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Background: Pregnancy related hypertension is a leading cause of preventable maternal morbidity and mortality in the US, with consistently higher rates affecting racial minorities. Many complications are preventable with timely treatment, in alignment with the Alliance for Innovation on Maternal Health's Patient Safety Bundle ("Bundle"). The Bundle has been implemented successfully in inpatient settings, but 30% of preeclampsia-related morbidity occurs in outpatient settings in North Carolina. To address this, we have integrated community engagement and implementation science approaches to identify facilitators and barriers to Bundle implementation, which supports its adaptation for outpatient settings and identifies implementation strategies to be tested in a subsequent study. Methods: Eleven key informant interviews were conducted across three clinics to assess the implementation needs for effectively utilizing the Bundle. The interview guide was created using the Consolidated Framework for Implementation Research domains to identify facilitators and barriers to implementation. Additionally, three focus group discussions with patient participants were conducted to understand lived experiences and perceptions of respectful care. A coalition of community partners, patients, providers, those with lived experience, and the research team reviewed materials from the formative study design to dissemination and planning for future study. Results: Barriers included inadequate provider-patient interaction time, patients' lack of transportation to access care, limited protocols to inform/assess/treat/escalate patients, and workforce capacity (staff training and turnover). Facilitators included staff recognition of the importance of treating preeclampsia, champion buy-in of the Bundle's ability to improve outcomes, co-location of pharmacies for immediate treatment, and staff capacity. Respectful care principles were repeatedly identified as a facilitator for Bundle implementation, specifically for patient awareness of preeclampsia complications and treatment adherence. Conclusions: Findings highlight the importance of community-engaged approaches. Further, clinic staff regarded Bundle implementation as crucial for the outpatient setting. Identified barriers suggest that strategies should address systemic social supports (i.e., transportation, childcare) and improve access to and use of home blood pressure monitoring. Identified facilitators support improving communication, increasing clinic champion engagement, enabling systems for identifying at-risk patients, and training staff on accurate blood pressure measurement. Successful Bundle implementation requires addressing systemic barriers to delivering respectful care, such as limited time with patients. [ABSTRACT FROM AUTHOR]

Abstract Background Pregnancy related hypertension is a leading cause of preventable maternal morbidity and mortality in the US, with consistently higher rates affecting racial minorities. Many complications are preventable with timely treatment, in alignment with the Alliance for Innovation on Maternal Health’s Patient Safety Bundle (“Bundle”). The Bundle has been implemented successfully in inpatient settings, but 30% of preeclampsia-related morbidity occurs in outpatient settings in North Carolina. To address this, we have integrated community engagement and implementation science approaches to identify facilitators and barriers to Bundle implementation, which supports its adaptation for outpatient settings and identifies implementation strategies to be tested in a subsequent study. Methods Eleven key informant interviews were conducted across three clinics to assess the implementation needs for effectively utilizing the Bundle. The interview guide was created using the Consolidated Framework for Implementation Research domains to identify facilitators and barriers to implementation. Additionally, three focus group discussions with patient participants were conducted to understand lived experiences and perceptions of respectful care. A coalition of community partners, patients, providers, those with lived experience, and the research team reviewed materials from the formative study design to dissemination and planning for future study. Results Barriers included inadequate provider-patient interaction time, patients’ lack of transportation to access care, limited protocols to inform/assess/treat/escalate patients, and workforce capacity (staff training and turnover). Facilitators included staff recognition of the importance of treating preeclampsia, champion buy-in of the Bundle’s ability to improve outcomes, co-location of pharmacies for immediate treatment, and staff capacity. Respectful care principles were repeatedly identified as a facilitator for Bundle implementation, specifically for patient awareness of preeclampsia complications and treatment adherence. Conclusions Findings highlight the importance of community-engaged approaches. Further, clinic staff regarded Bundle implementation as crucial for the outpatient setting. Identified barriers suggest that strategies should address systemic social supports (i.e., transportation, childcare) and improve access to and use of home blood pressure monitoring. Identified facilitators support improving communication, increasing clinic champion engagement, enabling systems for identifying at-risk patients, and training staff on accurate blood pressure measurement. Successful Bundle implementation requires addressing systemic barriers to delivering respectful care, such as limited time with patients.

