Championing Birth Companionship and respectful maternity care in Tanzania
Thamini Uhai is currently implementing a third phase of the project which targets to scales-up and sustains birth companionship embedded in a respectful maternity care framework, standardizes and institutionalizes birth companionship and respectful maternity care practices and mobilizes communities for demand creation and ownership of the practice that will improve and sustain the quality of maternity care in the years to come.
The design of the previous and current birth companionship projects addresses several elements of respectful care. Indeed, the pilot evaluation in Kigoma showed that when comparing birth companionship intervention sites (N=9) and comparison sites (N=6), providers at intervention sites were significantly more likely to: respond to women who called for help interact in a friendly way greet women respectfully and try to make them more comfortable Higher proportions of women who gave birth at pilot sites reported being “very satisfied” with the care they received and that the staff were “very kind” and “very encouraging” Overall, women who delivered at intervention sites were less likely to report experiencing emotional abuse (defined as being spoken to in an angry or condescending way that made the woman feel badly about herself, degraded, embarrassed, or sad) and physical abuse (defined as being hit, slapped, pushed, pinched, kicked or receiving any other type of physical force;) from providers.
Having a companion of choice throughout childbirth is therefore a critical component of respectful maternity care. Thamini Uhai launched the country’s first birth companionship project in 2017. The project has been successfully piloted in nine government health facilities in Kigoma for 20 months. Following the successful implementation of the project and the lessons learned from it, Thamini Uhai has been supporting the efforts of institutionalization and scale-up of birth companionship practice in Tanzania, which saw birth companionship featuring for the first time in National Guidelines for Gender and Respectful Care Mainstreaming and Integration Across RMNCAH services in Tanzania in 2019.
The World Health Organization (WHO) through several guidelines and practice recommendations emphasizes that experience of care is as important as the provision of clinical care in achieving strong person-centered health outcomes. The concept of respectful maternity care best responds to this need. Respectful maternity care has been defined as: “care organized for and provided to all women in a manner that maintains their dignity, privacy and confidentiality, ensures freedom from harm and mistreatment, and enables informed choice and continuous support during labor and childbirth. Respectful maternity care is a universal human right for every woman in every health system around the world. It expands the notion of safe motherhood beyond the prevention of morbidity or mortality to encompass respect for women’s basic human rights, including recognition of and support for women’s autonomy, dignity, feelings and preferences, such as choice of companionship. In 2011, the White Ribbon Alliance convened a global and multi-sectoral group of stakeholders to launch a global campaign to promote a clear standard for respectful maternity care rooted in international human rights. A comprehensive respectful maternity care practice requires a strong health system (e.g., infrastructure, health providers) and informed communities working together to ensure women giving birth receive care that is dignified, private and confidential and free from physical abuse, stigma and discrimination, abandonment and detention.