From Global Rights to Local Relationships: Exploring Disconnects in Respectful Maternity Care in Malawi

Bregje Christina de Kok; Isabelle Uny; Mari Imamura; Jacqueline Bell; Jane Geddes; Ann Phoya

doi:10.1177/1049732319880538

From Global Rights to Local Relationships: Exploring Disconnects in Respectful Maternity Care in Malawi

Bregje Christina de Kok^* (Corresponding Author), Isabelle Uny, Mari Imamura, Jacqueline Bell, Jane Geddes, Ann Phoya

^*Corresponding author for this work

Health Services Research Unit (HSRU)

Research output: Contribution to journal › Article › peer-review

10 Citations (Scopus)

Abstract

Widespread reports of "disrespect and abuse" in maternity wards in low- and middle-income countries have triggered the development of rights-based respectful maternity care (RMC) standards and initiatives. To explore how international standards translate into local realities, we conducted a team ethnography, involving observations in labor wards in government facilities in central Malawi, and interviews and focus groups with midwives, women, and guardians. We identified a dual disconnect between, first, universal RMC principles and local notions of good care and, second, between midwives and women and guardians. The latter disconnect pertains to fraught relationships, reproduced by and manifested in mechanistic care, mutual responsibilization for trouble, and misunderstandings and distrust. RMC initiatives should be tailored to local contexts and midwife-client relationships. In a hierarchical, resource-strapped context like Malawi, promoting mutual love, understanding, and collaboration may be a more productive way to stimulate "respectful" care than the current emphasis on formal rights and respect.

Original language	English
Pages (from-to)	341-355
Number of pages	15
Journal	Qualitative health research
Volume	30
Issue number	3
Early online date	23 Oct 2019
DOIs	https://doi.org/10.1177/1049732319880538
Publication status	Published - Feb 2020

Bibliographical note

Funding Information:
https://orcid.org/0000-0002-1294-2092 de Kok Bregje Christina 1 Uny Isabelle 2 Immamura Mari 3 Bell Jacqueline 4 Geddes Jane 5 Phoya Ann 6 1 University of Amsterdam, Amsterdam, The Netherlands 2 University of Stirling, Stirling, United Kingdom 3 University of Aberdeen, Aberdeen, United Kingdom 4 NHS Grampian, Aberdeen, United Kingdom 5 Edinburgh Napier University, Edinburgh, United Kingdom 6 The Association of Malawian Midwives, Lilongwe, Malawi Bregje Christina de Kok, Anthropology Department, University of Amsterdam, P.O. Box 15509, 1001 NA, Amsterdam, The Netherlands. Email: b.c.dekok@uva.nl 10 2019 1049732319880538 © The Author(s) 2019 2019 SAGE Publications Widespread reports of “disrespect and abuse” in maternity wards in low- and middle-income countries have triggered the development of rights-based respectful maternity care (RMC) standards and initiatives. To explore how international standards translate into local realities, we conducted a team ethnography, involving observations in labor wards in government facilities in central Malawi, and interviews and focus groups with midwives, women, and guardians. We identified a dual disconnect between, first, universal RMC principles and local notions of good care and, second, between midwives and women and guardians. The latter disconnect pertains to fraught relationships, reproduced by and manifested in mechanistic care, mutual responsibilization for trouble, and misunderstandings and distrust. RMC initiatives should be tailored to local contexts and midwife-client relationships. In a hierarchical, resource-strapped context like Malawi, promoting mutual love, understanding, and collaboration may be a more productive way to stimulate “respectful” care than the current emphasis on formal rights and respect. respectful maternity care human rights provider-client interaction Malawi qualitative team-ethnography Burdett Trust for Nursing https://doi.org/10.13039/501100000386 edited-state corrected-proof We are grateful to Martha Mballa, Priscilla Matinga, and Marleen van den Broek, who made important contributions to the fieldwork, and Claribel Nkhansa, who assisted with the data analysis. Declaration of Conflicting Interests The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Funding The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The study was funded by the Burdett Trust. ORCID iD Bregje Christina de Kok https://orcid.org/0000-0002-1294-2092 Supplemental Material Supplemental Material for this article is available online at journals.sagepub.com/home/qhr . Please enter the article’s DOI, located at the top right hand corner of this article in the search bar, and click on the file folder icon to view.

