The WHO Standards for Improving the Quality of Maternal and Newborn Care in Health Facilities state that healthcare provision “must take into account the preferences and aspirations of individual women and their families” including “the quality of care as experienced by women, newborns and their families.”

This approach links to the earlier statement by WHO, which declares that one of five global objectives for maternal and newborn healthcare should be to “harness the power of parents, families, and communities, and engage with society”.

One of a series of articles on WHO’s Quality Standards just published by BMC Pregnancy and Childbirth (Smith, Portelo & Marston, 2017) further elaborates on the link between the Quality Standards and engagement of fathers and families:

“The influence of family and community decision makers is crucial in implementing interventions. For example, influential family or community decision makers affected women’s use of maternity waiting homes, engagement with birth preparedness and complication readiness interventions, how awareness of rights was promoted and supported and uptake of demand-side financing interventions. They also affected interventions to involve men in maternal and newborn health care. Gender norms were also crucial in understanding implementation success. Interventions that took account of cultural norms around birth and integrated them, and interventions that women perceived as culturally appropriate and acceptable for birth, were integral to increasing acceptability and motivation to use childbirth facilities.”

Five WHO Quality standards requiring family engagement

Standard 1: Every woman and newborn should receive professional care.

There is a strong body of global evidence that shows engaging with fathers and families improves acces to professional healthcare. Particularly in poorer societies and more remote rural areas, pregnant women are dependent on others to reach health facilities. If families understand the importance of this happening, they are more likely to support it and provide the means, financial and transport.

We have covered recent research findings on attending facilities here on Family Included.

Standard 4: Effective communication with the woman and her family around her needs and preferences.

Communicating with families enables a ‘partnership of care’ where health professionals and families work together to support the health of the mother and newborn. When fathers and family members understand what they need to do, they are much more likely to do it.

This involves face-to-face communication with family members as well as creating printed and/or audiovisual and/or online content according to the local context, which is fully accessible to family members and focuses on what they can do. There is much experience and research from around the world on how this can be done effectively and according to the wishes of both mothers and fathers.

We have covered recent research findings on informing families here on Family Included.

Standard 5: Women and newborns receive care with respect and preservation of their dignity.

When fathers and/or other family members are present, pregnant women and women in labour are more likely to be treated with respect – they have an advocate, witness and protector.

We have covered recent research on respectful care here on Family Included.

Standard 6: Every woman and family should receive emotional support and every woman should have a birth companion of her choice.

When women have a choice to give birth in the presence of those they know and love (many still don’t), they tend to to choose a family member. Given what we now know about the importance of feeling secure and loved during labour and childbirth, this can be seen as as highly rational choice. Family members as birth companions happened very quickly in developed countries when birth was moved from the home into hospitals in the 1940s and 1950s.

Another article in the BMC Pregnancy and Childbirth series on the WHO Standards addresses birth companions (Kabakian-Khasholian & Portela, 2017).

• A key contribution of a birth companion who is a family member is love and trust – “emotional and spiritual” support, as one study describes it.
• Non-family birth companions have been shown to play a beneficial role, sometimes being present in addition to a family member. Like family members, they can be seen as helpfully independent of hospital staff and as a protection against being left alone or neglected. Also like family members, they can empower the woman in labour and achieve for her more respectful care from professionals.
• Birth companions, particularly family members who are inexperienced, need support in their role. Two studies, from Brazil and Chile, describe support of this kind for family members, fathers in particular. Without this support, there can be problems, namely birth companions without the knowledge and skills about how to create a positive environment for the woman. (The first ever time the need for education for birth companions was made was in 1949. When hospital-based maternal healthcare was being established in Europe and women were first demanding the security of loved ones at the birth, particularly their husbands/partners, Grantly Dick-Read, wrote in his classic book, Childbirth Without Fear, “These men cannot be superseded in the value of their service by the most patient nurse or obstetrician.” But he strongly advocated preparation: “The totally unprepared man has no place at the birth of his child.”)
• Allowing women to choose birth companions requires leadership and strategic change in health facilities. There are many considerations: the organisation of space (privacy in the labour room and places for birth companions to rest); protocols for how birth companions and health staff should interact; education for health professionals, particularly around possible fears that their own role will be challenged; and support for birth companions.

We have covered recent research on birth companions here on Family Included.

Standard 7 requires that staff have appropriate skills and competence.

This requires the skills and competence to engage effective with fathers and other family members in order to build a ‘partnership of care’ with them.

The Family Initiative has developed an accredited training course for health professionals that targets these skills and competencies in relation to fathers in particular, Engaging Fathers in Maternal and Newborn Health. This is being adapted to maternal and newborn healthcare in different settings.

We have covered recent research findings on midwife training here on Family Included.

Kabakian-Khasholian T & Portela A (2017), Companion of choice at birth: factors affecting implementation, BMC Pregnancy and Childcare

Smith HJ, Portelo AG & Marston C (2017), Improving implementation of health promotion interventions for maternal and newborn health, BMC Pregnancy and Childbirth

Photo: The White Ribbon Alliance. Creative Commons.