The Challenge
Clinical care alone is not enough.
42%
of women experienced abuse, neglect or discrimination during childbirth
Every 2 min
a woman dies from pregnancy-related causes worldwide
1 in 3
people say mistreatment and lack of privacy at health facilities cause patients to stop taking HIV medication
Fear and disrespect don't just push people out
of care — they prevent people from seeking it
in the first place. And once disengaged, many never return.
Entrenched power imbalances keep both
patients and health workers from raising
their voices. Patients fear retribution or
being turned away, and health workers,
too, fear blame or punishment.
This isn't about patient satisfaction. It's about barriers that cost lives and fall hardest on
those with the least power to push back.
Breaches of privacy, mistreatment, and lack of information can mean the difference between life and death. People living with HIV cite these barriers as primary reasons for abandoning lifesaving treatment. Obstetric violence — and the fear of it — drives women away from safe deliveries and future care. A recent study across four countries found that 42% of women experienced abuse or discrimination during childbirth. The consequences are devastating: every two minutes, a woman dies from pregnancy-related causes worldwide.
Broken equipment, medicine shortages, and the absence of basic infrastructure — clean toilets, wheelchair ramps, private consultation spaces — can make patients feel invisible and unwelcome. When people don't feel respected, or when they're afraid to speak up, they withdraw from care. And once disengaged, many never return. These are critical fault lines in the health system.
The culture of silence runs deep — silencing both patients and providers. Most frontline health workers entered the profession to provide good care — but without the tools, training, and support to make it possible, even the most committed become resigned to a broken system rather than empowered to change it.
This isn't about patient satisfaction. It's about removing the barriers that make healthcare inaccessible to those who need it most — and breaking cycles of preventable illness and death among the world's poorest and most marginalized.
In August 2020, WHO released its first-ever Compendium on Respectful Maternal and Newborn Care — recognising that mistreatment in health systems doesn't only harm individuals. It erodes the trust that makes care-seeking possible at all.
I was nine months pregnant. When I got to the
hospital, the nurse told me I had to pay 1,000 meticais. I didn't have the money, so she left me alone in the birthing room. When she finally came, my baby had already died.
ELSE, maternity Patient, Mozambique
Effective health systems are built on two foundations:
Dignity & Accountability
Clinical Capacity
Dignity and accountability are not nice-to-haves. Without them, clinical investment alone will never deliver the health outcomes we need.
