Implementing Respectful Maternity Care Intervention to Improve Perinatal Mental Health in Nepal

More than a third of women experience disrespectful care during childbirth in low- and middle-income settings. Mothers face physical and verbal abuse as well as discrimination based on age, ethnicity and social class. Other types of abuse are non-consented care or painful vaginal examination, and restraining from having companionship or food during childbirth.

Lack of dignified care during the vulnerable time during birth not only violates the universal right of childbearing women but also influences the overall quality of care. To address disrespect and abuse among women during childbirth, the Respectful Maternity Care (RMC) charter clearly articulates the basic inalienable human rights of women and newborns in the context of maternity care (pregnancy and childbirth) provided within a healthcare facility. 

There is some early evidence to suggest that women experiencing disrespect and abuse are more likely to experience common perinatal mental disorders. Common perinatal mental disorders (CPMD) include depressive, anxiety, adjustment and somatic disorders. In low- and middle-income countries, 19.7% of women suffer common perinatal mental disorders during pregnancy and 39.4% suffer from the disorders during postpartum period. There are several health care, societal and family related risk factors for CPMD. The adverse reproductive outcomes (unwanted or unintended pregnancy, nulliparity, past abortion, previous stillbirth, C-section) are associated with an increased risk of CPMD.  Socio-economic disparity, unemployment and the age of the mother are widely associated with CPMD. Poor relationship with intimate partner has also been shown to lead to increased risk for CPMD. 

This research project aims to develop, implement and evaluate an intervention for respectful maternity care in Nepal in order to address the growing concerns for perinatal mental illness. The project is carried out in collaboration with Golden Community and is part of Womher research school.