Supportive and Dignified Maternity Care (SDMC) - development and feasibility assessment of an intervention package for public health systems

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An increasing number of women in lower- and middle-income countries are giving birth in health facilities. However, a vast majority encounter abusive and disrespectful care which can have immediate and long-term adverse consequences on their lives - and on those of their infants. Emotional distress is common during childbirth, and lack of adequate support for women at this time can adversely affect birth outcomes, and lead to mental problems. There is a global consensus that women attending health facilities for maternity care should be treated with respect and dignity, and provided with informational (e.g. labour progress, techniques to cope with pain) and emotional (e.g. reassurance and praise) support during labour and childbirth. Despite the availability of international guidelines on supportive and dignified care, no service-delivery model currently exists that successfully demonstrates how to incorporate these principles into routine, facility-based maternity care. Levels of anxiety and depression in Pakistan are the highest in Asia, and recent evidence shows a high rate of reports of disrespect and abuse during childbirth in Pakistan's health facilities. Numerous factors in the running of health systems contribute to this compromised care, among them: lack of awareness and professional capacity of service-providers around respectful and supportive care; a non-conducive work environment; and poor governance and accountability. The main objective of this research is to develop a Supportive and Dignified Maternity Care SDMC service-delivery model, and test its feasibility and acceptability for content and operationalisation in public health facilities in Pakistan. The Supportive and Dignified Maternity Care (SDMC) service-delivery package has the following components: a) Engaging with implementers (practitioners, managers, policy-makers and communities) to identify bottlenecks around SDMC, and work collectively to develop capacity-building materials and mechanisms to ensure the implementation of SDMC guidelines in routine service delivery; b) 'Capacity building' of maternity teams on SDMC to improve understanding and team work for improved patient care; c) Implementation of 'Collaborative Care' where a team works collectively - its members supporting one another - to ensure internal accountability follow-up, and checks and balances against care-plans, to meet SDMC needs; d) Orientation of patients (and/or their companions) in the systems and processes of care, and in their SDMC rights; e) And finally, the accountability component of the model will include record-keeping of women's experiences, periodic reviews of performance in relation to SDMC, and the taking of remedial measures. For this early-phase research, we will collect extensive data before, during and after the implementation of intervention to assess how successfully SDMC guidelines are practised, and the challenges faced by service-providers. We will also observe changes in women's experiences of supportive and dignified care. Based on the sound feasibility of the early-stage research - especially its potential to improve maternity-ward processes and practices, and mothers' intrapartum-care experiences - our eventual aim would be to evaluate the effectiveness of the SDMC package through robust, large-scale research and its application in varied health-system settings.