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

Citation

de Kok BC, Uny I, Immamura M, Bell J, Geddes J & Phoya A (2020) From Global Rights to Local Relationships: Exploring Disconnects in Respectful Maternity Care in Malawi. Qualitative Health Research, 30 (3), pp. 341-355. https://doi.org/10.1177/1049732319880538

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.

Keywords
respectful maternity care; human rights; provider-client interaction; Malawi; qualitative; team-ethnography

Journal
Qualitative Health Research: Volume 30, Issue 3

• Accepted manuscript