Saygılı Annelik Bakımı ve Evrensel İlkeleri: Küresel Kılavuzlar ve Ulusal Yaklaşımlar
Özet
Gebelik ve doğum, kadın yaşamında fiziksel süreçlerin ötesine geçen, güçlü duygusal ve sosyal boyutları olan deneyimlerdendir. Bu deneyimlerin niteliği, yalnızca uygulanan klinik müdahalelerle değil, aynı zamanda bakımın sunulduğu ortamın özellikleri, bakım verenlerin tutumu, iletişim biçimi ve kadınların karar süreçlerindeki konumuyla şekillenir. Saygılı annelik bakımı, bu etkileşimli bakım sürecini kadın onuru, mahremiyeti ve özerkliği ekseninde ele alan hak temelli bir yaklaşım olarak uluslararası düzeyde önem kazanmıştır. Küresel politika belgeleri, doğum bakımının yalnızca güvenli değil, aynı zamanda insani ve destekleyici olması gerektiğini vurgulamıştır ve Türkiye’de ulusal mevzuat ve programlarda bu doğrultuda şekillenmiştir. Bakım ortamlarının iyileştirilmesi, profesyonel yetkinliklerin güçlendirilmesi ve saygılı bakım temelli modellerin uygulanması olumlu doğum deneyimlerini artırabilecek potansiyel alanlardır. Sonuç olarak, kadınların doğum sürecinde saygı gördükleri ve desteklendikleri bir bakımın güçlendirilmesi, doğum memnuniyetinin artmasına ve sağlık sistemine duyulan güvenin sürdürülmesine olumlu yönde katkı sağlayabilir.
Pregnancy and childbirth are experiences that extend beyond physical processes, encompassing profound emotional and social dimensions in women’s lives. The quality of these experiences is shaped not only by clinical interventions but also by the characteristics of the care environment, the attitudes of care providers, communication practices, and women’s involvement in decision-making. Respectful maternity care has gained international prominence as a rights-based approach that addresses this interactive care process through the principles of dignity, privacy, and autonomy. Global policy frameworks emphasize that childbirth care should be not only safe but also humane and supportive, and national legislation and programs in Turkey have been shaped accordingly. Improving care environments, strengthening professional competencies, and implementing respectful care–oriented models represent potential areas for enhancing positive birth experiences. In conclusion, strengthening care in which women feel respected and supported during childbirth may contribute to increased birth satisfaction and sustained trust in the health system.
Referanslar
Leap N. Woman-centred or women-centred care: does it matter? British Journal of Midwifery. 2009;17(1): 12–16.
Brady S, Gibbons KS, Bogossian F. Defining woman-centred care: A concept analysis. Midwifery. 2024;131: 103954. https://doi.org/10.1016/j.midw.2024.103954.
United Nations (UN). Convention on the Elimination of All Forms of Discrimination against Women (CEDAW). https://www.un.org/womenwatch/daw/cedaw/text/econvention.htm [Accessed 19th October 2025].
World Health Organization. The prevention and elimination of disrespect and abuse during facility-based childbirth. https://www.who.int/publications/i/item/WHO-RHR-14.23 [Accessed 29th October 2025].
Vedam S, Stoll K, Rubashkin N, Martin K, Miller-Vedam Z, Hayes-Klein H, et al. The Mothers on Respect (MOR) index: measuring quality, safety, and human rights in childbirth. SSM - Population Health. 2017;3: 201–210. https://doi.org/10.1016/j.ssmph.2017.01.005.
Bohren MA, Vogel JP, Hunter EC, Lutsiv O, Makh SK, Souza JP, et al. The Mistreatment of Women during Childbirth in Health Facilities Globally: A Mixed-Methods Systematic Review-PLoS Med-Vol. 12, 6-p. e1001847. 2015.
Morton CH, Simkin P. Can respectful maternity care save and improve lives? Birth: Issues in perinatal care. 2019;46(3).
Lukasse M, Schroll A, Karro H, Schei B, Steingrimsdottir T, Van Parys A, et al. Prevalence of experienced abuse in healthcare and associated obstetric characteristics in six European countries. Acta obstetricia et gynecologica Scandinavica. 2015;94(5): 508–517.
World Health Organization. Quality of care: a process for making strategic choices in health systems. In: Geneva: WHO; 2006.
Bohren MA, Tunçalp Ö, Miller S. Transforming intrapartum care: Respectful maternity care. Best Practice & Research Clinical Obstetrics & Gynaecology. 2020;67: 113–126. https://doi.org/10.1016/j.bpobgyn.2020.02.005.
Shakibazadeh E, Namadian M, Bohren MA, Vogel JP, Rashidian A, Nogueira Pileggi V, et al. Respectful care during childbirth in health facilities globally: a qualitative evidence synthesis. BJOG: An International Journal of Obstetrics & Gynaecology. 2018;125(8): 932–942.
Miller S, Abalos E, Chamillard M, Ciapponi A, Colaci D, Comandé D, et al. Beyond too little, too late and too much, too soon: a pathway towards evidence-based, respectful maternity care worldwide. The Lancet. 2016;388(10056): 2176–2192.
