomes are determined by many factors other than technical skill.  As such we need to explore the ways in which society via laws, policies; institutions, health professionals and cultural change can better support childbearing women and their access to optimal maternity care and full healthy lives.

Advancing support for embodied caregiving and all caregivers

Caring and respectful relationships with healthcare workers can make the difference between a positive and a negative birth experience.  We need to create practices and norms that enhance the value of, and support for, childbearing women, but also for nurturing and care giving in general.  We also need to challenge cultural categories of normative relationships between pregnant women and their care givers so as to achieve a positive birth experience.

Providers must show respect and compassion through their words and actions so that every person is given the respect and care they so richly deserve.  All health professionals have a role in ensuring that they provide evidence based respectful care and that the women they care for are empowered to be equal partners in this process

‘A woman’s relationship with her maternity providers is vitally important. Not only are these encounters the vehicle for essential lifesaving health services, but women’s experiences with caregivers can empower and comfort or inflict lasting damage and emotional trauma. Either way, women’s memories of their childbearing experiences stay with them for a lifetime and are often shared with other women, contributing to a climate of confidence or doubt around childbearing.’            

White Ribbon Alliance, Respectful Maternity Care, 2011

Removing barriers to skilled birthing support

A positive birth experience and the outcome of a healthy, strong and confident mother gives a baby the best start at birth, influencing the long-term wellness of herself, her child and the long term wellness of our society. This success is directly tied to support from skilled and accessible health workers; hence we need to ensure access for all child bearing women including the vulnerable, the disadvantaged, and those who live in rural and remote communities.

Advancing a positive childbirth experience as a cornerstone of health equity.

To achieve health equity, a commitment is required to not only recognise the unequal access to conditions and resources that support health but also to address the social systems, rooted in histories of oppression and exploitation of women, that reproduce these inequalities.  When we enhance the autonomy and freedom of a woman, we raise the living standards of her community and her children.

We need to ensure responsive, sensitive maternity care systems that cater for the individual woman and respect for her human rights.  Maternity care informed by the Respectful Maternity Care Charter** is an innovative approach to reform maternity care.

Thank you, Paige Hall Smith for inspiring this essay.***

References

*  WHO recommendations: intrapartum care for a positive childbirth experience. Geneva: World Health Organization; 2018. Licence: CC BY-NC-SA 3.0 IGO at http://apps.who.int/iris/bitstream/handle/10665/260178/9789241550215-eng.pdf;jsessionid=975EFE2877BD992A4CA0E2280A5033F3?sequence=1

**  The Respectful Maternity Care Charter http://www.who.int/woman_child_accountability/ierg/reports/2012_01S_Respectful_Maternity_Care_Charter_The_Universal_Rights_of_Childbearing_Women.pdf

*** Paige Hall Smith, PhD (2018) Social Justice at the Core of Breastfeeding Protection, Promotion and Support: A Conceptualization Journal of Human Lactation, Vol 34 Number 2, May 2018