From Global Rights to Local Relationships: Exploring Disconnects in Respectful Maternity Care in Malawi

Bregje Christina de Kok* (Corresponding Author), Isabelle Uny, Mari Imamura, Jacqueline Bell, Jane Geddes, Ann Phoya

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Widespread reports of "disrespect and abuse" in maternity wards in low- and middle-income countries have triggered the development of rights-based respectful maternity care (RMC) standards and initiatives. To explore how international standards translate into local realities, we conducted a team ethnography, involving observations in labor wards in government facilities in central Malawi, and interviews and focus groups with midwives, women, and guardians. We identified a dual disconnect between, first, universal RMC principles and local notions of good care and, second, between midwives and women and guardians. The latter disconnect pertains to fraught relationships, reproduced by and manifested in mechanistic care, mutual responsibilization for trouble, and misunderstandings and distrust. RMC initiatives should be tailored to local contexts and midwife-client relationships. In a hierarchical, resource-strapped context like Malawi, promoting mutual love, understanding, and collaboration may be a more productive way to stimulate "respectful" care than the current emphasis on formal rights and respect.

Original languageEnglish
Pages (from-to)341-355
Number of pages15
JournalQualitative health research
Issue number3
Early online date23 Oct 2019
Publication statusPublished - Feb 2020


  • respectful maternity care
  • human rights
  • provider-client interaction
  • Malawi
  • qualitative
  • team-ethnography
  • ME

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