Confronting the culture of care: a call to end disrespect, discrimination, and detainment of women and newborns in health facilities everywhere

Abstract

Quality and respect are increasingly recognized as critical aspects of the provision of health care, and poor quality may be an essential driver of low health care utilization, especially for maternal and neonatal care. Beyond differential access to care, unequal levels of quality exacerbate inequity, and those who need services most, including displaced, migrant, and conflict-affected populations, may be receiving poorer quality care, or may be deterred from seeking care at all. Examples from around the world show that mothers and their children are often judged and mistreated for presenting to facilities without clean or "modern" clothing, without soap or clean sheets to use in the hospital, or without gifts like sweets or candies for providers. Underfunded facilities may rely on income from those seeking care, but denying and shaming the poor further discriminates against vulnerable women and newborns, by placing additional financial burden on those already marginalized. The culture of care needs to shift to create welcoming environments for all care-seekers, regardless of socioeconomic status. No one should fear mistreatment, denial of services, or detainment due to lack of gifts or payments. There is an urgent need to ensure that health care centers are safe, friendly, respectful, and hospitable spaces for women, their newborns, and their families.

It's the Destination and the Journey—A Mapping of the Challenges in Transport and Referral for Maternal and Newborn Health in Pandemics and Beyond

“…Women and newborns deserve respectful care during each step on their journey to receive health services: during travel, upon arrival, and in the case of being referred to other facilities. Safe, reliable transport is as important as other healthcare needs (25). Even when transport is provided, there may be little or no assistance provided to facilitate the transfer and limited emotional or psychosocial support in a stressful time.…”

“…Women and families have been found to bypass the nearest options for perceived better quality care elsewhere, potentially leading to longer journeys, higher risk, and more delays (11). Families may completely avoid care-seeking (or delay until the health condition is more severe) due to stigma or fear of mistreatment upon arrival, as many women are blamed for arriving at facilities "late" and with complications, and some are even fined (25). Under-resourced and overcrowded facilities are more likely to treat women poorly or deny care, including turning people away, neglecting them once they arrive, or demanding payments before providing services or discharging (27,28).…”

Assessing respectful maternity care in a fragile, conflict-affected context: Observations from a 2016 national assessment in Afghanistan

“…Respectful maternity care (RMC) is even more important in humanitarian settings, where weakened and fragile health systems struggle to provide quality care and all women, but especially the most marginalized and vulnerable, may avoid care seeking as there are no perceived benefits in attending a health facility (Sacks & Peca, 2020). Systematic evidence on how women's health can be affected by armed conflict is sparse, however researchers have reported on poor mental health (e.g.…”

Protecting newborn infants during the COVID‐19 pandemic should be based on evidence and equity

“…However, to date, there is only one documented potential case of transplacental transmission, 6 and despite rare reports detecting virus in breastmilk, transmission via breastmilk has not been confirmed. pandemic, marginalised women and newborn infants were more likely to face discrimination in accessing and receiving respectful and evidence-based care, 12 and this vulnerability has been exacerbated by the pandemic. 3 Upholding the principles of reproductive, maternal and newborn rights, and respect for healthcare workers, must be a priority in every setting, even during emergencies.…”

“…If restrictions are necessary, they should be based on the best available science, applied equitably and transparently, and understood and agreed by all. Even before the COVID‐19 pandemic, marginalised women and newborn infants were more likely to face discrimination in accessing and receiving respectful and evidence‐based care, 12 and this vulnerability has been exacerbated by the pandemic 3 . Upholding the principles of reproductive, maternal and newborn rights, and respect for healthcare workers, must be a priority in every setting, even during emergencies.…”