1.3.a The International Context for Care

Canadian health care mandates are congruent with guidelines set by global health organizations like the World Health Organization (WHO), the Federation of International Gynaecologists and Obstetricians, the National Institute for Clinical Excellence (NICE),  and the United Nations Population Fund (UNFPA) . All of these agencies have recently issued evidence-based statements and reviews that focus on patient experience as a key component of quality and safety in maternity care (15-18). In these evidence-based reports, respect, shared decision making, choice of birth place, access to regulated providers, and interprofessional collaboration are all described as essential to addressing disparities in health outcomes for parents and babies in both low and high resource countries. The Respectful Maternity Care (RMC) Charter, which is developed by the White Ribbon Alliance,  "is based on a framework of human rights and is a response to the growing body of evidence documenting disrespect and abuse of childbearing persons." (19, p. v)

Here are some messages from the global reports that are relevant to what you will learn in this course:

In recent years, a movement has been advancing to promote implementation of more respectful maternity care, emphasizing the importance of underlying professional ethics and psycho-socio-cultural aspects of health care delivery as essential elements of care. As early as the 1970s, in the United States and Canada, some recognition of the need for respectful care was made by doulas, midwives, women giving birth, ... doctors and nurses, and so a movement developed for the humanization of childbirth." (19, p. 1)

 

"Increasing the proportion of women delivering in a health facility is challenging, as it requires comprehensive efforts to overcome sociocultural, economic, geographical, and infrastructural obstacles to reaching facility-based care. Furthermore, it requires efforts to improve both the coverage and quality of care provided to women and health facilities, including women's rights to dignified and respectful care." (6, p. 2)

 

".... several recent studies and reports clearly indicate that many women globally experience poor treatment during childbirth, including abusive, neglectful, or disrespectful care. Every woman has the right to dignified, respectful sexual and reproductive health care, including during childbirth, as highlighted by the Universal Rights of Childbearing Women charter. Therefore, mistreatment during childbirth can represent a violation of women's fundamental human rights and can serve as a powerful disincentive for women to seek care in facilities for their subsequent deliveries. In September 2014, a World Health Organization statement called for greater research, action, advocacy and dialogue on this important public health issue, in order to ensure safe, timely, respectful care during childbirth for all women." (6, p. 2)

 

About Canada, the USAID Respectful Maternity Care Report states some challenges:

Results are patchy and are usually the result of individual efforts. Compared to 30 years ago, there are more birthing rooms, women in labour can have their husband/partner besides [sic] them, and breastfeeding has increased. Several hospitals have been granted the "baby-friendly" designation. Midwifery has been legalized in several Canadian provinces..... In Quebec, with regarding [sic] humanized maternity care, the 10 birth centres (all outside of hospitals and staffed only by midwives) are considered to be the best places to have a baby."  (19, p. 34)