Ethical Framework for Respectful Maternity Care During Pregnancy and Childbirth

This document complements FIGO’s Statement – Childbirth: A Bill of Rights – by providing an ethical framework for respectful maternity care during pregnancy and childbirth. Together with the bill of rights, 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. 

Pregnancy, labour and birth are life-changing physiologic processes for most women and their families that benefit from collaboration between health care practitioners delivering maternity care. Multidisciplinary education and teamwork – including communication, collaboration, consultation and referral – are essential to ensuring optimal care for women and babies, especially those with obstetric-neonatal risk, or when obstetric-neonatal complications occur. 

FIGO, in collaboration with colleagues from the International Confederation of Midwives, White Ribbon Alliance, the International Pediatrics Association and the World Health Organization (WHO), launched the International Childbirth Initiative to promote active involvement by professional associations, governments, non-governmental organisations and civil society to improve quality of care and reduce abuse, neglect, and extortion of childbearing women in facilities. 

FIGO calls on these agencies to endorse and collaborate to implement the initiative. By working together, we can rapidly bring changes to the birthing environment that will help to ensure quality birthing experiences and reduce maternal mortality and morbidity. Furthermore, FIGO and its partners call upon all donors and health systems to support this initiative for implementation in across all countries. 

FIGO recommendations 

Principle of beneficence 

• Maternity care must be supportive, individualised and value-based – it is best served as a partnership model between health care practitioners and the 'MotherBaby–Family'.  
• Health care practitioners are expected to routinely provide maternity care for mother, baby and family – they must ensure that their practices are driven by health needs and expectations, as well as by health outcomes and cost-effectiveness based on optimising the normal processes of childbirth. 
• Health care practitioners are expected to follow evidence-based practice – they will promote practices proven to be beneficial in supporting the normal physiology of labour, birth and the postpartum and neonatal periods.  

Principle of nonmaleficence  

• Health care practitioners are expected to avoid harmful practices – they will avoid procedures that have insufficient evidence of benefit outweighing risk for routine or frequent use in normal pregnancy, labour, birth and the postpartum and neonatal period. 
• Health care practitioners should avoid disrespect and abuse – they must devote attention to defining, identifying and eliminating disrespect and the abuse of mothers and newborns. 

Principle of justice  

• Provide respect, dignity and informed choice – maternity care incorporates a rights-based approach, preventing exclusion and maltreatment of individuals that are marginalised and socioeconomically disadvantaged. Under no circumstances is physical, verbal or emotional abuse of women, their newborns and their families ever allowed. 
• Provide free or affordable care with cost transparency – respect every woman’s right to access and receive non-discriminatory and free or affordable care throughout the continuum of parenthood. 
• Promote wellness and the prevention of illness as the foundations of improving maternal and newborn health – health systems must: 
• Implement educational and public health measures that enhance wellness and prevent illness and complications for the mother and baby 
• Provide education about and foster access to good nutrition, clean water and a clean and safe environment 
• Make water, sanitation and hygiene (WASH) measures part of maternity services. Ensure promotion and provision of clean or boiled water, clean toilet facilities and a clean environment in all birth settings 
• Provide education in and access to methods of disease prevention and treatment for mother and baby, including for malaria, syphilis, hepatitis B, toxoplasmosis, HIV/AIDS, and tetanus toxoid immunisation 
• Take measures to avoid extremes of heat and minimise toxic exposures. 

Principle of autonomy 

• Health care practitioners should listen to what women and their families say – each HCP that a woman sees during the childbirth continuum should listen to what women and their families say and should communicate health knowledge and information in a culturally safe and sensitive manner, and in a language that the woman and her family understand.  
• Health care practitioners should always provide respectful and dignified care – clinicians should treat every woman and newborn with respect and dignity. They should fully inform and communicate with the woman and her family in decision making about care for herself and her baby, ensuring her the right to informed consent and refusal. Decision making should be a collaborative effort between the pregnant woman, her family and her health care providers.