Background: Labor is an important experience for women that affects them physically and emotionally. Women and their families need safety and a humanistic approach during labor. Measuring women’s perception of respectful maternity care provided in health facilities is important to provide holistic and humanistic care during labor. Objectives: This study aimed to evaluate the psychometric properties of the Turkish version of the respectful maternity care (RMC) scale. Methods: This methodological study was conducted on 150 postpartum women in Adana, Turkey from January to June 2021. Data were analyzed in SPSS v.22 and AMOS v.22 using suitable analysis methods. Researchers studied the RMC scale for the reliability of language, content, construct, validity, and internal consistency. The validity analysis of the scale was examined using Confirmatory factor analysis (CFA). The Root Mean Square Error of Approximation (RMSEA), Comparative Fit Index (CFI), Goodness of Fit Index (GFI), and Adjusted Goodness of Fit Index (AGFI) were used for confirmatory factor analysis. Results: The Turkish version of RMC has 12 items and three components. An analysis of the new results indicated a three-factor structure with a Kaiser-Meyer-Olkin (KMO) value of .84 explaining 70.74% of the total variance. The results showed that the data had a good level of fit with the model, χ²/df = 2.148, CFI = .96, GFI = .92, NFI = .92, TLI = .94, RMSEA = .08. Cronbach’s alpha of the scale was calculated 0.870. Conclusion: The Turkish version of the RMC scale is a valid and reliable scale for Turkish society.

Abstract Background In 2016, the World Health Organization (WHO) recommended increasing antenatal care (ANC) visits from four to eight to reduce maternal morbidity and mortality. However, many low-middle income countries (LMICs), including Uganda, struggle to achieve even the basic four ANC visits. To further improve ANC attendance, understanding the perceptions and beliefs of end users is crucial. This systematic review explores the perceptions, experiences, and behavior of pregnant or previously pregnant women, their families and healthcare workers on ANC attendance in Uganda. Methods The review includes qualitative and quantitative studies published from January 2012 to September 2022. Outcomes include early initiation of ANC visits and any attendance or utilization of routine ANC services. The Critical Appraisal Skills Programme (CASP) checklist was used to assess the quality of included studies. Results We searched 7 databases, identified 725 references and assessed 107 in full text for eligibility based on selected inclusion criteria. Forty-seven studies were eligible and are included in this review. Quantitative findings highlight socioeconomic factors like occupation, wealth index, and marital status as key determinants of ANC uptake and timely uptake of care, favoring higher wealth, younger age, marriage, and media access. Qualitative evidence reveals challenges to ANC attendance including financial constraints, cultural beliefs, gendered decision-making, and geographical distance from healthcare facilities. Potential solutions involve financially empowering women, providing reliable ANC equipment and medication, and community engagement and education. Conclusions This review offers valuable insights for policymakers and healthcare providers seeking to tailor interventions that address the unique needs and challenges faced by pregnant women, their families, and healthcare workers in Uganda. By doing so, it may enhance ANC accessibility and quality, ultimately aligning with the WHO’s recommendation of eight ANC contacts (ANC8) and contributing to reducing maternal morbidity and mortality rates.

