Black Womens and Birth Workers Experiences of Disrespect and Abuse in Maternity Care: Findings From a Qualitative Exploratory Research Study in Atlanta, Georgia

Public health research has generated increasingly sophisticated theories and methods for linking the biological to the social, and for understanding how historical and current forms of discrimination, trauma and injustice find expression in health outcomes. Stark racial disparities in maternal mortality and severe maternal morbidity are particularly appropriate for this exploration because women's sexuality and reproduction has always been a crucial battleground for social control of disadvantaged groups, for assertions of biomedical dominance and professional hierarchies, and for humiliation—and selective celebration—of individuals to further promote specific gender and racial ideologies.Yet, simultaneously, women's sexuality and reproduction has also provided the setting for women to assert their personhood, express their community and cultural solidarity, and define and demand their political and social citizenship. Over the last four decades, women of color have built social movements to link this profound understanding of the personal and political meaning of reproduction to the wider struggle for social justice across a broad range of social institutions where racism finds different forms of expression–schools, police and courts, voting rights and political representation, media and social discourse. The recent surge of attention to what advocates, scholars, politicians and journalists now routinely call the "Black maternal health crisis" helps to create an important opportunity for research to link to action, indeed for research to be action.This report is just one step towards recognition of the role of racism in maternal health. It describes findings from an exploratory, qualitative research study of Black women's experiences during pregnancy and childbirth in Atlanta, which was conducted in 2018 in partnership between Black Mamas Matter Alliance (BMMA), the Averting Maternal Death and Disability (AMDD) program of Columbia University Mailman School of Public Health, Center for Black Women's Wellness (CBWW), and other local community-based organizations. This was part of a larger study conducted in New York City in 2017 (Freedman et. al., 2020). Specifically, the study in Atlanta sought to understand Black women's perceptions of the disrespect and abuse they experienced during pregnancy and childbirth. By focusing on disrespect and abuse during childbirth, the study links to a wider global movement that is mobilizing around the concept of respectful maternity care (Armbruster et. al., 2011). It also constitutes initial steps in pursuit of a wider agenda led by BMMA and women of color organizations that seek to transform knowledge and how it is generated, and by doing so, build power and shift culture, bending the arc of history toward social justice (Aina et. al., 2019)

Availability of long-acting and permanent family-planning methods leads to increase in use in conflict-affected northern Uganda: evidence from cross-sectional baseline and endline cluster surveys

Humanitarian assistance standards require specific attention to address the reproductive health (RH) needs of conflict-affected populations. Despite these internationally recognised standards, access to RH services is still often compromised in war. We assessed the effectiveness of our programme in northern Uganda to provide family planning (FP) services through mobile outreach and public health centre strengthening. Baseline (n=905) and endline (n=873) cross-sectional surveys using a multistage cluster sampling design were conducted in the catchment areas of four public health centres in 2007 and 2010. Current use of any modern FP method increased from 7.1% to 22.6% (adjusted odds ratio [OR] 3.34 [95% confidence interval (CI) 2.27–4.92]); current use of long-acting and permanent methods increased from 1.2% to 9.8% (adjusted OR 9.45 [95%CI 3.99–22.39]). The proportion of women with unmet need for FP decreased from 52.1% to 35.7%. This study demonstrates that when comprehensive FP services are provided among conflict-affected populations, women will choose to use them. The combination of mobile teams and health systems strengthening can make a full range of methods quickly available while supporting the health system to continue to provide those services in challenging and resource-constrained settings

Birth companionship in a government health system: a pilot study in Kigoma, Tanzania

Background Having a companion of choice throughout childbirth is an important component of good quality and respectful maternity care for women and has become standard in many countries. However, there are only a few examples of birth companionship being implemented in government health systems in low-income countries. To learn if birth companionship was feasible, acceptable and led to improved quality of care in these settings, we implemented a pilot project using 9 intervention and 6 comparison sites (all government health facilities) in a rural region of Tanzania. Methods The pilot was developed and implemented in Kigoma, Tanzania between July 2016 and December 2018. Women delivering at intervention sites were given the choice of having a birth companion with them during childbirth. We evaluated the pilot with: (a) project data; (b) focus group discussions; (c) structured and semi-structured interviews; and (d) service statistics. Results More than 80% of women delivering at intervention sites had a birth companion who provided support during childbirth, including comforting women and staying by their side. Most women interviewed at intervention sites were very satisfied with having a companion during childbirth (96–99%). Most women at the intervention sites also reported that the presence of a companion improved their labor, delivery and postpartum experience (82–97%). Health providers also found companions very helpful because they assisted with their workload, alerted the provider about changes in the woman’s status, and provided emotional support to the woman. When comparing intervention and comparison sites, providers at intervention sites were significantly more likely to: respond to women who called for help (p = 0.003), interact in a friendly way (p < 0.001), greet women respectfully (p < 0.001), and try to make them more comfortable (p = 0.003). Higher proportions of women who gave birth at intervention sites reported being “very satisfied” with the care they received (p < 0.001), and that the staff were “very kind” (p < 0.001) and “very encouraging” (p < 0.001). Conclusion Birth companionship was feasible and well accepted by health providers, government officials and most importantly, women who delivered at intervention facilities. The introduction of birth companionship improved women’s experience of birth and the maternity ward environment overall

Comment: silent burden no more: a global call to action to prioritize perinatal mental health

Common perinatal mental disorders are the most frequent complications of pregnancy, childbirth and the postpartum period, and the prevalence among women in low- and middle-income countries is the highest at nearly 20%. Women are the cornerstone of a healthy and prosperous society and until their mental health is taken as seriously as their physical wellbeing, we will not improve maternal mortality, morbidity and the ability of women to thrive. On the heels of several international efforts to put perinatal mental health on the global agenda, we propose seven urgent actions that the international community, governments, health systems, academia, civil society, and individuals should take to ensure that women everywhere have access to high-quality, respectful care for both their physical and mental wellbeing. Addressing perinatal mental health promotion, prevention, early intervention and treatment of common perinatal mental disorders must be a global priority

Una respuesta a las necesidades de salud reproductiva de los desplazados internos

A pesar de los problemas administrativos, logísticos, políticos y culturales de trabajar en Darfur, el Centro Integral de Cuidados Obstétricos y Neonatológicos de Emergencia de Gereida ha realizado importantes progresos en poco tiempo

Responding to IDP reproductive health needs

Despite the administrative, logistical, political and cultural challenges of working in Darfur, the Gereida Comprehensive Emergency Obstetric and Newborn Care Centre has made significant progress in a short time