Project title: RESPECT - Toward a culture of Respectful Maternity Care (RMC): Enhancing Provider-Client Shared Decision Making and Informed Choice
Reference number: 101096681 — RESPECT — CERV-2022-DAPHNE
Project financed by: CERV-2022-DAPHNE
Project period: 1 April 2023 - 31 March 2025 (24 months)
Project budget (approved): €425 043.59
Cyprus University of Technology (CUT) – project lead
Roda - Roditelji u akciji (Croatia)
University of Genoa (UNIGE): University of Genoa - DINOGMI (Department of Neurology, Genetics, Ophthalmology, Maternal and Infant Sciences)
Every birth is unique and every experience personal! But, every mother should want to tell and share her birth story with a smile!
With this project, we want to move closer to this vision by taking local action towards promoting a culture of RESPECT in maternity-child health care services according to the principles of the WHO’s framework and White Ribbon Alliance’s Charter of Rights for Respectful Maternity Care (RMC).
Even if not intentional or always recognised as such (by healthcare providers), failure to uphold the highest professional clinical and ethical standards of care may lead to a range of situations, conditions, interactions or outcomes experienced as disrespectful (by pregnant/ birthing women service-users).
Based on the RMC framework, 'disrespect' in Maternity Care does not refer (exclusively) to unacceptable situations, such as physical, sexual or verbal abuse, prejudice and discrimination, suboptimal practices, undignified behaviours or other abusive phenomena . ‘Obstetric violence’, “obstetric mistreatment” or just “mistreatment” are some of terms used in the literature to describe such unwanted phenomena. The more general term “Disrespect and Abuse” corresponds - inversely – to the above standard of quality in care, under which a range of situations, conditions and suboptimal practices that do not ensure the right to a positive birth experience are collectively gathered and classified.
While Respectful Maternity Care is not just the converse of negative experiences, negative experiences are common and vary. In fact, it has been suggested that, unlike low- and middle-income countries, in high-income countries, to quote, “different subtypes [of Disrespect and Abuse] take precedence” . More commonly mentioned are: lack of autonomy, suboptimal or ineffective communication with healthcare providers about available care options, the medicalization of birth and unnecessary medical intervention, not respecting women’s wishes and preferences (including choice of birth partner and labour positions), and, generally, lack of support for pregnant women to make informed decisions about their own care, all of which can have a negative impact on their health, well-being and adjustment.
Several conditions and quality standards need to be met to uphold womens’ Rights to a positive childbirth experience. A cornerstone of the RMC framework is the fundamental Right to Iinformation and Informational Support. This requires maternity-child healthcare providers and women/ service-users are working in alliance (Shared-Decision Making), jointly taking decisions regarding maternity care and childbirth and practicing principles of informed choice.
Taking a pragmatic approach to focus on a well-defined and amenable-to-change issue (i.e. the professional obligation of healthcare providers and right of women to present/be presented, respectively, with informed choices) holds the potential to improve standards of practice and the quality of user-provider communication which is a root cause of problematic situations, thus, a form of primary prevention of Disrespect and promotion of Respectful Maternity Care.
 Darilek U. A woman’s right to dignified, respectful healthcare during childbirth: a review of the literature on obstetric mistreatment. Issues Ment Health Nurs (2017)
We would like women to be active agents in their pregnancy and childbirth experience and healthcare providers to effectively support and promote a woman-centre model of care with RESPECT.
To achieve this goal, we set a series of objectives for the RESPECT project:
- the current situation needs to be examined from the perspective of healthcare providers and, of course, based on the experiences of women themselves (i.e. through as structured research process),
- the principles, processes and standards of care need to be set (i.e. through a participatory process in partnership with the professional community),
- the necessary skills and competences need to be cultivated (i.e. through education and training activities directed at current and future healthcare providers and future mothers), and, above all,
- this high standard of clinical practice needs to be recognized and promoted as a Right and as an obligation (i.e. through raising societal awareness on the women’s rights to a positive birth experience).
Guided by principles of Participatory Action Research, the project aims to generate knowledge about the current situation, while trying in parallel to cause shift from current practices.
Thus, a series of activities have been planned accordingly:
We will begin with a series of research activities (online surveys, focus group discussions, structured research and learning workshops) to deepen our understanding about how Respectful and Person-Centred Maternity Care is currently in Cyprus and Croatia, and, we will do so through the perspective of healthcare providers and the ‘holders of the experience” themselves. We would like to know how healthcare providers conceptualize the concepts, the necessary processes, as well as skills and competences needed to uphold this standard of care. And, of course, we would like to record and unveil the experiences, opinions and suggestions of the women/service users themselves. Through the research process, we will form a Parental Consultant Group (PCG) to advise, shape and guide the project’s subsequent activities.
Subsequently, we will actively engage with all relevant profession al associations and wider stakeholders (within and beyond the healthcare sector), and of course civil society, facilitating an inclusive and open dialogue about systems and processes, needs and gaps, skills and competences. Through gathering the ‘collective intelligence’ of this multi-agent alliance of partners, we will draft a Strategy and Practice protocols to promote a common vision of advancing Respectful Maternity Care.
Promoting and supporting the active participation of women/ service-users in making decisions about their care is a dynamic process and requires healthcare providers to master certain skills and competencies. Similarly, women need to be empowered to be active agents and need guidance to effectively structure their interactions with healthcare providers. We will prepare a training manual, which we will test and evaluate in two training activities - one with practicing and future healthcare providers and one with women/service-users – in order to improve them with the participants’ contribution and provide useful resources and tools for the future.
Finally, we will run a Public Campaign to raise awareness about the importance of active participation in decision-making as an indispensable component Respectful Maternity Care. We want to stimulate public discourse on the right of women to give birth with RESPECT, which is grounded on the ethical principles of autonomy and the Right to information, informed consent or refusal for care and respect of informed choices and preferences, causing a shift and expanding the current understanding of thse issues among the local communities.
National Research Report – Cyprus
National Research Report – Croatia
Research Synthesis Report
National Strategy on Respectful Maternity Care – Cyprus
National Strategy on Respectful Maternity Care – Croatia
Respectful Maternity Care Protocol Guide for Practitioners
Training Curriculum for Health Professionals
Training Curriculum for Future & Expecting Parents
Pilot Intervention Assessment Reports
Public Awareness Campaign – Press Package - Cyprus
Public Awareness Campaign – Press Package – Croatia
For further information on the project, you can contact firstname.lastname@example.org
Funded by the European Union and co-funded by the Office for Cooperation with NGOs of Govenrment of Republic of Croatia. Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European,the European Education and Culture Executive Agency (EACEA) or the Office for Cooperation with NGOs of Govenrment of Republic of Croatia. Neither can be held responsible for them.