Respectful Maternity and Reproductive and Infant Psychology

‘All childbearing women need and deserve respectful care and protection of their autonomy and right to self-determination; this includes care to protect the mother-baby pair as well as marginalized or highly vulnerable women’ p1 White Ribbon Alliance 2011

The language of maternity care research, policy and practice has been slowly changing with the term ‘respectful maternity care’ coming to the fore in recent years. Respectful maternity care refers to ‘care organized for and provided to all women in a manner that maintains their dignity, privacy and confidentiality, ensures freedom from harm and mistreatment, and enables informed choice and continuous support during labour and childbirth’(WHO 2018).

Many of the concepts that are core to respectful maternity care are psychological and yet the contribution to the knowledge base on human rights from psychologists is not as comprehensive as might be expected. In 2009 the vision statement of American Psychological Society (APA) included a recognition that the application of psychology to promote human rights, health, wellbeing and dignity was needed. To date psychology and human rights have had very separate and distinct histories and consequently Human Rights Psychology as a field is very much in its infancy (APA, 2016).

So what are the potential benefits of a human rights approach in maternity care? First and foremost a human rights approach allows us to focus on the promotion of human rights rather than solely clinical outcomes. It also goes beyond the more traditional quality assurance approach of asking women about their satisfaction with care and goes to the heart of many of the problems that continue to dog our health systems eg inequality and discrimination. A shift towards respect for human dignity also re-balances our perspective of the law within the care environment which has been dominated by a negative culture of litigation: ‘when caregivers respect women’s dignity, they build a relationship of mutual respect and trust that will guard them against harm’p1015 Prochaska (2015).

To move forward with this approach it is important to understand what respectful maternity care is in practice. In the literature it is often defined by its absence i.e. what is disrespectful. A review by Bowser and Hill (2010) found seven major categories of disrespect and abuse that childbearing women encounter during maternity care: physical abuse, non-consent clinical care, non-confidential care, non-dignified care (including verbal abuse), discrimination based on specific patient attributes, abandonment or denial of care, and detention in facilities. The review also identified numerous factors that can contribute to this experience: individual and community-level factors normalizing disrespect and abuse, lack of legal and ethical foundations to address disrespect and abuse, lack of leadership, lack of standards and accountability, and provider prejudice due to training and lack of resources.

As we continue to clarify what respectful maternity care and a human rights approach represents, we need more research not only into understanding women’s experiences of care but, going a step further, to evaluate interventions that promote dignity and respect. Those of us interested in reproductive and infant psychology recognise commonalities with our research: inequalities in access to care for vulnerable groups, the stigma associated with mental illness, discrimination, PTSD related to childbirth to name but a few. This existing research can offer valuable insights to a human rights approach to maternity care and we should be doing more to explore the connections between human rights and psychology. A human rights approach provides a useful framework into which we can start to pull together what we already know about respectful maternity care and, most importantly of all, it can provide new perspectives on how to continue to improve care for all women.