Supportive and Dignified Maternity Care in Public Health Facilities

Summary

Brief Summary Poor psychosocial support and demeaning care during childbirth in health facilities are common worldwide, particularly in low- and middle-income countries. Despite a policy directive from the World Health Organization (WHO), there is no operational model that effectively demonstrates the incorporation of these guidelines into routine facility-based maternity services. Recent evidence from Pakistan highlights a high rate of reported disrespect and abuse during childbirth, with several health system factors contributing to this compromised care.

This early-phase research aims to develop, implement, and test the feasibility of a Supportive and Dignified Maternity Care (SDMC) service-delivery model. Based on WHO's guiding principles and framework, the model promotes respectful and supportive intrapartum care in public health facilities. The components of the SDMC model include:

Participatory and co-created service-delivery intervention;

Capacity-building of maternity teams (clinical and support staff) through a partnership approach;

Collaborative Care Model;

Patient orientation in the processes of care and their SDMC rights;

Information system (e.g., complaints register);

Accountability mechanisms (e.g., exit interviews); and

Embedding performance reviews.

Using a mixed-method design and extensive data collection before, during, and after the implementation of the intervention, we will assess the coverage of the intervention and its fidelity-the extent to which SDMC guidelines are being adhered to. Challenges faced, changes in maternity teams' understanding and attitudes, and improvements in women's maternity experiences and psychosocial well-being will also inform the success of the intervention.

Evidence from this research will guide further refinements to the SDMC model package. It will provide insights into behavior change among maternity staff and birthing women, as well as estimate the potential effect size to design a larger evaluation and scalability research in diverse health system contexts.

Conditions

• Behavior, Health

Interventions

BEHAVIORAL

Supportive and Dignified Maternity Care

SDMC is a theory-driven, inclusive service-delivery package which will be developed using the principles of the human-centred design approach. The model will include capacity-building of maternity teams, and the improvement of governance and accountability mechanisms within public health facilities to ensure that all women are treated with compassion and dignity, while also catering for their diverse needs, including disabilities and common mental health conditions. The integration of psychosocial support in routine maternity care will be a unique feature of the intervention package, a principal aim of which is to address the psychological needs of birthing women and their companions.

Sponsors & Collaborators

• London School of Hygiene and Tropical Medicine

  collaborator OTHER

• University of Karachi

  collaborator OTHER

• Aga Khan University

  lead OTHER

Principal Investigators

• Bilal Iqbal Avan, PhD · London School of Hygiene and Tropical Medicine

Study Design

Allocation

NA

Purpose

HEALTH_SERVICES_RESEARCH

Masking

NONE

Model

SINGLE_GROUP

Eligibility

Min Age

15 Years

Max Age

49 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2019-10-01

Primary Completion

2021-03-31

Completion

2022-03-31

Countries

• Pakistan

Study Locations