This post originally appeared on the Maternal and Child Survival Program website. Reposted with permission.

A midwife holds the hand of a woman in labor at a hospital in Gusau, Nigeria. (Karen Kasmauski/MCSP)

During a recent workshop on respectful maternity care (RMC) in Kabul, Afghanistan, a trainer addressed a group of midwives and doctors while holding a picture with four faces – two sad faces with tears, two happy faces:

“The midwife is unhappy, because she comes home from work, stressed and exhausted from a long day. And the woman who just gave birth is unhappy and scared, because the midwife shouted at her and didn’t explain what she was doing. What we have is two people who are sad; what we want to have are two happy people.”

This simple description describes a very real and complex problem in maternity wards around the world: disrespect and abuse. Mistreatment of women in childbirth manifests in many ways—as verbal abuse, neglect, humiliation or discrimination—and, as many of the participants in the Afghanistan workshop knew, it has deep roots.

Mistreatment in maternity care represents a breakdown in the accountability of a health system for both the women using its services and the health care workers it employs. These workers are often subject to very difficult working conditions, including dilapidated and overcrowded maternity wards, insufficient staff, lack of basic infrastructure and supplies, and a dearth of professional support.

Midwifery students help a pregnant woman off the examining table in Hohoe, Ghana. (Karen Kasmauski/MCHIP)

The World Health Organization’s (WHO) statement on prevention and elimination of disrespect and abuse during facility-based childbirth acknowledges the important role this problem plays in improving women’s health: “Every woman has the right to the highest attainable standard of health, which includes the right to dignified, respectful health care.” And in the WHO’s 2015 vision of quality care for pregnant women and newborns, women’s experience of care during labor and childbirth is considered as important to health care quality as the provision of evidence-based clinical care.

At USAID’s flagship Maternal and Child Survival Program (MCSP), we join the WHO in its support for “programs designed to improve the quality of maternal health care, with a strong focus on respectful care.” It was with this aim in mind—and in collaboration with the Tanzania Ministry of Health & Social Welfare (MoHSW)—that we recently convened a meeting in Tanzania to review available evidence related to RMC and mistreatment in childbirth in Tanzania and the region.

Participants included MoHSW representatives and stakeholders involved in RMC advocacy, program implementation, and related research. By meeting end, a shared consensus had emerged on promising approaches for reducing mistreatment and promoting RMC in Tanzania and beyond, including:

• Breaking down barriers between health workers and clients;
• Implementing continuous quality improvement measures, including participatory approaches that engage community representatives and health workers;
• Ensuring psychological support for health workers—“caring for the carer;”
• Strengthening health systems to overcome structural barriers, such as lack of commodities and basic infrastructure; and
• Advocating for policy change at national and local levels.

Not only is mistreatment of women during childbirth a health system failure and a violation of women’s rights at a highly vulnerable moment, it is also an important barrier to increasing facility-based births. MCSP continues to explore effective strategies to reduce mistreatment and achieve RMC as a central component of high-quality comprehensive care for all women.

As a midwife at an MCSP training in South Sudan stated so simply: “I started practicing [RMC] and my patients have noticed.”

During this week’s conference, we encourage you to add your voice to the global conversation – use the official conference hashtag (#GlobalMNH) and “virtually” attend via conference webcasts. You’ll be joining technical implementers, policymakers, researchers and practitioners from more than 50 countries, all strategizing on the best ways to eliminate preventable maternal and newborn mortality globally.