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Dr. Kathleen Hill Discusses Disrespectful Facility Childbirth Services in a Deeply Personal Blog
In a blog chronicling her experiences witnessing disrespectful maternal care in Niger and the US, Dr. Kathleen Hill, URC Senior Technical Advisor, reveals her passion for eradicating this problem.
She has worked extensively in both Niger, a country with one of the world's highest maternal mortality rates, and Washington, DC, with one of the highest maternal mortality rates in the US. Over the years, she has witnessed disrespectful maternal care in many world regions, regardless of geographic or resource setting. Also disturbing to her was the realization that her own capacity for kindness as a doctor had been tested due to stressful work.
It was with some uneasiness that she agreed to research the problem of disrespect and abuse in facility-based childbirth services for the USAID-funded Translating Research into Action (TRAction) project. She knew that potential solutions to the problem would be neither easy to identify nor quick to implement. Reflecting on the complex nature of the problem, she said,
"From my perspective, those of us who are concerned about non-dignified maternal care must answer two central questions: Why does disrespect and abuse happen so frequently in childbirth worldwide, and what can we do to curb it?"
The TRAction project research review identified evidence for disrespect and abuse in facility childbirth services in over 32 countries in five world regions. Dr. Hill and her co-author organized the evidence into seven categories: physical abuse, non-consented care, non-confidential care, non-dignified care, discrimination, abandonment of care, and detention in a care facility. The evidence indicates that likely contributors to the problem include power imbalances between providers and patients rooted in larger social inequities; health system shortages that burn out providers; provider training that shapes disrespectful behavior; lack of community entitlement, engagement, and oversight of healthcare; and lack of political commitment to hold health systems and maternity staff accountable.
Dr. Hill notes that few of the promising strategies for addressing the problem have ever been formally tested.
"In a world of limited resources, finding solutions that are effective and can be reliably repeated requires commitment to continued research. We need more studies that show what kinds of disrespect and abuse occur, how frequently, and why. And we must be willing to test and evaluate the effectiveness of a range of creative and sometimes bold interventions."
February 28, 2012