Kay, Lesley (2019) Respectful maternity care : mapping current global initiatives designed to achieve a positive experience of childbirth, reduce interventions without clinical benefit or increase access to high quality maternity care. In: 14th International Normal Labour and Birth Conference; 17-19 Jun 2019, Grange-over-Sands, U.K.. (Unpublished)

Abstract

Background Concerns about the quality of maternity care in both low and high income countries are often discussed as the twin problems of ‘too much too soon’ (TMTS), and ‘too little, too late’ (TLTL). The first is characterised by global increases in over-medicalisation and intervention affecting high, middle and, increasingly, low resource settings, and often associated with disrespectful care during birth. Over-intervention leads to increased morbidity and mortality for women and babies, and poor birth experiences, with pervasive and persistent inequalities of access to appropriate care. Care that is ‘too little, too late’ is more often associated with low resource settings, and is linked to high maternal and infant mortality and morbidity, and to poor quality disrespectful care, which deters women and families from attending facilities during labour. Little is known about the extent of global initiatives to address these issues. Objectives 1. Develop definitions to inform search for TMTS/TLTL initiatives globally using a collaborative approach. 2. Undertake a scoping search of research and grey literature, and reports, and access information from stakeholders/ experts using online networks. 3. Map and present preliminary findings using a visual format. 4. Use findings to inform future collaborative research with UK and international partners. Methods This is an initial exploratory mapping study. We will use a scoping review approach to develop initial terms, in collaboration with UK colleagues, and partners in low and middle income countries. Linking with stakeholders will ensure consensus and provide a starting point for mapping. We will develop a search protocol, and identify and appraise literature and other reports. We will develop a visual representation of the preliminary data in the form of global/ continental maps demonstrating the prevalence/ range of initiatives; if/when we identify gaps in our data, we will report issues encountered with a view to addressing these in a future study. Findings Our findings will raise awareness about what is known about TMTS/TLTL initiatives in the wider global maternity care community, and what barriers and facilitators exist in relation to accessing and collating this information. Conclusions/Implications As well as raising awareness, this study will determine the extent to which global TMTS/TLTL initiatives are being developed and evaluated. New data about areas where there is activity, and where initiatives are not being undertaken (or are difficult to identify) will inform future collaborative research to address these issues.

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