Mastawal suffered a miscarriage during her third pregnancy; she didn’t know about antenatal care (ANC) and hadn’t gone to a health clinic. When she became pregnant again, a Women’s Development Army (WDA) member from the neighborhood encouraged Mastawal to attend a local clinic for ANC check-ups. When Mastawal’s contractions came on suddenly, she delivered her baby safely and comfortably at the clinic, where, if not for a shortage of beds, she would have been happy to stay longer.
Sadly, Mastawal’s lack of ANC and miscarriage is common. Ethiopia accounted for 3.6 percent of global maternal deaths in 2020. Worldwide, the risk of death for girls and women of childbearing age in low-income countries, at 430 per 100,000 live births, is unacceptably high. The majority of these deaths can be avoided, as evidenced by the maternal mortality rate of 12 per 100,000 live births in high-income countries. Newborn mortality also remains high; in sub-Saharan Africa and central and southern Asia, it is 27 and 23 per 1,000 live births, respectively.
Childbirth is a deeply personal and culturally significant experience. Every girl and woman around the world has the right to respectful maternity care, which includes health services that meet specific cultural and personal preferences and needs, and that reduce knowledge, access, and resource gaps that threaten safe pregnancy and delivery. Similarly, the Institute of Medicine defines person-centered maternal care (PCMC) as “respectful and responsive to individual women’s preferences, needs and values; ensuring that their values guide all clinical decisions before, during and after childbirth.” Research from the Maternal Health Task Force goes further by including dignity, autonomy, privacy, confidentiality, communication, social support, supportive care, trust, and the health facility environment. These domains have been translated into a framework to measure person-centered maternal health services in diverse low-income country settings.
Person-centered maternal care has been documented as a key factor in reducing maternal mortality, newborn complications, and low rates of facility-based deliveries, while also increasing satisfaction. A study in Dessie town Ethiopia found that nearly 65 percent of 310 study participants got PCMC. A study in Addis Ababa found similar results and confirmed that it can increase patient satisfaction and positively influence health-seeking behaviors. Conversely, studies show that poor treatment contributes to under-utilization of maternal health services, and that women who live in rural areas, are poor, have less education, are ethnic minorities, and/or unmarried are less likely to receive PCMC.
Placing maternal health activities in Ethiopia within JSI’s Person-Centered Care Framework.
JSI’s Person-Centered Care Framework integrates a human rights-based approach by focusing on the rights holder (e.g., a woman seeking care) and the obligations of the duty bearers (e.g., providers, policymakers, implementers). The principles shown in the framework can be operationalized and assessed at each socio-ecological level (policy and environment, health system, facility, community, family, and individual) through interventions within six domains.
The point of care access and experience domain focuses on ensuring that supportive, empathetic, and responsive care is provided to all. When applied to maternal care, duty bearers can use it to examine access barriers (e.g., affordability, availability, physical accessibility) and design and implement solutions to ensure care is delivered according to the person-centered principles. This domain emphasizes the experience of those receiving services.
We examined maternity care interventions implemented by JSI’s Last Ten Kilometers (L10K) project within the framework to elucidate the strategies that are helping us strengthen outcomes for mothers and babies at various levels.
Click on the examples placed on the framework to learn more:
On International Women’s Day, a call to save lives
Between 2000 and 2020, Ethiopia reduced maternal and child mortality by half, but its maternal mortality rate of 412 per 100,000 live births and child mortality rate of 67 per 1,000 are still too high, and the country has far to go to reach the Sustainable Development Goal of a maternal mortality ratio of less than 70 per 100,000 by 2030.
Preventable maternal morbidity and mortality remain an urgent global health problem. Despite success in some countries, a recently published WHO report reveals alarming setbacks, with maternal deaths having either increased or remained stagnant around the world in the last 10 years. Putting girls and women of reproductive age at the center of maternal health programs is essential to advancing their rights, gender equity, agency, and ultimately maternal and newborn health outcomes. JSI’s global experience helped identify the following actions to ensure PCMC health services.
Let us involve girls and women in shaping policies and systems that influence how and where they give birth, and where, how, and by whom ANC services are offered. Policies should take into account the highly socio-cultural nature of pregnancy and birth, and ensure access to non-discriminatory, culturally appropriate care for girls and women who are religious and ethnic minorities, financially challenged, live with disabilities, and any others who may have particular pregnancy and birthing preferences and needs.
Let us ensure that health care workers provide respectful care before, during, and after pregnancy. This includes compassionate services that meet client needs and preferences, and ensure their safety, dignity, and overall emotional health.
Let us strengthen the enabling environment to uproot the causes of inequities that disrupt girls’ and women’s agency, access, and improved health outcomes. These include gender norms that stigmatize and shame sexually active adolescent girls and unmarried women, and limit or prevent their decision-making power. Transforming the maternity care system will require new models of health care delivery that are developed with input from community members and designed to reduce racial and gender health inequities.
And critically, let us ensure that the voices, preferences, and needs of girls and women are continually gathered and used to develop, deliver, and monitor maternal health policies and programs.
Mastawal’s experience during her most recent pregnancy and birth had a reverberating effect. It led her to seek postnatal and maternal care for herself and her newborn, use contraception, and ensure her child was fully vaccinated.