Uganda has one of the highest maternal mortality rates in the world. The Sustainable Development Goals framework focuses on improving Maternal Health through gender equality, human rights, empowerment and poverty reduction. Disrespectful care not only undermines women’s human rights and disempowers them; it also results in poor levels of engagement with public services and damaging delays in accessing them. 99% of all maternal mortality occurs in Low- and Middle-Income Countries; much of this is due to delays in women seeking care. In Uganda, it is not uncommon for women to receive verbal or sometimes physical abuse whilst giving birth in health facilities. Through empowerment of women and collaboration between healthcare staff, stakeholders, families and communities, this project aimed to improve the well-being of mothers and babies.
The ‘WeCare’ research project was initially funded by Wellbeing of Women in partnership with the Royal College of Midwives and the Burdett Trust for Nursing (Award Ref IFA203, £20,000) and ran throughout 2017 and 2018. It involved close collaboration between K4C’s professional midwifery volunteers and our midwifery colleagues at Kagote Health Centre, Uganda. Interviews and focus groups were conducted with midwifery staff and mothers to assess their perceptions of ‘respectful care’ and the barriers faced in delivering such care. For example; mothers expected privacy whilst giving birth, however midwives were often unable to provide this due to a lack of privacy screens. Midwives also explained how they were unable to give the mothers as much time as they would like due to being very overworked, under resourced and often having multiple critically ill mothers to assist simultaneously. At times, they may be forced to be slightly rude or abrupt with one mother in order to move on and provide better care for the next.
Gaining a detailed understanding of the challenges faced by mothers and staff enabled us to carefully plan our interventions to maximise their impact and sustainability. Our volunteers were able to suggest simple positive changes to practice that would not put additional pressure on staff. For example, staff were urged to greet mothers respectfully and introduce themselves by name; this small change was gratefully received by mothers. Other interventions included providing basic new equipment such as privacy screens and curtains, delivery beds and new mattresses for the ward beds. We renovated the maternity unit and waiting areas and built new facilities for cooking, toilet and hand washing. Our volunteers also provided training in aspects of respectful care, including allowing mothers their choice of birthing position, providing more information about procedures before beginning them and providing counselling and grieving care.
Conclusions & Related Publications
A number of simple, cost effective and sustainable interventions were implemented over the course of the project which greatly improved the level of respectful care received by mothers. The numbers of mothers accessing care at Kagote Health Centre continued to increase during and after the project, and the facility was selected as host for the National day of the Midwife celebrations in 2018, in recognition of its reputation and achievements. K4C’s close partnership with Kagote is ongoing and the successes of this project have been implemented at other K4C partner facilities. More information on the project and its findings have been published in the article below, which can be accessed for free:
Ackers, H.L, Webster, H., Mugahi, R. & Namiiro, R. (2018) What price a welcome? Understanding structure agency in the delivery of respectful midwifery care in Uganda. International Journal of Health Governance (Volume 23, Issue 1)