What is Respectful Maternity Care? An Ethnography Study of Mothers and Midwives in Fort Portal, Uganda

Abstract

Globally, the maternal mortality rate is high at 216 deaths per 100,000 live births. Within Sub-Saharan Africa the rate remains much higher at 546 deaths per 100,000 births. Uganda makes up two percent of the global maternal mortality rate signaling much needed improvement to the implementation of maternal health within the country. The highest indicator of maternal mortality is whether or not she has a facility based delivery in the present of a skilled birthing attendant. There are many factors hindering facility based deliveries. One reported factor is the lack of respect women feel in maternity wards and experience of mistreatment and disrespect & abuse by midwives and doctors. To explore the experiences of respect within a maternity ward, this study aims to understand how Ugandan women defined respectful maternity care within two health centers located in/about Fort Portal, Uganda. Two components of the respectful maternity care charter were the focus of the study: privacy and informed consent/information sharing. Participants included pregnant women and recently delivered mothers, midwives, and doctors. Interviews, focus groups and observational data were collected over a three month period. Ugandan women, in this study, presented no interest in critiquing or praising the services provided to them within the maternity ward. Privacy and informed consent/information sharing did not appear to be an important aspect of their care. Generally no woman voiced complaints or praise on services they received. Upon further analysis the researcher believes that an unequal balance of power between patient and provider exists that dissuades women from become active players in the experiences at a health facility. If an unequal balance between patient and provider exists respectful maternity care cannot exist. In order for respectful maternity care to even be an option for birthing women, there must be a shift of societal power dynamics that value all women and must ultimately be replicated within the health care system. Patient center care will facilitate respectful maternity care to emerge and only then will women be able to make reflections on their experiences and definitions of respect.