Dr Anshu Banerjee
Director, World Health Organization (WHO), Department of Maternal, Newborn, Child and Adolescent Health
Dr Allisyn Moran
Scientist, World Health Organization (WHO), Department of Maternal, Newborn, Child and Adolescent Health
Though globally maternal mortality declined by 44% since 1990, it is estimated that more than 300,000 mothers die around the time of childbirth, 2.6 million babies are stillborn, and 2.5 million newborns die annually.
Though access to services has increased resulting in almost 80% of live births occurring with the assistance of skilled health personnel in the latest period 2012-2017 globally (this was, however, only over 50% in sub-Saharan Africa), its impact can be limited as poor quality of care negatively impacts health outcomes. It is estimated that high quality health systems could prevent one million newborn deaths and half of maternal deaths per year. In addition, women often report experiencing a lack of respectful and compassionate care which decreases their confidence in the health system.
Access to healthcare is vital but quality of care is also important in reducing mortality and morbidity, says Dr Allisyn Moran, scientist at the World Health Organization (WHO).
WHO is strengthening its focus on improving the quality of healthcare, to promote healthy pregnancies and births as well as positive experiences of pregnancy and childbirth. This will result in fewer deaths, improved health and better long-term outcomes.
There are several essential elements to promote quality of care including adequate infrastructure, health worker availability and competence, equipment and supplies, and accountability. For example, it is estimated that one in five births globally takes place in less developed countries (LDCs), and that, each year, 17 million women in these countries give birth in health centres with inadequate water, sanitation and hygiene. Equally, there is a projected shortage of 18 million healthcare workers by 2030, which includes health personnel crucial to providing maternal healthcare services. Furthermore, there is a need to improve clinical care and reduce harmful interventions, as well as the necessity of harnessing patient, family and community engagement and empowerment.
Respectful and compassionate care are an essential element of quality of care. For example, the Quality Equity and Dignity Network includes three common components for improving respectful care and the experience of care during pregnancy and childbirth:
Emotional support
Every woman and her family are provided with emotional support that is sensitive to their needs and strengthens the woman’s capability, such as allowing women to choose to have a companion during labour and childbirth.
“There is evidence that allowing women to choose to have a companion during labour and childbirth can improve outcomes for both the woman and the baby. However, there are challenges for implementation especially in low-resource settings.”
Barriers include facilities that limit privacy and contribute to labour ward overcrowding, difficulties in maintaining hygiene standards, limited knowledge of the benefits of labour companionship and negative attitudes.
Dignity and respect
Women and newborns receive care with respect and preservation of their dignity.
It is not uncommon to hear of physical or verbal abuse, where women are shouted at or slapped by healthcare professionals.
Communication and information
Communication with women and their families is effective and responds to their needs and preferences.
All women and their families should receive information about their care and have effective interactions with staff as well as coordinated care, with clear, accurate information exchange between relevant health and social care professionals.
Dr Anshu Banerjee notes: “All these improvements should be part of the commitments made towards Universal Health Coverage, which should also guarantee that, in order to leave no one behind, these services are affordable for all and do not lead to catastrophic health payments for anyone.”
