Childbirth: A Bill of Rights

This FIGO Statement sets out a bill of rights for childbirth. It has been produced by obstetrics and gynaecology professional membership organisations, led by FIGO, the Royal College of Obstetricians and Gynaecologists and the American College of Obstetricians and Gynecologists, in collaboration with national public health organisations and charities.

The bill of rights supports the theme for the 2021 World Health Organization (WHO) World Patient Safety Day to ‘Act now for safe and respectful childbirth’. It will help to power Sustainable Development Goals 3.1 and 3.2, which aim to reduce the global maternal mortality ratio to less than 70 per 100,000 live births and end preventable deaths of children and newborns by 2030.

All countries have an obligation to respect, protect and fulfil the right to health, including maternal health. Maternal health encompasses the health care dimensions of pre-pregnancy, prenatal and postnatal care. Together, they ensure a positive and fulfilling experience and wellness during pregnancy, at the time of birth and during parenting. 

All countries must provide safe, inclusive, accessible, affordable and respectful maternity care to ensure the best possible health outcomes. This can be achieved through the following actions. 

Providing access to safe and respectful care for all who need it  

• Ensuring maternal care is provided to all who need it, regardless of their race, ethnicity, faith, religion, disability, socio-economic background, age, marital status, migration status or statelessness, or sexual identity. 
• Developing risk-appropriate care pathways for people requiring maternity care services, including safe abortion and post-abortion care pathways. 
• Safeguarding people by ensuring support from health professionals and relevant charities and non-governmental organisations, particularly if giving birth as a result of violence or conflict. 
• Ensuring the availability and accessibility of high-quality sexual and reproductive health services, including the provision of contraception, and timely safe abortion and post-abortion care. 
• Delivering respectful care that recognises the rights and wishes of the individual, within  
• An ethical framework of beneficence, nonmaleficence, justice and autonomy. 
• Providing appropriate mental health support throughout pregnancy and in the postpartum period, up to one year. 

Producing a model of care to prepare individuals for pregnancy 

• Taking a well women health care approach – improving the health and wellbeing of women and girls around the world so they are healthy if pregnancy is desired. Globally, 50% of pregnancies are unintended, so improving the health of all women will ensure the health of pregnant women. 
• Providing appropriate pre-pregnancy and inter-pregnancy care to optimise health and reduce the risk of potential negative outcomes. 
• Taking action to address modifiable risk factors, including nutritional screening for anaemia, treating underlying diseases such as malaria, and ensuring supplementation with iron, folic acid and vitamin D (where appropriate) to support healthy pregnancy. 

Producing a model of care for people who are pregnant and giving birth 

For women and girls who are pregnant and giving birth, providing access to: 

• Free or affordable maternity health care, which includes care and advice for anyone who is pregnant 
• Freely available information to enable women to make the appropriate choices about their pregnancy, childbirth and postnatal care for themselves 
• The right location for care and delivery at the right time, including transfer of care when needed for maternal and newborn health  
• Appropriate care in labour – to address nutrition, pain relief and foetal surveillance 
• At least one birth partner of the woman’s choice during labour and birth – having a trusted birth partner present throughout labour is known to make a significant difference to the safety and wellbeing of women in childbirth 
• Surveillance and review of any physical or mental illness or disability directly related to pregnancy or childbirth to address maternal morbidity. 

For health care practitioners, providing: 

• Training, resources and health system strengthening and support on the delivery of care from pre-pregnancy to prenatal, perinatal, childbirth and postnatal 
• Access to surgical interventions, blood products, water, oxygen, effective medications and treatments to provide appropriate and safe care to all pregnant women. 
• Registering all maternal deaths and their causes – no person should suffer a preventable death in relation to pregnancy, whether it be from haemorrhage, infection, hypertension, unsafe abortion or heart disease. Through registering all deaths and their causes, investigation and learning can lead to improvements of care. 

Producing a model of care for the postpartum period, up to one year after birth 

• Offering trained expertise to support breastfeeding – protecting, promoting and supporting breastfeeding will save more lives of babies and children than any other single preventive intervention. 
• Providing access to postpartum care and postnatal mental health services – 1 in 10 women experience postnatal depression within a year of giving birth. 
• Instigating policies and practices that support healthy parenthood, such as the provision of parental leave, to support attendance of health services in the postpartum/postnatal period. 
• Ensuring access to appropriate surveillance during the postpartum period for pregnancy related complications known to result in morbidity and mortality during the postpartum period, such as postnatal depression, severe hypertension and cardiovascular disease. 
• Providing a comprehensive choice of safe and effective contraceptive methods right after birth, suited to the individual, in a manner the patient can understand. Short spacing between pregnancies (less than 12 months) increases the risk of complications including preterm birth, low birthweight, stillbirth and neonatal death.