Miranda J, Bareghamyan H, Therrien MNS, Lalonde A, Steinholt M, Palestra F, et al. FIGO statement on respectful care: Addressing disrespectful maternity care. International Journal of Gynecology & Obstetrics. n/a(n/a). https://doi.org/10.1002/ijgo.70513.
World Health Organization. WHO recommendations on maternal and newborn care for a positive postnatal experience. https://www.who.int/publications/i/item/9789240045989 [Accessed 3rd November 2025].
Jewkes R, Penn-Kekana L. Mistreatment of women in childbirth: time for action on this important dimension of violence against women. PLoS medicine. 2015;12(6): e1001849.
Vogel J, Bohren M, Tunçalp Ӧ., Oladapo O, Gülmezoglu A. Promoting respect and preventing mistreatment during childbirth. BJOG: An International Journal of Obstetrics & Gynaecology. 2016;123(5): 671–674. https://doi.org/10.1111/1471-0528.13750.
Jolivet RR, Gausman J, Kapoor N, Langer A, Sharma J, Semrau KEA. Operationalizing respectful maternity care at the healthcare provider level: a systematic scoping review. Reproductive Health. 2021;18(1): 194. https://doi.org/10.1186/s12978-021-01241-5.
Abuya T, Warren CE, Miller N, Njuki R, Ndwiga C, Maranga A, et al. Exploring the prevalence of disrespect and abuse during childbirth in Kenya. PloS one. 2015;10(4): e0123606.
Sando D, Ratcliffe H, McDonald K, Spiegelman D, Lyatuu G, Mwanyika-Sando M, et al. The prevalence of disrespect and abuse during facility-based childbirth in urban Tanzania. BMC pregnancy and childbirth. 2016;16(1): 236.
Habte A, Tamene A, Woldeyohannes D, Endale F, Bogale B, Gizachew A. The prevalence of respectful maternity care during childbirth and its determinants in Ethiopia: A systematic review and meta-analysis. PLOS ONE. 2022;17(11): e0277889. https://doi.org/10.1371/journal.pone.0277889.
World Health Organization. Compendium on respectful maternal and newborn care. https://www.who.int/publications/i/item/9789240110939 [Accessed 29th October 2025].
Bilgin Z. Anne Dostu Hastane Modeli ve Annelerin Doğum Memnuniyetleri. Dokuz Eylül Üniversitesi Hemşirelik Fakültesi Elektronik Dergisi. 2022;15(3): 279–288. https://doi.org/10.46483/deuhfed.892932.
Bohren MA, Hunter EC, Munthe-Kaas HM, Souza JP, Vogel JP, Gülmezoglu AM. Facilitators and barriers to facility-based delivery in low-and middle-income countries: a qualitative evidence synthesis. Reproductive health. 2014;11(1): 71.
Respectful Maternity Care Charter. The Universal Rights of Women & Newborns. 2019; https://www.healthynewbornnetwork.org/hnn-content/uploads/Respectful-Maternity-Care-Charter-2019.pdf
Molina RL, Patel SJ, Scott J, Schantz-Dunn J, Nour NM. Striving for Respectful Maternity Care Everywhere. Maternal and Child Health Journal. 2016;20(9): 1769–1773. https://doi.org/10.1007/s10995-016-2004-2.
World Health Organization. WHO recommendations: intrapartum care for a positive childbirth experience. https://www.who.int/publications/i/item/9789241550215 [Accessed 1st November 2025].
Jeong G, Kim HK, Bang U. Effect of a continuity of midwifery care model that used a respectful maternal care framework in Korea: a non-randomized study. Frontiers in Public Health. 2025;13: 1578158. https://doi.org/10.3389/fpubh.2025.1578158.
Fares KK, Ahmed HM. Effect of respectful maternity care and effective communication during labor on postpartum depression: an interventional study. Pakistan Journal of Medical & Health Sciences. 2021;15(9): 2692–2698.
Bagherzadeh R, Chananeh M, Kamali F, Samsami K. Investigating impact of consulting midwives on maternal rights charter on perception of respectful maternity care and postpartum blues among postpartum women: a quasi-experimental study. BMC medical ethics. 2025;26(1): 15. https://doi.org/10.1186/s12910-025-01164-x.
Bowser D, Hill K. Exploring evidence for disrespect and abuse in facility-based childbirth. Boston: USAID-traction project, Harvard school of public health. 2010;3.
White Ribbon Alliance. Respectful maternity care: the universal rights of childbearing women. White Ribbon Alliance. 2011; 1–6.
IAWG Maternal and Newborn Health Sub-Working Group. Approaching Implementation of Respectful Maternity Care in Humanitarian Settings. https://iawg.net/resources/approaching-implementation-of-respectful-maternity-care-in-humanitarian-settings [Accessed 30th October 2025].
Adeniran A, Likaka A, Knutsson A, Costello A, Daelmans B, Maliqi B, et al. Leadership, action, learning and accountability to deliver quality care for women, newborns and children. Bulletin of the World Health Organization. 2018;96(3): 222–224. https://doi.org/10.2471/BLT.17.197939.
