Problem: Absence of obstetric care standards resulting in variability of services and outdated practices; limited involvement or choice for women in the obstetric care process; lack of information relating to obstetric care or patient rights available.
Solution highlights: The Childbirth with Dignity Foundation was established to advocate for improved obstetric care through uniting the voices of thousands of women and bringing evidence to light on key issues. Advocacy efforts ultimately led the Ministry of Health to establish obstetric care standards; systematically collecting and documenting patient experiences served as an important advocacy tool and engaging with the target population helped build public support; leveraging a highly-visible public media platform lent sufficient credibility to information conveyed and gained needed attention for action; all stakeholders were engaged to effect change from both the bottom-up and top-down.
Description of practice
In the early 1990s, an absence of care standards caused variability in obstetric care across Poland and practices, such as routine performance of enemas and episiotomies during labour, were out-of-date with current evidence. Furthermore, women lacked information on their rights and were given little opportunity to influence their care by deciding, for example, birthing position or treatments administered during labour.
In an effort to expose suboptimal obstetric services and start a public dialogue about childbirth, a group of women partnered with the largest national daily newspaper - Gazeta Wyborcza - in a campaign asking women to write in about childbirth experiences. The overwhelming number of responses received - 2050 letters in 1994 growing to 50 000 in 1995 - inspired the organizers to establish the Childbirth with Dignity Foundation to advocate for change on the issues brought forward and empower women to openly express their needs and exercise their rights. To gain political action for their cause, in 2006 the Foundation released the ground-breaking report, Childbirth with Dignity is not a Privilege. The report highlighted key issues faced during childbirth, giving testimonials from over 26 000 women, as well as views of health providers. In response, the Ministry of Health convened an expert working group in 2007 to develop obstetric care standards and, after several years of deliberation, the first Perinatal and Postnatal Care Standards were published in 2011. The Foundation continues to work closely with providers through hosting trainings and other educational opportunities to both improve knowledge of standards and increase understanding of women’s needs. Additionally, the Foundation publishes educational resources for women on their website, as well as an online database of all hospitals documenting self-reported ratings and reviews of women’s childbirth experiences for each facility. The Foundation continues to work with women and providers to support further improvements to obstetric care and is currently pushing for stronger monitoring and evaluation systems to ensure adherence to care standards.
Implementation of practice
What stage is the practice currently in?
Who was/is responsible for the implementation of the practice?
The initiative started with a small group of motivated individuals “who felt they had to do something” and assistance from the largest daily newspaper in Poland helped generate widespread support. As the initiative gathered momentum, the Childbirth with Dignity Foundation was established to unite actors and formalize activities. Success of the Foundation is largely attributed to the women who lent their voices; these women are the base for the Foundation and the driving force behind its work. The Foundation relies on external donors and volunteers to run and draws on experts in obstetrics and other fields as needed. While it took time, grassroots action led by the Foundation was successful in securing top-down support from the Ministry of Health, although greater Ministry involvement is still desired.
Since the Childbirth with Dignity Foundation was founded, testimonials indicate women’s experience of childbirth has improved dramatically and that many hospitals are now providing obstetric care according to national standards. Surveys among Polish midwives indicate widespread respect for the Foundation’s work and the Foundation is now well-recognized and respected within the maternal and child health field. While there is still progress to be made, improvements already achieved are evident in the positive testimonials from women and providers. In 2015, the Foundation was awarded the Sasakawa Health Prize at the World Assembly for its work improving maternal care.
This case was prepared as part of a larger effort by the WHO Regional Office for Europe and published (2016) in the document, "Lessons from transforming health services delivery: Compendium of initiatives in the WHO European Region".
© Copyright World Health Organization (WHO), 2016
The methodology used for the development of this case is slightly different from the templates used on the IntegratedCare4People web platform, in particular in the analysis of enabling factors and barriers to change.
Please click on the link below for more information about this practice.
- Joanna Pietrusiewicz
- Childbirth with Dignity Foundation
- Civil society representative