By Loubna Belaid
and Valery Ridde
University of Montreal
About 830 mothers die due to pregnancy and childbirth complications around the world every day. Most are preventable deaths. That’s why improving childbirth outcomes was a critical issue at the recent G7 Health Ministers Meeting, and why Canada must remain committed to the cause.
We know where it’s happening. The number of mothers who die relative to the number of births – the mortality maternal ratio – is much higher in low-income countries. In 2015, the ratio in low-income countries was estimated at 239 deaths per 100,000 births, compared to 12 per 100,000 in high-income countries.
We know that improving access to healthcare services is important for pregnant women. In fact, it is included in the Millennium Development Goals adopted by the United Nations and 23 international organizations, including Canada, in 2000.
Canada supported that goal by spearheading the 2010 Muskoka initiative, where G8 countries invested $7.3 billion to reduce maternal, neonatal and child mortalities globally. Canada alone invested $1.1 billion to the cause.
But what if access to healthcare isn’t enough? What if expecting mothers, despite the risks they see around them, reject health services offered to them?
That’s what researchers discovered in a meta-analysis on the barriers expecting mothers face when seeking medical care in low- and middle-income countries.
Studies reported women were concerned about or had experienced disrespect and abuse in healthcare facilities. For example, care in hospitals and health facilities was often associated with physical and verbal abuse, non-consensual care, discrimination, neglectful care, lack of privacy and even detention against the patient’s will.
The analysis found hospital facilities were perceived to provide too many invasive interventions, such as unnecessary vaginal examinations, that they were insensitive to privacy issues and that they took away women’s control over the birthing process.
Many complained of a lack of supportive attendants at birth during a hospital delivery. Some experienced long delays for care. Some had a fear of cutting (from episiotomy or caesarean section).
Some women described health providers as verbally abusive, lacking compassion or even physically abusive during delivery. Some feared compulsory HIV testing or HIV-status disclosure. And some feared stigmatization because of their unwed status.
These issues of cultural disconnect, disrespect and abuse are matters of quality of care that haven’t had enough attention globally. But they are important for improving maternal outcomes. In fact, researchers have found that improving the quality of care is essential for improving maternal outcomes.
Around the world, civil and professional movements promote childbirth based on respect and dignity. The White Ribbon Alliance, for example, convenes individuals, non-governmental organizations, professional associations, government entities, youth, community leaders, academics and donor agencies to promote every woman’s right to a safe birth.
Canada has committed to 20 projects in which Canadian researchers work with African counterparts and policy-makers to improve access and quality of care for expecting mothers and babies.
But Canada can – and must – do more. Canada can direct policies and funding to tackle disrespect and abuse at health facilities. We can insist on sensitization training for global health students and non-governmental organization workers. We can encourage more awareness on the issue for policy-makers and health professionals. We can support more research on evidence-based policies to inform our goals.
Of course, Canada should always work with local practitioners, researchers and policy-makers to avoid the mistakes of the past. And quality of care should be an integral part of our broader commitment to addressing barriers to healthcare, such as access, transportation, education and more.
The government of Prime Minister Justin Trudeau has said it wants Canada to take a leadership role in global health, including infant and maternal mortality. Addressing maternal barriers to healthcare – including quality of care – will help the work we’re doing go a lot farther.
Loubna Belaid is a post-doctoral researcher at the CRCHUM and the school of public health of the University of Montreal. Valery Ridde is an associate professor of global health in the Department of Social and Preventive Medicine and the Research Institute of the University of Montreal School of Public Health (IRSPUM).