The World Health Organization has recently published a statement on the prevention and elimination of disrespect and abuse during facility-based childbirth (WHO, 2014). It embraces the needs of all women in both developing and developed countries. The statement opens with: ‘Every woman has the right to the highest attainable standard of health, which includes the right to dignified, respectful health care.’
While increasing the coverage of skilled birth attendance is a key strategy in the battle to reducing maternal mortality and achieving Millennium Development Goal 5, there is evidence to suggest that some women would prefer to have no care than care that is unkind and cruel. This is true throughout the world—not only in developing countries. In 2011 a 66-page report was published entitled ‘Stop making excuses: Accountability for Maternal Health Care in South Africa’ (Human Rights Watch, 2011). The report documents maternity care failures in South Africa, including abuse of women and their newborn babies by health care workers. The report describes how women were ridiculed and shouted out for ‘messing up’ when they bled on the floor. Similar findings have been reported in other countries (Bowser and Hill, 2010).
Abuse and mistreatment of pregnant women will only contribute to the increase in maternal mortality and morbidity, as we have seen in countries like South Africa and Mozambique where there is skilled birth attendance but women do not attend as they are fearful. Each country must value the role of the their midwives and skilled birth attendants as low motivation is a particular challenge in low income settings (Mathauer et al, 2006).
This statement is essential reading and a reminder to what women deserve: respectful care.
Experiences, utilisation and outcomes of maternity care in England
The objective of this analysis was to explore the health care-seeking behaviours and experiences of maternity care among women from different socioeconomic groups in order to improve understanding of why socially disadvantaged women have poorer maternal health outcomes in the UK. This was a secondary analysis of a national maternity survey conducted in 2010 of women 3 months after they had given birth. The study reported that women from lower socioeconomic groups were 60% less likely to have received antenatal care compared to women in higher socioeconomic groups and 38% less like to have been seen by a health professional in the first trimester. The authors concluded that with decreasing socioeconomic position women were more likely to report that they were not treated respectfully or spoken to in a way they could understand by doctors and midwives.
Breastfeeding and postnatal depression
This is the first study to look at the causal effect of breastfeeding on postnatal depression (PND), by looking at women's intentions to breastfeed and the influence this has on subsequent PND. Data on mothers from a British survey, the Avon Longitudinal Study of Parents and Children were used. Multivariate linear and logistic regressions were performed to investigate the effects of breastfeeding on mothers’ mental health, measured at 8 weeks, 8, 21 and 32 months postpartum.
Results differed according to whether women had shown signs of depression during pregnancy, and according to whether they had planned to breastfeed.
For women who had not shown signs of pre-existing depression, those who had wanted to breastfeed and had not gone on to, the risk of PND was greatest. Those who did breastfeed showed the lowest risk of PND.
For women who had shown signs of depression in pregnancy, the effects were smaller; however, exclusive breastfeeding for 4 weeks appeared to have a protective effect.
The authors conclude that the effect of breastfeeding on maternal depression is mediated both by breastfeeding intentions during pregnancy and by mothers’ mental health during pregnancy. They argue that this demonstrates the importance of providing expert breastfeeding support to women who want to breastfeed; but also, of providing compassionate support for women who had intended to breastfeed, but who find themselves unable to.