Leading global health and development agencies today released a new first-of-its-kind implementation guide to help countries provide respectful, dignified care and eliminate mistreatment across maternal and newborn health services: Compendium on respectful maternal and newborn care .
This mistreatment takes different forms, ranging from neglect and abuse to non-consensual medical procedures – and evidence suggests it remains alarmingly widespread in many countries around the world.
A 2019 study by the UN's Special Programme in Human Reproduction (HRP), supported by World Health Organization (WHO), in four countries found that over 40% of women experienced abuse or discrimination during labour or childbirth – with some being slapped, shouted at, or forcibly restrained. Communication gaps are also prevalent in many contexts. Across this same study, women reported that more than 75% of episiotomies and 60% of vaginal examinations were performed without their consent.
"Respectful care is not a luxury – it is a fundamental human right that shapes health outcomes and people's experiences of care," said Dr Hedieh Mehrtash, Technical Officer and co-lead of the compendium. "Yet too often, women are not part of decision-making and are treated with contempt or even abuse. This new publication is a call to action for health systems to proactively embed dignity, equity, and respect into every aspect of maternity and newborn care."
A decade of focus
Representing the first global effort to translate principles of respectful care into tangible implementation strategies, WHO's new Compendium on respectful maternal and newborn care marks a major milestone in this area.
It builds on the Organization's 2014 statement on preventing disrespect and abuse during childbirth, and reflects growing global recognition that mistreatment in health care not only harms individuals but also undermines trust in health systems and jeopardizes people's health.
"Ending mistreatment and achieving respectful care doesn't happen by chance – it needs the commitment of health authorities and all stakeholders so that these principles are purposefully integrated within the health system," said Anayda Portela, Scientist at WHO, also a co-lead of the compendium. "This means creating environments where women, parents and health workers feel safe, heard and valued, while ensuring services are equipped to provide the quality care every woman, baby and family needs and deserves."
A global resource for local action
Targeted primarily at health programme managers, the publication gathers recent evidence, provides links to practical tools, and outlines actions to help countries strengthen respectful care across a full range of maternal and newborn services. Cited interventions include enacting supportive laws and policies; training and supporting health workers by improving their work environments and ensuring they have up to date knowledge and skills, and involving women and families in planning and monitoring of care.
The publication also highlights critical areas where mistreatment is often overlooked, such as perinatal mental health and support for bereaved families, or for parents caring for small and sick newborns.
The guide urges decision-makers to identify and address root causes of mistreatment. These may include harmful policies, for example, around forced detention for non-payment of medical bills or mother–baby separation; stigma and discrimination, for instance, against younger or unmarried women or those from disadvantaged backgrounds; as well as heavy workloads of health workers or under-resourcing in health systems.
Making respectful care a reality
Over the past decade, research and advocacy in this area have significantly expanded. WHO has developed different tools and standards to support quality improvements – from advancing midwifery models of care to WHO's rights-based clinical recommendations for maternal and newborn health. The new compendium complements these various products, providing a useful 'one-stop' reference for available resources and evidence on respectful care.
The Compendium is published by WHO together with UNFPA, UNICEF and the United Nations' Special Programme on Human Reproduction (HRP), with support from Jhpiego and the MOMENTUM Country and Global Leadership programme.
