East, Central and Southern Africa Health Community: Translating Evidence to Policy in Support of Respectful Maternity Care

Apr 30, 2018

Not all babies born in health facilities are delivered in an environment of respect and dignity.  Across the globe, in low, middle and high-income countries, women and families often face humiliating and traumatic experiences during institutional childbirth. Mistreatment results from poor interpersonal interactions between provider and client, infrastructure and human resource deficits, socio-cultural norms, lack of accountability and mechanisms to ensure high quality client care.  Until recently, these experiences were not documented or studied. In a world eager to increase access to care, how care was experienced was not the focus. No longer are women’s tales of mistreatment during childbirth cast as anecdotes. Increasingly, these negative experiences have become the subject of scientific inquiry and contribute to a growing body of evidence around disrespect, abuse of women and the need to advance respectful maternity care. Evidence generation and advocacy efforts have paved the way for policy and programmatic change.

Over the last two years, a regional process has been underway in East Africa to sensitize, educate and determine appropriate policy and actions to address disrespect and abuse of women during facility-based childbirth. The East, Central and Southern Africa Health Community (ECSA-HC) is a sub-regional intergovernmental health organization comprised of nine member states and has served as a platform for debate, agenda-setting and evidence to policy translation.  The discussion around Respectful Maternity Care (RMC) formally began in 2016 when the ECSA-HC Secretariat organized a half-day regional consultation on respectful maternity care supported by the Translating Research into Action (TRAction) Project.

Awareness and sensitization around RMC was reinforced during a plenary session held at the 2017 Best Practices Forum (BPF) in which HEARD partners presented findings from cutting edge implementation research (Kenya, Tanzania) detailing manifestations of disrespect, abuse and promising approaches for advancing RMC.  The BPF concluded with the ECSA-HC’s Director’s Joint Consultative Committee recommending RMC as a priority action area.

The former positioned RMC to be a prominent discussion thread at the ECSA-HC’s 65th Health Ministers’ Conference. During a panel on accountability for MCH post 2015, the Minister of Health and Social Welfare from Tanzania, Hon. Ummy Mwalimu, a human rights lawyer by training and champion of women’s rights, spoke about her commitment to advancing RMC. This further reinforced HEARD project partners from Africa Academy for Public Health and University of California, San Francisco, who presented on how implementation science partnerships can advance RMC. During the plenary, the ministers from the region shared their country-specific reflections on the need to address mistreatment during childbirth.

The Health Ministers’ Conference culminated with the passage of a set of resolutions, including one specifically on RMC. The resolution represents tangible member state recognition of RMC as a priority as well as the need to apply implementation science approaches to addressing disrespect and abuse and the advancement of respectful maternity care.  A regional resolution is an important step toward influencing and reinforcing national policy and programmatic action among member states.