Respecting Women in the Delivery Room Should Be the Norm—Too Often It’s Not

Part of my work at IntraHealth International is on a program in Ethiopia that aims to prevent HIV transmission from mother to child. One of the ways we do this is by encouraging women to deliver in a health facility where they can get prophylactic care to stop HIV transmission. Yet, particularly in Ethiopia, it is still an uphill battle because the vast majority of women deliver at home. There are many reasons—financial, cultural, and practical such as a lack of transportation—women do not go to health facilities, even though that is where they will be more likely to get the care they need in an emergency.

But one of the things we don’t talk enough about is the abuse too many girls and women endure in the delivery room. Years ago, in 1991 during a social work internship, I worked at a home for pregnant teenage girls in Cape Town, South Africa. I frequently heard stories from the girls about nurses who shouted at them to ‘shut up’ if they cried or screamed during childbirth, told them that they were ‘sluts’ because they were pregnant, slapped them around, or simply ignored or abandoned them to give birth alone. For these girls—many of whom were pregnant as the result of rape or incest—it was just another step in a continuum of abuse, which in all likelihood would be passed down to their babies, if they kept them. It is all part of a troubling cycle. Yet, the part that was particularly incongruous for me was that people entering a helping profession ended up with such attitudes and behaviors towards their patients, the people they are entrusted to care for.

Recently, I heard Dian Bowser present her analysis, “Exploring Evidence for Disrespect and Abuse in Facility-Based Childbirth,” which describes cases of abuse in 18 countries.* Bowser describes what many of us know and what can feed abusive behavior: health workers are overworked and operate in a system that lacks strong leadership, management, and supervision; offers poor pre-service training; and is chronically short-handed. Health workers are demoralized by these conditions as well as the lack of resources and opportunities to develop professionally. They, too, suffer disrespect and abuse at the hands of supervisors and, in fact, patients. In too many communities, the abuse of women—either in the home, the workplace, or the clinic—is a cultural norm for which there are too few channels for voicing complaints or seeking redress.

So what can be done?

Bowser points to the urgent need for impact studies on how current programs can build the evidence base on which interventions are most effective at promoting respectful care at birth and preventing disrespect and abuse at health facilities. It also requires a broader commitment to changing the way women are treated and valued as a necessary part of building health systems. When it comes to the immediate goal of encouraging women to deliver in a health facility, this will only happen when women can be assured of competent, sensitive, respectful care. In a country like Ethiopia that is ranked by the United Nations Development Programme as the fifth worst country in the world (139 out of 144) in status and treatment of women, this is an ambitious undertaking, but it is one we cannot ignore if we are serious about changing the way women are cared for.

*South Africa, Kenya, Burkina Faso, Burundi, Tanzania, Zimbabwe, Malawi, Ghana, Sierra Leone, Sudan, Peru, Dominican Republic, Brazil, Pakistan, Lebanon, India, United States and Canada

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  • harry834

    Scroll down to the person from “Topeka, KS”:

    “Do you have any advice for a gal who despises her mother-in-law? We got along great until she decided that what she (and her daughter—my sister-in-law) wanted at the birth of my child was more important than what I wanted and threw a fit at the hospital…..”

    You read the rest. Also scroll down to comments and read what Amber Victor has to say. She calls what the mother-in-law did “birth rape”, fourth comment down: “Topeka,  I liked Prudies advice.  BUT want you to know I understand where you stand and how you feel and I do not blame you on bit for still being pissed off.  I would have disowned my in-laws right then and there…..”


    Read the full response by Topeka, Dear Prudence, and Amber Victor:



  • deb-r

    it is really disturbing but not surprising that the United States and Canada are in the list of the worst countries for abuse of pregnant women!

  • arekushieru

    Yeah, I’m Canadian but not really surprised, either.  We are the only country without an unconstitutional abortion law, yet so many bills attempting to restrict a woman’s access have, at least, been introduced, including one preventing coerced abortion.  What about one preventing coerced childbirth?  Oh, of course, I forgot, it’s not really about the woman but the contents of her uterus.  So, who really cares what she has to endure during pregnancy or childbirth?

  • mary-beth-hastings

    This is excellent proof of why U.S. policy on maternal health cannot just focus on “skilled attendants” and access to hospitals. These are important, but if women aren’t treated with human dignity and respect, they will not return to birth in a hospital, and they will dissuade their sisters and friends from birthing in hospitals.

    But U.S. programs do not currently capture how women are treated by “skilled birth attendants,” except through special research. Human rights need to routinely part of what we measure in US-funded maternal health programs.

  • crowepps

    While I am ready to be dazzled by the miracle of getting the average hospital administrator and hospital lawyer and hospital employees union to allow and cooperate with research on the “human rights” of the patients, I think it would be more likely there would be success slipping that issue into studies if a euphemism is used that won’t make all their tort alarms go off.  At the present time, various power structures in the United States are apparently in the process of repealing the human rights of pregnant women and they’re sure not going to want someone reminding those women that “for one brief shining moment” they had rights (temporarily).