RESPECTFUL MATERNITY CARE:

THE
UNIVERSAL RIGHTS
OF CHILDBEARING WOMEN



The Distinctive Importance of the Childbearing Period
Ineverycountryandcommunityworldwide,pregnancyandchildbirtharemomentouseventsinthelivesof
womenandfamiliesandrepresentatimeofintensevulnerability.Theconceptofsafemotherhoodisusually
restrictedtophysicalsafety,butchildbearingisalsoanimportantriteofpassage,withdeeppersonalandcultural
significanceforawomanandherfamily.Becausemotherhoodisspecifictowomen,issuesofgenderequityand
genderviolencearealsoatthecoreofmaternitycare.Thus,thenotionofsafemotherhoodmustbeexpanded
beyondthepreventionofmorbidityormortalitytoencompassrespectforwomensbasichumanrights,including
respectforwomensautonomy,dignity,feelings,choices,andpreferences,includingchoiceofcompanionship
whereverpossible.

Bydesign,thisdocumentfocusesspecificallyontheinterpersonalaspectsofcarereceivedbywomenseeking
maternityservices.Awomansrelationshipwithmaternitycareprovidersandthematernitycaresystemduring
pregnancyandchildbirthisvitallyimportant.Notonlyaretheseencountersthevehicleforessentialand
potentiallylifesavinghealthservices,womensexperienceswithcaregiversatthistimehavetheimpactto
empowerandcomfortortoinflictlastingdamageandemotionaltrauma,addingtoordetractingfromwomens
confidenceandselfesteem.Eitherway,womensmemoriesoftheirchildbearingexperiencesstaywiththemfora
lifetimeandareoftensharedwithotherwomen,contributingtoaclimateofconfidenceordoubtaround
childbearing.

Growing Evidence of Disrespect and Abuse
Imaginethepersonaltreatmentyouwouldexpectfromamaternitycareproviderentrustedtohelpyouora
womanyoulovegivebirth.Naturally,weenvisionarelationshipcharacterizedbycaring,empathy,support,trust,
confidence,andempowerment,aswellasgentle,respectful,andeffectivecommunicationtoenableinformed
decisionmaking.Unfortunately,toomanywomenexperiencecarethatdoesnotmatchthisimage.Agrowing
bodyofanecdotalandresearchevidencecollectedinmaternitycaresystemsfromthewealthiesttopoorest
nationsworldwidepaintsadifferentanddisturbingpicture.Infact,disrespectandabuseofwomenseeking
maternitycareisbecominganurgentproblemandcreatingagrowingcommunityofconcernthatspansthe
domainsofhealthcareresearch,quality,andeducation;humanrights;andcivilrightsadvocacy.

In2010,alandscapereportbyBowserandHill,ExploringEvidenceforDisrespectandAbuseinFacilitybased
Childbirth,summarizedtheavailableknowledgeandevidenceonthistopic.iWhilethereviewrevealedarelative
lackofformalresearchonthetopic,theauthorsindepthsearchofpublishedandtechnicalliteratureaswellas
interviewsanddiscussionswithcontentexpertsdescribedsevenmajorcategoriesofdisrespectandabusethat
childbearingwomenencounterduringmaternitycare.Thesecategoriesoverlapandoccuralongacontinuum
fromsubtledisrespectandhumiliationtoovertviolence;theyincludephysicalabuse,nonconsentedclinicalcare,
nonconfidentialcare,nondignifiedcare(includingverbalabuse),discriminationbasedonspecificpatient
attributes,abandonmentordenialofcare,anddetentioninfacilities.

Interpersonalcarethatisdisrespectfulandabusiveinnaturetowomenbefore,during,andafterbirthisappalling
becauseofthehighvaluesocietiesattachtomotherhoodandbecauseweknowtheintensevulnerabilityof
womenduringthistime.Allchildbearingwomenneedanddeserverespectfulcareandprotectionoftheir
autonomyandrighttoselfdetermination;thisincludesspecialcaretoprotectthemotherbabypairaswellas
marginalizedorhighlyvulnerablewomen(e.g.,adolescents,ethnicminorities,andwomenlivingwithphysicalor

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mentaldisabilitiesorHIV).Furthermore,disrespectandabuseduringmaternitycareareaviolationofwomens
basichumanrights.

