Promoting Respectful Maternity Care During Labor and Delivery in Zambia and Liberia

Abstract for Preformed Panel Presentation from the 2022 International SBCC Summit in Morocco:

"Mistreatment during labor and delivery is a well-established global problem, yet research on effective interventions to change provider behavior is still quite limited. This presentation will highlight solutions for provider behavior change - part of the During Stage of the Circle of Care. A four-prong set of solutions was tested in Zambia and adapted and piloted in Liberia: 1) a pain management toolkit-a range of cues and tools placed through the ward to continuously prompt supportive care 2) a provider-client promise-a list of promises read out loud to clients upon admission and signed to set boundaries around acceptable provider care and shift power imbalances, 3) a feedback box-a means to default women into evaluating their experience of care and elevate their voice, 4) a reflection workshop-a safe space for providers to discuss facility norms and build motivation and a commitment to improve client care. The results of the evaluation showed statistically significant differences between clients in the treatment and control sites related to their experiences of disrespect and abuse and pain management support received. The package of solutions, informed by behavioral science, holds promise to positively impact the experience of care of women in labor. The solution set was feasible to implement in both Zambia and Liberia and well received by health workers, thus suggesting its promise for scale. Additional research is needed to more rigorously test impact, refine intervention design to more effectively elevate client expectations of care, and ensure acceptability and feasibility at scale."