World Health Organization. Strategies toward ending preventable maternal mortality (EPMM). https://www.who.int/publications/i/item/9789241508483 [Accessed 29th October 2025].
World Health Organization. Standards for improving quality of maternal and newborn care in health facilities. https://www.who.int/publications/i/item/9789241511216 [Accessed 29th October 2025].
World Health Organization. WHO recommendations on antenatal care for a positive pregnancy experience. https://www.who.int/publications/i/item/9789241549912 [Accessed 29th October 2025].
World Health Organization. Quality of Care for Maternal, Newborn and Child Health (QoC Network). https://www.who.int/groups/Quality-of-care-network [Accessed 29th October 2025].
World Health Organization, UNICEF, World Bank Group. Nurturing Care Framework for Early Childhood Development. 2018. https://nurturing-care.org/ [Accessed 1st November 2025].
Office of the United Nations High Commissioner for Human Rights (OHCHR). Report on a human-rights based approach to mistreatment and obstetric violence during childbirth. OHCHR. https://www.ohchr.org/en/calls-for-input/report-human-rights-based-approach-mistreatment-and-obstetric-violence-during [Accessed 3rd November 2025].
White Ribbon Alliance. What Women Want | World We Want. https://whatwomenwant.whiteribbonalliance.org/en [Accessed 3rd November 2025].
Seymour K. “Stand up, speak out and act”: A critical reading of Australia’s White Ribbon campaign. Australian & New Zealand Journal of Criminology. 2018;51(2): 293–310. https://doi.org/10.1177/0004865817722187.
Butler MM, Fullerton JT, Aman C. Competence for basic midwifery practice: Updating the ICM essential competencies. Midwifery. 2018;66: 168–175. https://doi.org/10.1016/j.midw.2018.08.011.
International Confederation of Midwives. RESPECT Toolkit. 2020. https://internationalmidwives.org/resources/respectful-maternity-care-toolkit/ [Accessed 7th November 2025].
International Confederation of Midwives. RESPECT Facilitator Guide. 2020. https://internationalmidwives.org/resources/respect-facilitator-guide/ [Accessed 7th November 2025].
FIGO. Childbirth: A Bill of Rights | Figo. https://www.figo.org/resources/figo-statements/childbirth-bill-rights [Accessed 8th November 2025].
FIGO. Ethical Framework for Respectful Maternity Care During Pregnancy and Childbirth | Figo. https://www.figo.org/resources/figo-statements/ethical-framework-respectful-maternity-care-during-pregnancy-and-childbirth [Accessed 8th November 2025].
ICI. Introducing The International Childbirth Initiative. 2025. https://icichildbirth.org/about/ [Accessed 7th November 2025].
ICI. The Initiative – International Childbirth Initiative. https://icichildbirth.org/initiative/ [Accessed 7th November 2025].
Lothian JA. The International Childbirth Initiative: Twelve Steps to Safe and Respectful MotherBaby–Family Maternity Care. The Journal of Perinatal Education. 2020;29(2): 69.
Penwell V, Davis-Floyd R. Become an Implementing Partner of the International Childbirth Initiative: A Model for Safety and Respect in Childbirth that Works in Every Setting, Everywhere in the World. Midwifery Today. 2022. https://www.midwiferytoday.com/mt-articles/become-an-implementing-partner-of-the-international-childbirth-initiative/ [Accessed 7th November 2025].
Downe S, Lawrie TA, Finlayson K, Oladapo OT. Effectiveness of respectful care policies for women using routine intrapartum services: a systematic review. Reproductive health. 2018;15(1): 23.
Sağlık Bakanlığı. Hasta Hakları Yönetmeliği. https://pertekeih.saglik.gov.tr/TR-943217/hasta-haklari-yonetmeligi.html [Accessed 9th November 2025].
Türkiye Cumhuriyeti Resmî Gazete. Ebelik Yönetmeliği 32741. https://www.resmigazete.gov.tr/eskiler/2024/12/20241203-2.htm
T.C. Sağlık Bakanlığı. Anne Dostu Hastane- Genelge. 2018. https://hsgm.saglik.gov.tr/depo/birimler/kadin-ve-ureme-sagligi-db/Rehberler/GENELGE.pdf
T.C. Sağlık Bakanlığı. Anne Dostu Hastane Listesi. https://khgmsaglikhizmetleridb.saglik.gov.tr/TR,42835/anne-dostu-hastane-listesi.html [Accessed 9th November 2025].
Kaya A, Yeşildere Sağlam H, Gursoy E. Women’s Experiences of Vaginal Birth: A Qualitative Study. Genel Tıp Dergisi. 2025;35(2): 269–275. https://doi.org/10.54005/geneltip.1563740.
Aktaş Reyhan F, Dağlı E. Kadınların Saygılı Annelik Bakımı Doğrultusunda Doğum Deneyimlerinin Değerlendirilmesi: Nitel Bir Araştırma. Sakarya University Journal of Holistic Health. 2023;6(1): 124–141. https://doi.org/10.54803/sauhsd.1228231.