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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.
Many patients don't know what care they're entitled to in the first place. When people are unaware of services national policy guarantees them — TB preventive therapy, nevirapine and cotrimoxazole for HIV-exposed newborns, or basic diagnostic tests — lifesaving care goes unreceived. In overstretched, under-resourced systems, these gaps are invisible but deadly: patients who don't know to ask, and health workers too overwhelmed to ensure nothing is missed.
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. 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 2025, the World Health Organization released a Compendium on Respectful Maternal and Newborn Care, confirming that mistreatment erodes the trust that makes care-seeking possible at all — driving women away from the services they and their newborns need most.
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