Assertion of the Universal Rights of Childbearing Women

Humanrightsarefundamentalentitlementsduetoallpeople,recognizedbysocietiesandgovernmentsand
enshrinedininternationaldeclarationsandconventions.Todate,nouniversalcharterorinstrumentspecifically
delineateshowhumanrightsareimplicatedinthechildbearingprocessoraffirmstheirapplicationtochildbearing
womenasbasic,inalienablehumanrights.ThisCharteraimstoaddresstheissueofdisrespectandabuseamong
womenseekingmaternitycareandprovideaplatformforimprovementby
Raisingawarenessofchildbearingwomensinclusionintheguaranteesofhumanrightsrecognizedin
internationallyadoptedUnitedNationsandothermultinationaldeclarations,conventions,andcovenants;
Highlightingtheconnectionbetweenhumanrightslanguageandkeyprogramissuesrelevantto
maternitycare;
Increasingthecapacityofmaternalhealthadvocatestoparticipateinhumanrightsprocesses;
Aligningchildbearingwomenssenseofentitlementtohighqualitymaternitycarewithinternational
humanrightscommunitystandards;and
Providingabasisforholdingthematernalcaresystemandcommunitiesaccountabletotheserights.

Bydrawingonrelevantextractsfromestablishedhumanrightsinstruments,theCharterdemonstratesthe
legitimateplaceofmaternalhealthrightswithinthebroadercontextofhumanrights.Sevenrightsareincluded,
drawnfromthecategoriesofdisrespectandabuseidentifiedbyBowserandHill(2010)intheirlandscapeanalysis
(seetable).Alltheserightsaregroundedininternationalormultinationalhumanrightsinstruments,includingthe
UniversalDeclarationofHumanRights;theUniversalDeclarationonBioethicsandHumanRights;the
InternationalCovenantonEconomic,SocialandCulturalRights;theInternationalCovenantonCivilandPolitical
Rights;theConventionontheEliminationofAllFormsofDiscriminationAgainstWomen;theDeclarationofthe
EliminationofViolenceAgainstWomen;theReportoftheOfficeoftheUnitedNationsHighCommissionerfor
HumanRightsonpreventablematernalmortalityandmorbidityandhumanrights;andtheUnitedNationsFourth
WorldConferenceonWomen,Beijing.Nationalinstrumentsarealsoreferencediftheymakespecificmentionof
childbearingwomen.Eachrightissourcedtotherelevantinstruments.ii

Tackling Disrespect and Abuse: Seven Rights of Childbearing Women

Category of Disrespect and Abuse i Corresponding Right

1. Physicalabuse Freedomfromharmandilltreatment
2. Nonconsentedcare Righttoinformation,informedconsentandrefusal,
andrespectforchoicesandpreferences,includingthe
righttocompanionshipofchoicewhereverpossible
3. Nonconfidentialcare Confidentiality,privacy
4. Nondignifiedcare(includingverbalabuse) Dignity,respect
5. Discriminationbasedonspecificattributes Equality,freedomfromdiscrimination,equitablecare
6. Abandonmentordenialofcare Righttotimelyhealthcareandtothehighest
attainablelevelofhealth
7. Detentioninfacilities Liberty,autonomy,selfdetermination,andfreedom
fromcoercion



In seeking and receiving maternity care before, during, and after childbirth:

ARTICLE I: Every woman has the right to be free from harm and ill treatment
International Standards
DeclarationoftheEliminationofViolenceAgainstWomen,1994,Article1
InternationalCovenantonCivilandPoliticalRights(ICCPR),1966,Article7
InternationalMotherBabyChildbirthInitiative:AHumanRightsApproachtoOptimalMaternityCare,2010,
Article9
InternationalPlannedParenthoodFederationCharteronSexualandReproductiveRights,1996,Article12
UniversalDeclarationonBioethicsandHumanRights,1997,Article4
Multinational and National Standards
EuropeanCharterofPatientsRights,2002,Article9
LeyOrgnicasobreelDerechodelasMujeresaunaVidaLibredeViolenciadeVenezuela,2007,Article15j


