Mother–Baby Friendly Birthing Facilities Initiative
Guidelines for mother–baby friendly birthing facilities have been developed by the FIGO Safe Motherhood and Newborn Health (SMNH) Committee in collaboration with colleagues from the International Confederation of Midwives, White Ribbon Alliance, the International Pediatrics Association, and the World Health Organization (WHO) [1]. FIGO announces the launch of this new initiative to promote active involvement by professional associations, governments, nongovernmental organizations, and civil society to improve quality of care and reduce abuse, neglect, and extortion of childbearing women in facilities. This initiative was approved by the FIGO Executive Board in July 2014 and will use 10 criteria and 10 sets of indicators to help to assure that women and families are treated with respect and dignity, as well as afforded evidence-based maternity care in facilities. This initiative was inspired by the WHO/UNICEF Baby Friendly Initiative and was grounded philosophically and ethically in the Charter on the Universal Rights of Childbearing Women [2,3].
The organizational authors of this initiative are well aware that while global maternal health experts are urging facility-based delivery with skilled attendance, maternal mortality is not decreasing as rapidly as expected. The authors, along with other global maternal health experts, posit that one reason for the slow progress may be the lack of accountability and adherence to globally recognized, evidence-based practices applied rapidly and with attention to quality [4,5].
In recent surveys and qualitative observational studies, providers have been seen yelling at and slapping childbearing women, and coercing them to pay bribes or fees when no fees are due. This in turn has led many women to avoid facility-based delivery [6–8]. Further, low-quality or absent care has been associated with higher rates of mortality and morbidity [4].
Adherence to the indicators developed jointly by the participating maternal, pediatric, grass-roots, and interdisciplinary organizations should result in development of trust, security, and perceptions of quality among childbearing women and their families. This should lead to higher rates of facility-based deliveries with better outcomes.
The 10 criteria for a mother–baby friendly birthing facility include: mobility and positions of preference for labor and birth; privacy; choice of birth partner; nondiscriminatory policies for the treatment of women with HIV, youth, minorities, etc; no physical, verbal, emotional, or financial abuse; affordable or free maternity care; no practices used routinely that are not evidence-based; nonpharmacological and/or pharmacological pain relief as required; and promotes immediate skin-to-skin mother–baby care and breastfeeding.
Assessors equipped with checklists of indicators for observations of policies promoting quality care and who directly observe deliveries will be able to nominate facilities for global certification as mother–baby friendly birthing facilities.
The process of certification of facilities as mother/newborn friendly could—with an enabling environment and proper implementation, supportive supervision, and ongoing accountability—effect significant changes in the quality of care at maternity facilities and the provision of that care by enabled providers who are sensitized by the initiative to give quality care. Realistically, this initiative alone will not be enough to change health systems, but in conjunction with other organizational, governmental, and community-level efforts to improve maternal health, it could result in both the demand for and the provision of mother–baby friendly facilities providing the highest quality evidence-based care.
FIGO is calling on all UN agencies, professional organizations, nongovernmental organizations, governments at all levels, and civil society to endorse and collaborate to implement this initiative. By working together, we can rapidly bring changes to the birthing environment that will help to ensure quality birthing experiences and reduce maternal mortality and morbidity. Further, FIGO and its partners call upon all donors to support this initiative for implementation in both low- and high-resource countries.