Publisher Copyright:
© The Author(s) 2019.

Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.

Keywords

respectful maternity care
human rights
provider-client interaction
Malawi
qualitative
team-ethnography
QUALITY
SERVICES
DELIVERY
WOMEN
ABUSE
CHILDBIRTH
ME
MIDWIVES
PERCEPTIONS

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

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Cite this

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title = "From Global Rights to Local Relationships: Exploring Disconnects in Respectful Maternity Care in Malawi",

abstract = "Widespread reports of {"}disrespect and abuse{"} in maternity wards in low- and middle-income countries have triggered the development of rights-based respectful maternity care (RMC) standards and initiatives. To explore how international standards translate into local realities, we conducted a team ethnography, involving observations in labor wards in government facilities in central Malawi, and interviews and focus groups with midwives, women, and guardians. We identified a dual disconnect between, first, universal RMC principles and local notions of good care and, second, between midwives and women and guardians. The latter disconnect pertains to fraught relationships, reproduced by and manifested in mechanistic care, mutual responsibilization for trouble, and misunderstandings and distrust. RMC initiatives should be tailored to local contexts and midwife-client relationships. In a hierarchical, resource-strapped context like Malawi, promoting mutual love, understanding, and collaboration may be a more productive way to stimulate {"}respectful{"} care than the current emphasis on formal rights and respect.",

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author = "{de Kok}, {Bregje Christina} and Isabelle Uny and Mari Imamura and Jacqueline Bell and Jane Geddes and Ann Phoya",

note = "Funding Information: https://orcid.org/0000-0002-1294-2092 de Kok Bregje Christina 1 Uny Isabelle 2 Immamura Mari 3 Bell Jacqueline 4 Geddes Jane 5 Phoya Ann 6 1 University of Amsterdam, Amsterdam, The Netherlands 2 University of Stirling, Stirling, United Kingdom 3 University of Aberdeen, Aberdeen, United Kingdom 4 NHS Grampian, Aberdeen, United Kingdom 5 Edinburgh Napier University, Edinburgh, United Kingdom 6 The Association of Malawian Midwives, Lilongwe, Malawi Bregje Christina de Kok, Anthropology Department, University of Amsterdam, P.O. Box 15509, 1001 NA, Amsterdam, The Netherlands. Email: b.c.dekok@uva.nl 10 2019 1049732319880538 {\textcopyright} The Author(s) 2019 2019 SAGE Publications Widespread reports of “disrespect and abuse” in maternity wards in low- and middle-income countries have triggered the development of rights-based respectful maternity care (RMC) standards and initiatives. To explore how international standards translate into local realities, we conducted a team ethnography, involving observations in labor wards in government facilities in central Malawi, and interviews and focus groups with midwives, women, and guardians. We identified a dual disconnect between, first, universal RMC principles and local notions of good care and, second, between midwives and women and guardians. The latter disconnect pertains to fraught relationships, reproduced by and manifested in mechanistic care, mutual responsibilization for trouble, and misunderstandings and distrust. RMC initiatives should be tailored to local contexts and midwife-client relationships. In a hierarchical, resource-strapped context like Malawi, promoting mutual love, understanding, and collaboration may be a more productive way to stimulate “respectful” care than the current emphasis on formal rights and respect. respectful maternity care human rights provider-client interaction Malawi qualitative team-ethnography Burdett Trust for Nursing https://doi.org/10.13039/501100000386 edited-state corrected-proof We are grateful to Martha Mballa, Priscilla Matinga, and Marleen van den Broek, who made important contributions to the fieldwork, and Claribel Nkhansa, who assisted with the data analysis. Declaration of Conflicting Interests The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Funding The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The study was funded by the Burdett Trust. ORCID iD Bregje Christina de Kok https://orcid.org/0000-0002-1294-2092 Supplemental Material Supplemental Material for this article is available online at journals.sagepub.com/home/qhr . Please enter the article{\textquoteright}s DOI, located at the top right hand corner of this article in the search bar, and click on the file folder icon to view. Publisher Copyright: {\textcopyright} The Author(s) 2019. Copyright: Copyright 2020 Elsevier B.V., All rights reserved.",

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From Global Rights to Local Relationships: Exploring Disconnects in Respectful Maternity Care in Malawi

Abstract

Bibliographical note

Keywords

UN SDGs

Access to Document

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