FIGO collaboration for safe and respectful maternity care

Andre B. Lalonde MD Chair, FIGO International Childbirth Initiative and Working Group Email: [email protected] Dr Lalonde is Professor of Obstetrics and Gynecology at McGill University, Ottawa, Canada. He is Past President of FIGO’s Safe Motherhood and Newborn Health Committee, present Chair of the FIGO International Childbirth Initiative (ICI) Working Group, and Chair of the FIGO Congress Organizing Committee (COC) 2021. Currently he is responsible for the development and implementation of the ICI initiative on quality of obstetrical care. He is a recognized expert in postpartum hemorrhage simulation workshops and training of obstetricians, family physicians, and midwives to help reduce maternal mortality and morbidity.The ICI website can be found at www.internationalchildbirth.com. The International Federation of Gynecology and Obstetrics (FIGO) is dedicated to the improvement of women's health and rights, the reduction of disparities in healthcare for women and newborns, and advancing the science and practice of obstetrics and gynecology. Marking 65 years of work to improve the wellbeing of all women, FIGO has renewed its commitment to a future where every woman is empowered to achieve active participation in her own health and rights. The FIGO ICI Working Group supports the International Childbirth Initiative (ICI) 12 Steps for Safe and Respectful MotherBaby–Family Maternity Care.1 This initiative promotes quality healthcare practice with a multidimensional approach that ensures evidence-based approaches and interventions focused on better (bio)-medical and psychosocial health and wellbeing outcomes for the MotherBaby–Family triad. MotherBaby–Family refers to an integral unit during pre-conception, pregnancy, birth, and infancy influencing the health of one another. Within this triad, the MotherBaby dyad remains central in importance, as the care of one significantly impacts on the other. The ICI initiative also encourages and supports the active participation by providers and users of services in a sustainable quality of care monitoring and evaluation process. FIGO is one of the ICI founding partner organizations, along with the International MotherBaby Childbirth Organization (IMBCO). ICI was built upon their respective previous initiatives,2, 3 incorporating the most recent scientific evidence and insights relating to quality maternity care provision. This initiative is aligned with the ongoing work on quality improvement and respectful care of many organizations involved in maternity health care worldwide. The ICI has been endorsed by 20 partner organizations including maternity care professionals and other care providers, facilities providing maternity care, advocacy organizations, educators, and research institutions.1 ICI documentation has been translated into more than 20 languages, and five facilities (in four countries) are current ICI implementers. Pregnancy and birth are not isolated events in the lives of women, their partners, and their families. Physical and mental health; social, lifestyle, and financial environment; stress and fear in work and relationships; nutritional intake; and parenting skills are only some of the many factors influencing pregnancy and birth outcomes and the growth and development of the baby, newborn, and infant. The period from conception until two years of age is a window of opportunity for parents and caregivers to lay the foundation for health and wellbeing to last a lifetime and to positively affect future generations. Quality, evidence-based care with respect and compassion are essential for every MotherBaby–Family to have the ability to survive, thrive, and transform their lives. Hill and Brower’s4 groundbreaking publication brought international attention to the issue of women undergoing disrespect and abuse during the continuum of MNCH care.5 Since then, there has been a growing body of evidence from countries throughout the world documenting these violations of human rights and the mistreatment of women and newborns. There is increasing global recognition of the need for respectful maternity care (RMC).6-8 This paradigm shift in thinking around the broader concept of quality MNCH is demonstrated in the WHO framework for quality care, which identifies two key dimensions of quality hospital services for the mother and newborn: provision of care—including evidence-based practices, efficient information, and referral systems, and experience of care—including effective communication, respect, dignity, and emotional support.9 Research and case studies that involve listening to women’s voices have resulted in a much better understanding of the intersection between respectful maternity care and quality care, showing that RMC is more than merely the absence of mistreatment. In fact, Miller et al.10 noted that even evidence-based interventions are not as effective if they are not delivered with respect and dignity. The results of the What Women Want Campaign are a resounding call for better quality health services, with respectful and dignified care being foremost among issues that women identified.11 The ICI is a template for MotherBaby–Family-focused timely, effective, and respectful care that can be implemented by facilities, centers, hospitals, and units providing care before, during, and after birth to women and their babies throughout the world. The ICI embodies an evidence and value-based approach that acknowledges the MotherBaby dyad, the importance of family inclusion, and the influence of interactions with healthcare providers and health systems on the health and wellbeing of the MotherBaby–Family and societies. The ICI 12 Steps for Safe and Respectful Maternity Care (Table 1) are building blocks to guide quality improvement at the intersection between RMC and the provision of evidence-based essential interventions, while also addressing a number of health system issues that contribute to the achievement of quality of care in practice, including working conditions and relationships between healthcare providers. ICI has developed a minimum dataset for monitoring and evaluation. Real-time data and lessons learned will be shared by implementing facilities in the web-based ICI Learning Community of Practice. Funds were awarded by the government of New South Wales, Australia for a legacy grant for a 3-year project to implement the ICI 12 Steps in Papua New Guinea, Solomon Islands, and Fiji. This project will be a pragmatic exercise in initiating change in the clinical maternity setting. The FIGO ICI Working Group will oversee this project, working closely with a multi-disciplinary regional advisory and support group based in Australia and country point-persons. FIGO believes that the international community has a responsibility to ensure that women, wherever they are, are given choices in their lives and are given the means to implement these choices. The ICI envisions that FIGO member societies can endorse the ICI and partner at the country level with other health care professional associations and key stakeholders in maternal, newborn, and child health, both governmental and non-governmental, to promote ICI and implement the 12 Steps. We call upon FIGO member societies to work with us to achieve our goal of 1000 ICI-recognized facilities by 2025. We look forward to improved and enhanced experiences and outcomes for mothers, babies, and families everywhere, as well as rewarding work for maternal healthcare professionals.