ARTICLE II: Every woman has the right to information, informed consent and refusal,
and respect for her choices and preferences, including the right to her choice of
companionship during maternity care, whenever possible
International Standards
InternationalCovenantonCivilandPoliticalRights(ICCPR),1966,Article7,19
InternationalPlannedParenthoodFederationCharteronSexualandReproductiveRights,1996,Article6
InternationalMotherBabyChildbirthInitiative:AHumanRightsApproachtoOptimalMaternityCare,2010,
Article3,4
ReportoftheOfficeoftheUnitedNationsHighCommissionerforHumanRightsonpreventablematernal
mortalityandmorbidityandhumanrights,2010
UniversalDeclarationonBioethicsandHumanRights,1997,Article6
Multinational and National Standards
BirthJusticeasReproductiveJustice,NAPW,2010
CharterofFundamentalRightsoftheEuropeanUnion,2000,Article3.2,7
ConventionfortheProtectionofHumanRightsandDignityoftheHumanBeingwithregardtothe
ApplicationofBiologyandMedicine:ConventiononHumanRightsandBiomedicine,1997,Article5
DeclarationonthePromotionofPatientsRightsinEurope,1994,Articles1.5,2,3,4.6,5
EuropeanCharterofPatientsRights,2002,Article3,4,5,12
LeydeAcompaamientoduranteelTrabajodeParto,NacimientoyPostpartodePuertoRico,2006,
Article3e,3f
LeydePartoHumanizadoLeyNacionalNo.25.929deArgentina,2004,Article2f,2g
TheRightsofChildbearingWomen,ChildbirthConnection1999,2006,Articles3,4,5,6,9,12,13,14,16,19



ARTICLE III: Every woman has the right to privacy and confidentiality
InternationalStandards
InternationalCovenantonCivilandPoliticalRights(ICCPR),1966,Article17
InternationalPlannedParenthoodFederationCharteronSexualandReproductiveRights,1996,Article4
UniversalDeclarationonBioethicsandHumanRights,1997,Article9
Multinational and National Standards
DeclarationonthePromotionofPatientsRightsinEurope,1994,Article1.4,4
EuropeanCharterofPatientsRights,2002,Article6
TheRightsofChildbearingWomen,1999,2006,Article7

ARTICLE IV: Every woman has the right to be treated with dignity and respect
International Standards
InternationalCovenantonCivilandPoliticalRights(ICCPR),1966,Article2
InternationalMotherBabyChildbirthInitiative:AHumanRightsApproachtoOptimalMaternityCare,
Article1
ReportoftheOfficeoftheUnitedNationsHighCommissionerforHumanRightsonpreventablematernal
mortalityandmorbidityandhumanrights,2010
UnitedNationsFourthWorldConferenceonWomen,Beijing1995
UniversalDeclarationonBioethicsandHumanRights,1997,Article8,10,11
Multinational and National Standards
BirthJusticeasReproductiveJustice,NAPW,2010
CharterofFundamentalRightsoftheEuropeanUnion,2000,Article1,3,7
ConventionfortheProtectionofHumanRightsandDignityoftheHumanBeingwithregardtothe
ApplicationofBiologyandMedicine:ConventiononHumanRightsandBiomedicine,1997,Article1
DeclarationonthePromotionofPatientsRightsinEurope,1994,Article1.1,1.4,1.5
EuropeanCharterofPatientsRights,2002,Article7

ARTICLE V: Every woman has the right to equality, freedom from discrimination, and
equitable care
International Standards
ConventionontheEliminationofAllFormsofDiscriminationagainstWomen(CEDAW),1979,Article1
InternationalCovenantonEconomic,SocialandCulturalRights(ICESCR),1976,Article2
InternationalCovenantonCivilandPoliticalRights(ICCPR),1966,Article26
InternationalPlannedParenthoodFederationCharteronSexualandReproductiveRights,1996,Article3
ReportoftheOfficeoftheUnitedNationsHighCommissionerforHumanRightsonpreventablematernal
mortalityandmorbidityandhumanrights,2010
UnitedNationsFourthWorldConferenceonWomen,Beijing1995,Article28
UniversalDeclarationonBioethicsandHumanRights,1997,Article10,11
Multinational and National Standards
CharterofFundamentalRightsoftheEuropeanUnion,2000,Article21,23
DeclarationonthePromotionofPatientsRightsinEurope,1994,Article5.1



