Prensa. voanews.com
Reports over the past decade have drawn global attention to shocking
abuses some women have been subjected to during childbirth in developed and
developing countries. The maltreatment has ranged from lack of privacy and
neglect to forced sterilization, sexual and physical assault, and refusal to
release a mother or child from a birth facility without payment. The problems
are especially acute in sub-Saharan Africa, which accounts for 66 percent of
all maternal deaths per year worldwide, according to a February report from
UNICEF, the U.N. Children's Fund.
A four-year study by researchers in the United States and Tanzania
looked at ways to reduce abuse of mothers-to-be. Keys included gathering
community stakeholders and health care workers to define standards of care and
identifying barriers to change. Previous efforts to reduce mortality of women
giving birth focused on getting them into health care facilities to deliver
their children. Despite dramatic increases in facility-based childbirth,
however, decreases in mortality remained modest. Even when facilities are
equipped to save a mother's life, reports of abuse can keep women from seeking
medical treatment during birth.
Site is no guarantee
"It doesn't matter where you give birth — just because it's a
building doesn't mean you survive," Lynn Freedman of Columbia University's
Mailman School of Public Health told VOA. With colleagues from Columbia, the
Ifakara Health Institute in Tanzania and Harvard University, Freedman designed
one of the first attempts to show how abuse could be reduced. The researchers
followed facilities in the Tanga Region of Tanzania for their study and
randomly selected one to receive the intervention. They called their project
Staha, which means "respect" in Swahili.
They first gathered stakeholders in the community and asked them to
develop a set of standards for what appropriate care during childbirth should
be. The residents were able to provide a unique local perspective. In this
case, stakeholders felt it was important to foster a mutual respect between
patients and health providers. Freedman agreed, saying, "Patients can
blame the health workers, who are more an expression of systemic problems and
not the sole cause of them."
Quality improvement
Researchers then distributed the standards in the facility and convened
a quality-improvement team made up of its employees. The team determined
drivers of abuse and implemented changes to correct them. Changes included
continuous patient surveys, increased oversight by management and educators,
and tea for the staff to show appreciation on difficult days.
A year after they finished working with the facility, the researchers
went back to see whether there had been changes in reported abuse and if
progress had been sustained. They found that there was a 66 percent decrease in
levels of reported abuse. The sharpest decreases were seen in reports of
neglect and physical assault. But Freedman warned against immediately
recommending that others implement these changes. Getting the community
involved is most important, she said.
It's not, " 'Here's the best practice. Do this,' " she said.
It's vital "that people themselves analyze the situation and develop the
intervention." While attention has
been growing, Freedman hopes for more. This is an issue that "everyone who
actually lives with and works in the system knows is there, but has been so not
the priority of policymakers and donors — almost like a silent emergency."