Respectful maternity care in Paraguay puts women's autonomy at the centre of childbirth

KATUETE/ASUNCIÓN, Paraguay – Preparing to give birth for the first time at age 39, Claudelina Ortellado Portillo was anxious. “Because of my age and because everything was new to me, plus I had a hard time getting pregnant,” she explained to UNFPA, the United Nations sexual and reproductive health agency. 

Yet at the Public Health Centre in the city of Katuete, some 300 kilometres from the capital Asunción, she was met with delight and respect throughout the process. “My team focuses on the patients’ emotional well-being as well as their physical health,” explained Victoria García, who heads the facility’s obstetrics department. 

Ms. Ortellado credited this psychological support she received during the pre and postnatal periods in helping her navigate the emotional tides of pregnancy; childbirth can take a heavy emotional and physical toll and requires respectful, responsive care – an approach that emphasizes women's dignity, their emotional state, beliefs, consent and autonomy. 

Childbirth as a dignified experience 

Respectful maternity care also means discouraging over-medicalization and protecting women from obstetric abuse and violence. In Paraguay, a law for protecting women defines obstetric violence as “dehumanizing treatment that violates women's human rights.” The legislation, which was passed in July 2018, sets out parameters for the conduct of health-care workers towards female patients, and in the case of pregnant women, their full pregnancy term and childbirth.

Women must be assured the right to their chosen birth plan and able to access all available information in order to participate fully in decision making over their own labour process – including choices such as the position to give birth in and whether or not to be accompanied in the delivery room. 

She added, “It was important that the team trusts the mother's decisions, her ability to give birth without haste and unnecessary procedures.”

For the couple, information is power. “The more we know about respectful maternity care, the more obstetric violence we can prevent,” said Ms. Vergara.

Involving families during childbirth 

Another essential part of the respectful maternity care approach is to encourage family members to engage in the lead-up, becoming aware of the necessary check-ups, changes during pregnancy, and warning signs that require urgent medical attention. It’s an approach that has proved to help women feel more psychologically and emotionally supported.

Ms. Vergara’s husband, Luis Cañete, said the experience was also an emotional rollercoaster. “You see your partner's effort and pain, and that makes you feel bad, but it's an effort that brings a lot of happiness too.” He encountered no barriers when accompanying Ms. Vergara during the consultations or the delivery, with the medical team seeking to open all doors for them and create a safe and respectful environment.

Respectful maternity care is linked to advancing universal access to sexual and reproductive health. In Paraguay, UNFPA supports staff training to promote respectful childbirth, in partnership with the Association of Obstetricians of Paraguay and the National Federation of Gynecology and Obstetrics. 

UNFPA also works on updating national regulations, for example on improving social norms, gender equality and the health of men and boys, including their active participation throughout pregnancy and labour processes, and informing pregnant women and their families on how to advocate for their rights and preferences before, during and after childbirth.