ARTICLE VI: Every woman has the right to healthcare and to the highest attainable
level of health
International Standards
DeclarationofAlmaAta,InternationalConferenceonPrimaryCare,1978,Preamble,Articles4,6
InternationalPlannedParenthoodFederationCharteronSexualandReproductiveRights.1996,Article9
ReportoftheOfficeoftheUnitedNationsHighCommissionerforHumanRightsonpreventablematernal
mortalityandmorbidityandhumanrights,2010
UnitedNationsFourthWorldConferenceonWomen,Beijing1995
UniversalDeclarationofHumanRights,1948,Article25
UniversalDeclarationonBioethicsandHumanRights,1997,Article14.2
Multinational and National Standards
CharterofFundamentalRightsoftheEuropeanUnion,2000,Article35
ConstitucinPolticadelEstadoPlurinacionaldeBolivia,2008,Article45.V
ConventionfortheProtectionofHumanRightsandDignityoftheHumanBeingwithregardtothe
ApplicationofBiologyandMedicine:ConventiononHumanRightsandBiomedicine,1997,Article3
DeclarationonthePromotionofPatientsRightsinEurope,1994,Article5
TheRightsofChildbearingWomen,1999,2006,Article1

ARTICLE VII: Every woman has the right to liberty, autonomy, self-determination, and
freedom from coercion
International Standards
DeclarationoftheEliminationofViolenceAgainstWomen,1994,Article1
InternationalCovenantonEconomic,SocialandCulturalRights(ICESCR),1976,Article1
InternationalPlannedParenthoodFederationCharteronSexualandReproductiveRights,1996,Article2
InternationalCovenantonCivilandPoliticalRights(ICCPR),1966,Article9.1,18.2
UniversalDeclarationonBioethicsandHumanRights,Article5
Multinational and National Standards
CharterofFundamentalRightsoftheEuropeanUnion,2000,Article6
DeclarationonthePromotionofPatientsRightsinEurope,1994,Article1.2

i
Bowser,D.,andK.Hill.2010.ExploringEvidenceforDisrespectandAbuseinFacilitybasedChildbirth:ReportofaLandscape
Analysis.Bethesda,MD:USAIDTRActionProject,UniversityResearchCorporation,LLC,andHarvardSchoolofPublicHealth.
ii
TheCharterborrowsheavilyfromtheframeworkoftheInternationalPlannedParenthoodFederationCharteronSexualand
ReproductiveRights,1996.



Thischarterwasdevelopedcollaborativelybyamultistakeholdergroupwithexpertisebridgingresearch,
educational,clinical,humanrights,andadvocacyperspectives.Thefollowingpeoplecontributedtothisconsensus
documentasmembersofacommunityofconcernworkinginconcerttoaddresstheissueofdisrespectandabuse
duringmaternitycarewithintheirvariousconstituencies:

DebbieArmbruster,USAID
DianaBowser,HarvardSchoolofPublicHealth
NealBrandes,USAID
CatherineCarr,MCHIP/JHPIEGO
BlamiDao,JHPIEGO
RaeDavies,InternationalMotherBabyCare
Initiative
BarbaraDeller,JHPIEGO
FarahDiazTello,NationalAdvocatesfor
PregnantWomen
SimoneDiniz,Researcher
SooDowne,UniversityofCentralLancashire
LorraineFontaine,RegroupementNaissance
Renaissance
LynnFreedman,AvertingMaternalDeathand
Disability,ColumbiaUniversity
MauraGaughan,TranslatingResearchinto
ActionProject
JoanneGleason,PopulationCouncil
KathleenHill,TranslatingResearchintoAction
Project
DebraJones,FamilyCareInternational
MargeKoblinsky,JohnSnowInternational
DouglasLaube,USAID
KathleenMacFarland,FamilyCareInternational
PegMarshall,USAID
LizMason,WorldHealthOrganization
MonaMoore,Independentconsultant
NesterMoyo,InternationalConfederationof
Midwives
MarthaMurdock,FamilyCareInternational
WinnieMwebesa,SavetheChildren
DaveNicholas,TranslatingResearchintoAction
Project
DoyinOluwole,AcademyforEducational
Development
DebraPascaliBonaro,InternationalMother
BabyCareInitiative
BerthaPooley,SavetheChildren
AnniePortela,WorldHealthOrganization
VeronicaReis,JHPIEGO
AramSchvey,CenterforReproductiveRights
MaryEllenStanton,USAID
AnnStarrs,FamilyCareInternational
ErinThornton,EveryMotherCounts
MelissaUpreti,CenterforReproductiveRights
HeleneVadeboncoeur,Perinatalresearcherand
author
RachelWilson,PATH

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OCTOBER 2011