ANN TORNKVIST/AFP 

CURT CARNEMARK,1994

Promoting 

Evidence &

Action for 

Respectful 

Care at Birth

Disrespect and abuse in childbirth constitutes both a human rights issue and an 

important quality of care problem. Various

approaches have been developed to address

these issues, including quality improvement,

stigma reduction, and accountability measures. Civil society organizations are also

promoting human rights efforts and public

interest litigation to raise awareness and

hold governments accountable. 

“Most of the women don’t know 

they have the right to respectful

treatment. If we do a patient 

satisfaction survey now, you will

find [patient satisfaction] is high.

Because women [in my country] by character ... never say

they are mistreated ... maybe

that is the fact, but they never

speak the truth. They don’t

object or speak out. They 

accept what they get.”

Interviewee, 

TRAction Project, 2010

The U.S. Government’s Global Health 

Initiative seeks to remove barriers that 

prevent women from accessing lifesaving

health services such as assisted delivery.

When women are able to access needed

quality health services and protect themselves from the many health risks they 

face, long-term social and economic

progress can be achieved.

USAID is funding grants to develop 

and evaluate interventions addressing 

disrespect and abuse in childbirth.

For more information about 

USAID programs, please contact

info@usaid.gov or visit www.usaid.gov

For further information:

www.tractionproject.org 

www.whiteribbonalliance.org
hroughout the world, women are 

humiliated and abused in subtle and

overt ways during childbirth, a time 

of intense vulnerability. While the world 

has focused on overcoming financial and 

geographic obstacles to connecting women

with lifesaving childbirth care, little attention

has been paid to documenting and tackling

the significant barriers posed by disrespect

and abuse of women in facilities. 

T

ROBERTO SCHMIDT/AFP 

A review of the evidence

identifies seven categories 

of disrespect and abuse 

in childbirth:

• Physical abuse

• Non-dignified care

• Non-consented care

• Non-confidential care

• Discrimination

• Abandonment of care

• Detention in facilities

Numerous factors contribute to

disrespect and abuse in childbirth: 

• Individuals and communities 

normalize disrespect and abuse 

during childbirth. 

• National laws and policies do not

exist or are not enforced.

• Leadership and governance for 

respect and non-abuse is lacking.

• Standards of care and mechanisms

for accountability are not available.

• Providers demonstrate prejudices 

or are demoralized due to 

weaknesses in the health system.

“She [nurse] may also rough you up.

... Some female nurses rough you

up to an extent that you can tell

her to let you deliver alone. You 

are in pain, and all she does is give

you a harsh and rude approach.

That is why I don’t go to the hospital to deliver because I am not used

to somebody who roughs me up.

That is why I like somebody who

would handle me with care because

at that moment you are in pain you

need somebody to soothe you, 

not one who roughs you [up].”

Woman interviewee, Kenya, 

FCI Skilled Care Initiative, 2003

“In medical school ... we went to 

attend a delivery; a woman resident

was doing it. She was sitting there 

in front and yelling at the mother:

‘Shut your mouth! Stop yelling and

push! You knew what you were

doing when you had sex, and now

you see the result, you’re going to

cry?’ And, we students stared and

said to ourselves: ‘Wow, she’s really

totally in control of the situation.

She’s my idol!’” 

Brazil, d’Oliveira, 2002, Lancet