World Patient Safety Day: Safe and Respectful Childbirth Must Include Quality Surgical Obstetric Care

About 15% of women develop a potentially life-threatening complication during pregnancy or childbirth, and some will require a major surgical intervention to survive. Few of these complications can be predicted, but almost all can be addressed through quality and timely care—including surgical interventions such as cesarean section. While significant progress has been made in recent years in preventing maternal and newborn deaths, the number is still much too high. Each year, over 290,000 women and almost 3 million newborns die and millions more are injured due to complications during pregnancy or childbirth. The vast majority of deaths, 94%, occur in low- and middle-income countries (LMICs), and nearly all these lives might be saved by timely, quality care.

Photo by: Carielle Doe

Persistently high levels of morbidity and mortality, even in places that have achieved a high rate of facility-based births, highlight the importance of going beyond access to health services alone. In fact, the evidence for the role of quality of care in ensuring patient safety is clear, as poor-quality care accounts for 61% of neonatal deaths and half of maternal deaths globally. Efforts to ensure quality of care must also prioritize women’s experiences, as poor treatment of women has been shown to be a significant barrier to seeking care at health facilities.

Dr. Vandana Tripathi, director of the USAID-funded MOMENTUM Safe Surgery in Family Planning and Obstetrics project, stated, “Women and their families can expend tremendous effort and social and financial capital to get to health facilities for labor and delivery. They have the right to the best possible care upon arrival. Unfortunately, we know that because of capacity and resource gaps, too often women don’t receive the care they need to be safe during childbirth. It’s incumbent upon all actors to support health systems to strengthen the quality of childbirth services, so that women and newborns are safe at this essential moment of contact with health care.”

MOMENTUM Safe Surgery in Family Planning and Obstetrics supports national governments and institutions to strengthen surgical safety within maternal health and voluntary family planning programs by promoting evidence-based approaches and testing new innovations. The USAID-funded project enables country organizations and networks to build awareness of, equitable access to, and provision of a high quality of care for safe, voluntary, and consented obstetric and reproductive surgeries. MOMENTUM Safe Surgery in Family Planning and Obstetrics focuses on three clinical areas: safe and appropriate surgical obstetric care, including indicated cesarean delivery and peripartum hysterectomy; fistula prevention and treatment; and long-acting and permanent contraceptive methods.

Dr. Tripathi refers to the example of iatrogenic fistula, an urgent obstetric quality of care challenge. “One of the most disturbing trends we have documented through our work in fistula care is the increase in iatrogenic fistula, especially associated with unsafe cesarean sections. Fistula is a devastating morbidity, and a sentinel indicator that childbirth care has not been able to meet minimum standards of quality and safety. MOMENTUM Safe Surgery in Family Planning and Obstetrics will work to support obstetric surgical teams through competency-based training, improved availability of essential components of safe surgery such as trained anesthesia providers and adequate equipment; and systematic monitoring and reporting of adverse outcomes associated with obstetric surgery. Improvements in these areas will help systems provide safer maternal and newborn care in low-resource settings, and address a leading contributor to fistula today.”

There is a clear consensus that quality health services should be effective, safe, and people-centred, and that ensuring quality care requires concrete actions. Through a collaborative co-creation process, MOMENTUM Safe Surgery in Family Planning and Obstetrics engages key stakeholders in each country of operation to identify and address specific health systems challenges in four cross-cutting areas: Community, health facilities, health systems/institution, and evidence generation and sharing. While specific activities may vary by country, at the core will be the voice of healthcare workers and the women they serve in determining priority actions to ensure patient safety and dignity.  

Patient safety is fundamental to delivering these essential health services at a minimum acceptable standard of quality. The WHO established the annual World Patient Safety Day to enhance global understanding of what patient safety entails, and encourage stakeholders to take global actions to reduce patient harm. When asked what this year’s theme, “Safe Maternal and Newborn Care,” means to MOMENTUM Safe Surgery in Family Planning and Obstetrics, Dr. Tripathi states, “When childbirth is complicated, and surgery is required, it’s essential that we continue to provide respectful care to women and their families, including counseling, informed consent, and debriefing after surgical procedures.”

On this World Patient Safety Day 2021, as we are encouraged to “act now for safe and respectful childbirth”, MOMENTUM Safe Surgery in Family Planning and Obstetrics is speaking out to urge the global community to remember that the path to increased access to maternal health services must never compromise quality, safety, or respectful care.