When Ms. Fatoumata Binta Toure learned the results of a WHO/HRP-led study in four countries showing that more than one-third of women experienced mistreatment during childbirth in health facilities, she was not entirely surprised.

“We often heard that women were experiencing these issues, but this research gave us the truth,” the President of the National Association of Nurses of Guinea explained.

“It is not the objective of childbirth, for women to be treated with violence. We saw this study as a chance to move forward – to put a plan of action in place and improve respectful care for women.”

A positive childbirth experience is about more than the birth of a healthy baby. It meets a woman’s personal and cultural expectations. It gives her a sense of control and involvement in decision-making in her own care, supported by competent clinical staff and her own choice of birth companion.

This is not the experience or the expectation for many women preparing to give birth. The WHO/HRP study, carried out in Ghana, Guinea, Myanmar and Nigeria, recorded a range of negative experiences in health facilities. These included physical and verbal abuse, stigma and discrimination, and medical procedures performed without consent.

For scientists at CERREGUI (Center for Research in Reproductive Health in Guinea), the coordinating research institute in Guinea, publishing the evidence in The Lancet was not the end of the story.

“If a woman expects mistreatment, why will she go to a hospital to deliver? We know that improving respectful care will encourage more women to deliver at a facility with skilled birth attendance, reducing maternal mortality in the long-term. It is also crucial from a women’s rights perspective,” explained Dr Mamadou Dioulde Balde, Coordinator of CERREGUI, which has also been a grantee of the HRP Alliance’s research capacity strengthening activities.

“When we understood the scale of the problem, our team was motivated to move beyond the published literature to practical recommendations.”

Less than two months after publication in December 2019, with support from WHO/HRP, CERREGUI brought ministry officials with maternity hospital directors, nongovernmental organizations, professional associations and international agencies to present the research findings together in Conakry, Guinea). Together they developed a set of recommendations which could be implemented at the national level to reduce mistreatment of women during childbirth.

These include practical steps such as allowing chosen birth companions and accepting the birth position desired by the woman, as well as health system changes such as scaling up training in respectful maternity care and strengthening governance and oversight.

Accepted by the Ministry of Health, these recommendations are incorporated into the Reproductive, Maternal, Newborn, Infant, Adolescent Health and Nutrition (SRMNIA-N 2020-2024) Strategic Plan and the MUSKOKA Action Plan of 2021.

“All women have the right to dignified, respectful health care across pregnancy and childbirth, free from violence and discrimination,” said Dr Bernadette Dramou, WHO National Professional Officer for Reproductive, Maternal, Newborn, Child & Adolescent Health /Nutrition. “From the Ministry of Health to the maternity ward, we are committed and enthusiastic about turning this research into action, putting into practice these recommendations for respectful care which can improve the experience of childbirth for every woman in Guinea.”

Some health facilities are already taking steps which make a significant difference to the well-being of women.

At the maternity ward of the National Teaching Hospital, Ignace Deen, in Conakry, birth companions of choice are being accommodated.

“We shared the recommendations widely with a lot of midwives, and immediately took actions to improve respectful maternity care in our hospital,” explained Mrs. Hawa Keita, Head Midwife of Maternity Ward at Ignace Dean.

“We now have a chair by the side of each bed in the labour ward, so that every woman can have their companion of choice by their side through childbirth.”

Nurses and midwives make up nearly half of the global health workforce. They were critical stakeholders at the meeting to develop national recommendations.

“When we know the numbers, we can make informed decisions, improving our own work practices and conditions in ways that lead to improvement for women,” said Mrs. Marie Conde, President of the Order of Midwives in Guinea.

“All midwives should be aware of the different types of mistreatment women can experience. We also need to be proactive and make sure that women in our care during labour and childbirth understand what kind of treatment they should receive.”

For Dr Balde, the experience of coordinating this study, as well as ongoing research capacity strengthening support from the HRP Alliance has made a difference on several levels.

“As a teacher, I see how important this has been for my students and my colleagues. First, we now have viable data which we know can make a difference to policy. Second, being part of a multi-country study has led to very interesting exchanges of experiences between teams. Third, I see members of our team going on to further research training with the help of the HRP Alliance, taking on new projects that can improve sexual and reproductive health for women across Guinea.”

“It is encouraging to see countries take on board the importance of ensuring a positive experience for women during childbirth.” said Dr Ӧzge Tunçalp, scientist at WHO and senior author of the study. “We hope that women in Guinea will reap the benefits of this new approach, which puts women’s wishes and preferences more at the centre of their care”. “It should not be forgotten either that evidence also suggests a positive experience at childbirth may lead on to improved outcomes for each woman and her child - in the immediate post-pregnancy period and far beyond.”