Malian Midwife Champions Respectful Care for Pregnant Women and their Families

This blog was originally published by MCHIP.

The man brings his pregnant wife into the health center and is confronted by the irritated midwife who raises her voice: “I’m too busy, what do you want? Go outside, this is no place for a man!” Later, the man returns for news about his wife’s condition and is promptly told to “go back and sit there.”

This role play session about abuse and disrespect in maternity care was part of a training in Burkina Faso sponsored by MCHIP. Through role play, MCHIP trainers demonstrated to doctors and midwives what not to do when attending to their patients, as disrespectful treatment of pregnant women and their families is all too common in health facilities around the world. This is especially true in developing countries, where doctors and midwives often lack basic infrastructure, supplies, manpower, or even awareness about patients’ rights to be treated with dignity during birth.

Training participant Haoua Ba had never heard about  respectful care until this MCHIP training, even after 22 years  as a midwife in Mali. Haoua and about 30 other midwives, pediatricians and obstetricians are known as Africa “Champions” (or advocates) for improving maternal and newborn health by promoting up-to-date knowledge, practices and attitudes in their countries and region. Mali is one of 10 key African countries—along with Benin, Guinea, Kenya, Liberia, Madagascar, Senegal, South Sudan, Uganda and Zambia—where the MCHIP Africa Champions Program is being implemented over two years (2011-2013).

MCHIP maternal and newborn health trainings have always emphasized “women friendly care,” for example by introducing skills checklists with which providers are evaluated on their ability to provide respectful care. However, given the prevalence of disrespect and abuse—in Africa in particular—and the lack of knowledge about this issue, Africa Champion trainers developed an entire training module devoted to this topic. In this 1.5 hour session, a facilitator helps training participants understand during group discussion that there is evidence that key components of respectful care, such as involving a woman in her care, will make the birth experience go more smoothly for both the woman and the health care provider.

Haoua described how this training session taught her to respect pregnant women and their families by greeting them politely and continually informing them in a soothing voice about everything she is doing. And since the training last year, Haoua has seen a big difference after putting into practice these new skills.

“When you show respect, it really facilitates things,” she said. “If you calmly tell the woman what to do and explain things her, it comforts her. And word gets around so women know who is going to treat them well and they request that midwife when they come into the hospital.”

It is important that women and their families are welcomed and have a positive birth experience at health centers so that they choose to have subsequent children at a health center. Women and their newborn babies have better odds of survival when women deliver in a facility than at more risky home births.

After participating in three Africa Champions maternal and newborn health trainings on innovative, lifesaving practices, Haoua is uniquely positioned to transfer these lessons learned. She plans to do so with both staff and student interns at the busy Referral Health Center in Bamako, Mali, where she also works as a midwife with 22 other midwives and three gynecologists. In fact, one of her primary goals as a Champion is to help strengthen the health center team by promoting evidence-based care. She described how she and one of the doctors will organize trainings about twice a month on a particular theme and have attendees practice on mannequins under their supervision to ensure they are correctly using their newly acquired skills and knowledge.

Importantly, Haoua has taught her colleagues that a woman should be allowed to have a companion by her side during the birth, which is a central tenant of respectful care. Having a loved one present provides women with essential comfort and support during the birth process, especially when the health center staff are busy or overworked. Evidence supports this practice as one that can help to shorten labor and increase normal outcomes.

[Above: Renovated maternity ward in Bobo Dioulasso, Burkina Faso, where each room has a chair so that the woman in labor can be accompanied by a family member.]

As MCHIP Africa Champion trainer and obstetrician Blami Dao explained, “Timing can make a big difference. Maybe in the morning, when there are lots of hospital staff, a provider can take good care of the patient. But at two or three in the morning when there may be 10 or 11 patients and only one provider to attend to them, the mood may be very different.”

Seasoned trainer Blami further explained that “health providers behave better where the woman has a companion, because there is an external observer watching them provide care. If the facility can accommodate it, the woman will receive better care if she is not alone.”

Blami is intimately familiar with the challenges that resource poor countries face when it comes to having basic equipment to enable pregnant women to give birth under decent conditions.  Blami and his colleagues took advantage of the 2002 renovation of the hospital in Bobo Dioulasso, Burkina Faso, where he was the head of the maternity ward, and wisely made sure that each birthing room was equipped with both a door to ensure privacy, and a chair for a birth companion. Thanks to concerted efforts of people like Blami, this hospital in Bobo Dioulasso is a model of respectful maternity care relative to many other hospitals throughout Africa.

A pregnant woman who must give birth without the company of a loved one or who must lie on the floor because there are not enough tables, without the privacy of a curtain, is not receiving respectful care. But even in the worst conditions, said Haoua, “if you have the will to do things well, you can help women.”

She is a perfect example of how the USAID-funded Africa Champions program is helping to prevent the untold suffering of women during one of the most vulnerable but extraordinary times in their lives.

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