Background: The provision of compassionate, respectful, and caring healthcare is an essential component of health workforces because it builds deep relationships between healthcare practitioners and mothers. However, respectful maternity care has received less attention in practice, and existing research is inconclusive as well. Therefore, this study is aimed to assess respectful maternity care and its predictors during childbirth in Siltie Zone, Ethiopia. Methods: We conducted a cross‐sectional study on 374 mothers from May 1 to 30, 2021. A systematic random sampling technique was used to select the study participants. A structured questionnaire was used to collect the data. The data was entered into Epi Data 3.1, and the analysis was done using SPSS 24.0. Binary logistic regression was employed to identify candidate variables for multivariable logistic regression. In the multivariable analysis, variables having a p‐value of less than 0.05 were taken as measures of the degree of association between independent variables and the outcome variable. Results: The result of the study revealed that the overall prevalence of respectful maternal care is 41.0%. Rapport built through communication during antenatal care (AOR = 6.32, 95% CI: 2.81, 16.67), pre‐communication of husband and wife (AOR = 2.45, 95% CI: 2.01, 13.69), clearly known communication of family with mother (AOR = 0.35, 95% CI: 0.11, 0.69), caring culturally and appropriately (AOR = 7.45, 95% CI: 2.88, 19.28), perceived length of the stay during labor (AOR = 1.36, 95% CI: 0.230, 0.551), number of ANC received (AOR = 1.98, 95% CI: 0.037, 0.260), and number of deliveries (AOR = 1.36, 95% CI: 0.230, 0.551) were independent predictors of the outcome variable. Conclusion: The study revealed that respectful maternity care was provided very low. Multidimensional communication with the mother was identified as a significant proximal predictor of respectful maternity care. The study suggests that stakeholders should improve respectful maternity care through the provision of professional health training and create guidelines to identify and address challenges to its practice. [ABSTRACT FROM AUTHOR]

BackgroundRespectful maternity care is care organized for and provided to all women in a manner that maintains their dignity, privacy, and confidentiality, ensures freedom from harm and mistreatment, and enables informed choice and continuous support during labor and childbirth. However, in many healthcare settings in Ethiopia, the standard practice of respectful obstetric care is not the norm, and a significant proportion of health professionals view patients merely as cases and do not show compassion.ObjectivesTo assess respectful maternity care and associated factors among mothers who gave birth at public health institutions in Debre Tabor town, Northwest Ethiopia from December 1, 2023, to January 30, 2024.MethodsAn institution-based cross-sectional study was conducted using qualitative and quantitative data collection methods. Three hundred seventy participants were selected for quantitative analysis using systematic random sampling, while eight were chosen for the qualitative study through purposive sampling. The quantitative data were coded and entered into Epi Data version 4.6, then exported to the Statistical Package for the Social Sciences (SPSS) version 25 for analysis. A multivariable logistic regression analysis was performed to identify factors associated with the outcome variable. Adjusted odds ratios with 95% confidence intervals were computed to determine the significance level. Thematic analysis was used for the qualitative data.ResultsThe proportion of respectful maternity care was 34.1% (95%CI: 29.4, 39.2) cesarean delivery [AOR = 3.45, 95%CI: 1.60, 7.42]. Daytime delivery [AOR = 3.14, 95%CI: (1.59, 6.18)] and less than or equal to 1 day stay in a healthcare facility [AOR = 3.03, 95%CI: (1.51, 6.08)] were positively associated with respectful maternity care. Inadequate equipment and supplies, shortage of staffing, and lack of accountability were barriers to providing respectful maternity care.ConclusionsThe proportion of respectful maternity care was low. Therefore, health institutions and other stakeholders should support and strengthen monitoring and evaluation mechanisms for maternal and neonatal healthcare providers and enhance education and constant support for women during their pregnancy and childbirth. Additionally, adequate access to basic equipment and supplies should be given due attention to ensure respectful maternity care.

