"I had to bring my own water and carry it myself."
–Rasoambolasoa Edwige, Madagascar
"The condition of the toilets here is very bad. There's no water to wash your hands with."
–Salome Elias, Tanzania
"I feel thirsty which makes me feel bad."
–Rosa Corina Lackwood Ocampo, Nicaragua
Though Rasoambolasoa, Salome, and Rosa all live in very different places, the stories they tell about childbirth are remarkably similar. They talk of overflowing latrines buzzing with flies, and of having to walk – often through public areas – to reach them. They talk of seeing blood and other fluids pooled on the floor or spattered on the walls. They talk of asking family members to bring water to the clinic, or feeling embarrassed when they have to borrow money to buy water.
“Quality” and “respect” are not words they use.
Today is the International Day for Maternal Health and Rights and the kickoff of What Women Want, a global campaign to survey one million women worldwide about their priorities for maternal health. Conversations around respectful maternity care don’t often center around toilets (or even mention them). But the environment a woman gives birth in – the cleanliness of the facility and the availability of water and sanitation – can profoundly affect her experience, in addition to the health of both mother and child.
The World Health Organization (WHO) officially includes water, sanitation and hygiene in its framework for quality maternal and newborn health care, under the standard for “availability of essential physical resources.” The framework mandates that “water, energy, sanitation, hand hygiene and waste disposal facilities are functioning, reliable, safe and sufficient for the needs of staff, women and their families.”
But good water sanitation and hygiene are also the foundation for achieving other standards in the framework around preventing hospital acquired infections, respect and preservation of dignity for women and newborns, and competent and motivated human resources. Today, roughly half (50%) of healthcare facilities in low and middle-income countries lack access to piped water, a third (33%) are without access to improved toilets, and 39% do not have facilities for handwashing with soap. The fact is that without these necessities, it can be difficult for health workers to provide quality, dignified care or take the needed precautions to prevent infection – an unfair burden on both the workers and their patients.
Ludia Chilembwe, a nurse midwife at Chamwabvi Health Centre in Malawi, said it broke her heart to watch seven- to nine-months pregnant women carrying heavy buckets of water to the health center. And Kassahun Simegn, a midwife at Burie Health Centre in Ethiopia, said the unhygienic conditions in his facility almost made him quit.
“There were days when I almost gave up on my job, when I felt I couldn’t take it anymore,” he said. “There were days when I helped a woman deliver and I couldn’t wash my hands after. The old toilet was so full you could feel the feces splashing up on your body. I had pregnant women asking to go to the loo ten or twenty minutes before delivery and we had to let them."
To reduce mortality, maternal health advocates have made it a priority to encourage women to deliver at health facilities. But the truth is that women do not want to go to a dirty facility with overflowing toilets and no water. Skilled staff are not going to want to work there, either. They shouldn’t have to.
“Having access to these basic services such as water and sanitation is a matter of dignity for us as health experts and also for the mothers who come here to deliver in a safe environment,” Kassahun said.
He’s absolutely right. So today or any other day, when discussing respectful maternity care, I encourage you to talk about toilets. Tweet about handwashing using the hastags #IntlMHDay and #WhatWomenWant. Ask about water access and quality. Water, sanitation and hygiene need to be part of these conversations, as well as part of maternal health policies, plans and programs to build stronger, women-centered health systems.
Authored by WaterAid sanitation policy project officer Danielle Zielinski, this is part of a blog carnival for What Women Want, a global campaign to improve quality maternal and reproductive healthcare for women and girls.