Women who are treated with respect and dignity during childbirth are more likely to have positive birth experiences, feel empowered to make informed decisions about their care, and have better health outcomes for themselves and their newborns. 

Respectful Maternity Care (RMC) is an approach to maternal healthcare that helps create these outcomes. It prioritizes communication, consent, privacy, and dignity for women during pregnancy, childbirth, and the postpartum period. RMC is not just the elimination of disrespectful care: It is an aggregation of person-centered efforts and a key component of quality healthcare.  

RMC’s effectiveness as an approach for improving maternal and newborn healthcare outcomes is not conjecture. Studies have shown that training healthcare providers in RMC can lead to better communication, higher satisfaction rates, and improved health outcomes for women and newborns. In addition, the implementation of RMC policies and programs has been associated with a reduction in maternal mortality. Community-based initiatives and advocacy campaigns have also played a crucial role in promoting awareness and demand for RMC, resulting in more successful implementation of RMC policies. 

Yet, successful refinement and implementation of RMC will require finding ways to adapt its powerful formula across varied cultures – and to make sure its practices are integrated on a consistent basis in the widest variety of locations and institutions. 

Applying Standards in Varied Geographical Contexts 

Implementing RMC guidelines and standards, such as the World Health Organization (WHO) Standards, is important to ensure consistent and equitable care across different settings.  

Several key actions have been identified by the WHO as necessary to improve the quality of maternal healthcare. These include increased support from governments and development for research and action, programs aimed at improving the quality of care with a strong focus on respect, and greater emphasis on the rights of women to receive dignified and respectful healthcare during pregnancy and childbirth.  

The WHO also highlights the need for generating data related to respectful and disrespectful care practices, establishing systems of accountability, and providing meaningful professional support. Finally, the involvement of all stakeholders, including women, is crucial in efforts to improve the quality of care and eliminate abusive practices.  

RMC requires effective communication between healthcare providers and women, obtaining informed consent for medical interventions, ensuring privacy and confidentiality, and treating women with dignity and respect throughout the entirety of the perinatal period—even when viewpoints and choices may differ from that of the healthcare worker. Yet how will implementation of uniform standards work across varied geographical contexts?  

In different cultural and geographical contexts, RMC can—and should—take on different forms to address specific cultural or social barriers that prevent women from accessing quality maternity care. 

For example, in India, traditional birth attendants (TBAs) play a vital role in providing emotional and physical support during childbirth—and excluding them from maternal healthcare can cause a breakdown in trust between women and their healthcare providers. Obstetricians and other medical professionals oftentimes overlook the value of TBAs (who are often from the same community as the birthing person). This not only disempowers women to make informed decisions, but also deprives them of the support they need to have a positive childbirth experience. Implementing RMC in India may entail encouraging medical professionals to work collaboratively with TBAs with respect for their role in the community. 

Ethiopia offers another case. Cultural and social barriers, such as distrust in healthcare institutions, financial constraints, and limited access to transportation to reach healthcare facilities can hinder women from accessing quality maternity care. The result is a preference for home births, despite the known risks involved in that decision. Further, gender inequalities and patriarchal societal norms may limit women’s autonomy and decision-making power regarding their healthcare decisions. Overcoming these barriers requires enhanced transportation options, education on the value of skilled birth attendants (including midwives) and establishing culturally sensitive birth centers that honor local traditions.   

Throughout Latin America, where traditional gender and social norms also prevail, women often defer decision-making to their husbands or partners, limiting their autonomy during childbirth. To enhance RMC in this region, it is crucial to empower women to make informed decisions about their care, educate partners and families about the importance of women’s autonomy, and foster an environment where women feel empowered to advocate for themselves. 

Which Policies and Programs Improve RMC? 

Improving RMC involves a range of strategies, including communication, cultural sensitivity, and technology. For example, a study in Tanzania explored the use of mobile apps to improve communication and information-sharing between healthcare providers and women during childbirth. The midwives from the study largely expressed satisfaction with the app for several reasons, including comprehensive content, and reciprocal communication. 

One common hallmark of successful RMC policies is an emphasis on the importance of listening to the community. India’s Labor Room and Quality Improvement Initiative (LaQshya) shows how amplifying women’s voices can bring positive changes to birthing experiences. Launched in 2016, the initiative aims to reduce maternal deaths and improve the quality of care in labor rooms, while ensuring RMC for all pregnant women attending public health facilities.  

Listening was a big part of its success. The White Ribbon Alliance (WRA) India campaign, “Hamara Swasthya Hamari Awaaz,” saw 335,000 women share their maternal and reproductive health requests. The campaign, which also inspired the “What Women Want” campaign, highlighted the need for RMC, based on survey results from women demanding that they are treated with respect, dignity, and non-discrimination while seeking care. These requests were subsequently integrated into LaQshya guidelines. It was a policy change that led to significant training and curriculum changes, resulting in tens of thousands of health facilities being required to provide RMC in facility-based labor and post-partum care.  

“After the campaign, in the labor rooms, I saw a change,” said Dr. Manju Chhugani, Dean of the School of Nursing Sciences and Allied Health at Jamia Hamdard University in New Delhi, for an article for White Ribbon Alliance, India. “The health providers were explaining to the mother what they were going to do. I am happy that gradually it has been engrained in the health provider’s practice so now they are just doing it. They are sensitized now.”  

Similarly, in Malawi, women’s voices are now a cornerstone of two prominent tools launched in 2020 to measure the quality of government-sponsored reproductive, maternal, and newborn healthcare services. The first intervention was an assessment toolkit that measures the quality of maternity services in government-run units by asking women about their experiences of care. The auditing and accountability tool was the second innovation, and it is used during inspections by regulatory bodies to grade health facilities. Both tools incorporate women’s top demands, including privacy, improved water, sanitation, and hygiene, and respectful, timely, and attentive care. They also bring women’s demands to the forefront of quality care and create new pathways to hold decision-makers accountable to better meet women’s care needs.  

Future Directions to Improve RMC 

How will future efforts to improve respectful maternity care succeed? First, they should focus on expanding the understanding of RMC across the continuum of care, including newborn and immediate postpartum care, antenatal and postnatal care, sexual and reproductive health, and family planning. The importance of RMC and the right of women and patients to receive respectful care, must be understood by healthcare providers and the community they serve, alike.  

Recognition of the stress on healthcare workers and strategies to support them are also essential. The stress and pressure healthcare providers face, especially in emergency situations, can affect their mental health and pose additional challenges to their ability to provide respectful care. Tools to manage workplace stressors must be integrated into obstetric and newborn care training to support providers in delivering high-quality and respectful care.  

Finally, efforts to improve RMC should be evidence-based and measurable. Developing common measures that accurately capture what matters to women and their families and integrating them into routine measurement systems is necessary. By focusing on these areas and working collaboratively, we can create sustainable, equitable, and respectful maternity care for all. 

Read More: 

• Respectful Maternity Care and Maternal Mental Health are Inextricably Linked 
• Raising Momentum for Integrating Respectful Maternity Care in Humanitarian Settings 
• What Can Improving Respectful Maternity Care Look Like?