Background: Respectful maternity care (RMC) emphasizes the social and relational elements of maternity care and is a crucial part of initiatives to improve service accessibility and quality. Women's perceptions have influenced much of what we know about RMC and contempt in the labor ward. In order to understand midwives' perspectives of RMC, this meta-synthesis focused on them. Method: For this inquiry, the databases PubMed/Medline, Embase, Web of Science, and Scopus were searched to find studies on midwives' perceptions of RMC written between 2011 and April 20th 2023. The included articles were to English language restriction. The results of the included research were examined using thematic analysis. Using the inclusion criteria, 84 potentially relevant articles were carefully reviewed, and only 22 were ultimately selected for synthesis. The quality of the qualitative study was assessed using the CASP, a tool for quality evaluation and PRISMA guidelines were followed. Using the MAXQDA program, the cited quotes and the original authors' interpretations were combined. Result: There were 22 studies total, thematic synthesis was determined to be appropriate for a total of 22 research studies. Following are the topics which we summarized our analysis: in six major themes: Midwives' conceptualizations of RMC, Midwives commitment to woman's rights, The value and impact of RMC to midwives, Midwife's perception of disrespectful care, Challenges in providing respectful maternity care, and Midwives' recommendations for optimal RMC practice. Conclusion: In addition to specific focus on promoting cooperation, policies to enhance health systems and strategic consideration of the midwifery profession's future are required. [ABSTRACT FROM AUTHOR]

ABSTRACT Background The provision of compassionate, respectful, and caring healthcare is an essential component of health workforces because it builds deep relationships between healthcare practitioners and mothers. However, respectful maternity care has received less attention in practice, and existing research is inconclusive as well. Therefore, this study is aimed to assess respectful maternity care and its predictors during childbirth in Siltie Zone, Ethiopia. Methods We conducted a cross‐sectional study on 374 mothers from May 1 to 30, 2021. A systematic random sampling technique was used to select the study participants. A structured questionnaire was used to collect the data. The data was entered into Epi Data 3.1, and the analysis was done using SPSS 24.0. Binary logistic regression was employed to identify candidate variables for multivariable logistic regression. In the multivariable analysis, variables having a p‐value of less than 0.05 were taken as measures of the degree of association between independent variables and the outcome variable. Results The result of the study revealed that the overall prevalence of respectful maternal care is 41.0%. Rapport built through communication during antenatal care (AOR = 6.32, 95% CI: 2.81, 16.67), pre‐communication of husband and wife (AOR = 2.45, 95% CI: 2.01, 13.69), clearly known communication of family with mother (AOR = 0.35, 95% CI: 0.11, 0.69), caring culturally and appropriately (AOR = 7.45, 95% CI: 2.88, 19.28), perceived length of the stay during labor (AOR = 1.36, 95% CI: 0.230, 0.551), number of ANC received (AOR = 1.98, 95% CI: 0.037, 0.260), and number of deliveries (AOR = 1.36, 95% CI: 0.230, 0.551) were independent predictors of the outcome variable. Conclusion The study revealed that respectful maternity care was provided very low. Multidimensional communication with the mother was identified as a significant proximal predictor of respectful maternity care. The study suggests that stakeholders should improve respectful maternity care through the provision of professional health training and create guidelines to identify and address challenges to its practice.

Abstract Background The rates of maternal and neonatal deaths in Madagascar are among the highest in the world. In response to a request for additional training from obstetrical care providers at the Ambanja district hospital in north-eastern Madagascar, a partnership of institutions in Switzerland and Madagascar conducted innovative training on respectful emergency obstetric and newborn care using e-learning and simulation methodologies. The training focused on six topics: pre-eclampsia, physiological childbirth, obstetric maneuvers, postpartum hemorrhage, maternal sepsis, and newborn resuscitation. Cross-cutting themes were interprofessional communication and respectful patient care. Ten experienced trainers participated in an e-training-of-trainers course conducted by the Swiss partners. The newly-trained trainers and Swiss partners then jointly conducted the hybrid remote/in-person training for 11 obstetrical care providers in Ambanja. Methods A mixed methods evaluation was conducted of the impact of the training on participants’ knowledge and practices. Trainees’ knowledge was tested before, immediately after, and 6 months after the training. Focus group discussions were conducted to elicit participants’ opinions about the training, including the content and pedagogical methods. Results Trainees’ knowledge of the six topics was higher at 6 months (with an average of 71% correct answers) compared to before the training (62%), although it was even higher (83%) immediately after the training. During the focus group discussions, participants highlighted their positive impressions of the training, including its impact on their sense of professional effectiveness. They reported that their interprofessional relationships and focus on respectful care had improved. Simulation, which was a new methodology for the participants native to Madagascar, was appreciated for its engaging and active format, and they enjoyed the hybrid delivery of the training. Participants (including the trainers) expressed a desire for follow-up engagement, including additional training, and improved access to more equipment. Conclusion The evaluation showed improvements in trainees’ knowledge and capacity to provide respectful emergency care to pregnant women and newborns across all training topics. The hybrid simulation-based training method elicited strong enthusiasm. Significant opportunity exists to expand the use of hybrid onsite/remote simulation-based training to improve obstetrical care and health outcomes for women and newborns in Madagascar and elsewhere.

