Dear research team at the Institute of Public Health, University of Heidelberg, Germany and at the School of Public Health and Family Medicine, University of Malawi.

You have just published research in BMC Pregnancy and Childbirth about how Malawian women rate the quality of maternal and newborn care. It is a thorough piece of work and you did much work to develop a set of 27 quality questions.

We invite you to consider the new World Health Organisation advice that engaging with fathers and families is important. The issue of family engagement was not among the quality questions you asked the 821 mothers as they left antenatal, birth and postnatal facilities, and yet one set of questions related to “inter-personal relations”.

Do you know for sure that women do not want family members to be with them at facilities and don’t mind how they are engaged? We have recently reported on other studies that show that many do – Nepal, for example. What was the basis for deciding that how families are engaged is not a quality issue that mothers care about?

In Norway they include family inclusiveness in the measurement of quality

Another article published this month – from Norway – describes a similar thorough process of developing a maternity service quality survey. The survey includes four questions to women about the way the service engages with their partner:

“Was your partner received well by the health personnel at the delivery ward?
Were things arranged so that your partner could be present if you both so wished?
Was your partner received well by the health personnel during the post-natal stay?
Were things arranged so that your partner could be present if you both so wished?”

You do recognise that assessing quality is a subjective issue and that “ignorance of what constitutes the ideal” is a problem for service users. But is a lack of certainty about what constitutes quality a permanent challenge for all of us, service providers and service researchers included?

This is an important question because, as family inclusion becomes an ever more considered issue, following WHO’s declaration, it will challenge the current paradigm about what a good service is.

Kambala et al. (2015), How do Malawian women rate the quality of maternal and newborn care? Experiences and perceptions of women in the central and southern regions, BMC Pregnancy & Health

Sjetne IS et al. (2015), A questionnaire to measure women’s experiences with pregnancy, birth and postnatal care: instrument development and assessment following a national survey in Norway, BMC Pregnancy & Health

Photo: DFID, UK.  Creative Commons.