Abstract Background Increasing rates of maternal mortality and morbidity, coupled with ever-widening racial health disparities in maternal health outcomes, indicate that radical improvements need to be made in the delivery of maternity care. This study explored the provision of patient-centered maternity care from the perspective of pregnant and postpartum people; experiences of respect and autonomy were examined through the multi-dimensional contexts of identity, relational trust, and protection of informed choices. Methods We conducted primary data collection among individuals who experienced a pregnancy in the five years preceding the survey (N = 484) using the validated Mothers on Respect Index (MORi) and Mothers Autonomy in Decision Making (MADM) scale. We conducted an exploratory factor analysis (EFA) which produced three factor variables: trust, informed choice, and identity. Using these factor variables as dependent variables, we conducted bivariate and multivariate analysis to examine the relationship between these factor variables and social marginalization, as measured by race, disability, justice-involvement, and other social risk factors, such as food and housing insecurity. Results Results of our bivariate and multivariate models generally confirmed our hypothesis that increased social marginalization would be associated with decreased experiences of maternity care that was perceived as respectful and protective of individual autonomy. Most notably, AI/AN individuals, individuals who are disabled, and individuals who had at least one social risk factor were more likely to report experiencing identity-related disrespect and violations of their autonomy. Conclusions In light of the findings that emphasize the importance of patient identity in their experience in the healthcare system, patient-centered and respectful maternity care must be provided within a broader social context that recognizes unequal power dynamics between patient and provider, historical trauma, and marginalization. Provider- and facility-level interventions that improve patient experiences and health outcomes will be more effective if they are contextualized and informed by an understanding of how patients’ identities and traumas shape their healthcare experience, health-seeking behaviors, and potential to benefit from clinical interventions and therapies.

Abstract Background Women’s childbirth experiences provide a unique understanding of care received in health facilities from their voices as they describe their needs, what they consider good and what should be changed. Quality Improvement interventions in healthcare are often designed without inputs from women as end-users, leading to a lack of consideration for their needs and expectations. Recently, quality improvement interventions that incorporate women’s childbirth experiences are thought to result in healthcare services that are more responsive and grounded in the end-user’s needs. Aim This study aimed to explore women’s childbirth experiences to inform a co-designed quality improvement intervention in Southern Tanzania. Methods This exploratory qualitative study used semi-structured interviews with women after childbirth (n = 25) in two hospitals in Southern Tanzania. Reflexive thematic analysis was applied using the World Health Organization’s Quality of Care framework on experiences of care domains. Results Three themes emerged from the data: (1) Women’s experiences of communication with providers varied (2) Respect and dignity during intrapartum care is not guaranteed; (3) Women had varying experience of support during labour. Verbal mistreatment and threatening language for adverse birthing outcomes were common. Women appreciated physical or emotional support through human interaction. Some women would have wished for more support, but most accepted the current practices as they were. Conclusion The experiences of care described by women during childbirth varied from one woman to the other. Expectations towards empathic care seemed low, and the little interaction women had during labour and birth was therefore often appreciated and mistreatment normalized. Potential co-designed interventions should include strategies to (i) empower women to voice their needs during childbirth and (ii) support healthcare providers to have competencies to be more responsive to women’s needs.

Background: This review aimed to provide healthcare professionals with a scientific summary of best available research evidence on factors influencing respectful perinatal care. The review question was 'What were the perceptions of midwives and doctors on factors that influence respectful perinatal care?' Methods: A detailed search was done on electronic databases: EBSCOhost: Medline, OAlster, Scopus, SciELO, Science Direct, PubMed, Psych INFO, and SocINDEX. The databases were searched for available literature using a predetermined search strategy. Reference lists of included studies were analysed to identify studies missing from databases. The phenomenon of interest was factors influencing maternity care practices according to midwives and doctors. Pre-determined inclusion and exclusion criteria were used during selection of potential studies. In total, 13 studies were included in the data analysis and synthesis. Three themes were identified and a total of nine sub-themes. Results: Studies conducted in various settings were included in the study. Various factors influencing respectful perinatal care were identified. During data synthesis three themes emerged namely healthcare institution, healthcare professional and women-related factors. Alongside the themes were sub-themes human resources, medical supplies, norms and practices, physical infrastructure, healthcare professional competencies and attributes, women's knowledge, and preferences. The three factors influence the provision of respectful perinatal care; addressing them might improve the provision of this care. Conclusion: Addressing factors that influence respectful perinatal care is vital towards the prevention of compromised patient care during the perinatal period as these factors have the potential to accelerate or hinder provision of respectful care. [ABSTRACT FROM AUTHOR]

Background: Women's childbirth experiences provide a unique understanding of care received in health facilities from their voices as they describe their needs, what they consider good and what should be changed. Quality Improvement interventions in healthcare are often designed without inputs from women as end-users, leading to a lack of consideration for their needs and expectations. Recently, quality improvement interventions that incorporate women's childbirth experiences are thought to result in healthcare services that are more responsive and grounded in the end-user's needs. Aim: This study aimed to explore women's childbirth experiences to inform a co-designed quality improvement intervention in Southern Tanzania. Methods: This exploratory qualitative study used semi-structured interviews with women after childbirth (n = 25) in two hospitals in Southern Tanzania. Reflexive thematic analysis was applied using the World Health Organization's Quality of Care framework on experiences of care domains. Results: Three themes emerged from the data: (1) Women's experiences of communication with providers varied (2) Respect and dignity during intrapartum care is not guaranteed; (3) Women had varying experience of support during labour. Verbal mistreatment and threatening language for adverse birthing outcomes were common. Women appreciated physical or emotional support through human interaction. Some women would have wished for more support, but most accepted the current practices as they were. Conclusion: The experiences of care described by women during childbirth varied from one woman to the other. Expectations towards empathic care seemed low, and the little interaction women had during labour and birth was therefore often appreciated and mistreatment normalized. Potential co-designed interventions should include strategies to (i) empower women to voice their needs during childbirth and (ii) support healthcare providers to have competencies to be more responsive to women's needs. [ABSTRACT FROM AUTHOR]

Background: Increasing rates of maternal mortality and morbidity, coupled with ever-widening racial health disparities in maternal health outcomes, indicate that radical improvements need to be made in the delivery of maternity care. This study explored the provision of patient-centered maternity care from the perspective of pregnant and postpartum people; experiences of respect and autonomy were examined through the multi-dimensional contexts of identity, relational trust, and protection of informed choices. Methods: We conducted primary data collection among individuals who experienced a pregnancy in the five years preceding the survey (N = 484) using the validated Mothers on Respect Index (MORi) and Mothers Autonomy in Decision Making (MADM) scale. We conducted an exploratory factor analysis (EFA) which produced three factor variables: trust, informed choice, and identity. Using these factor variables as dependent variables, we conducted bivariate and multivariate analysis to examine the relationship between these factor variables and social marginalization, as measured by race, disability, justice-involvement, and other social risk factors, such as food and housing insecurity. Results: Results of our bivariate and multivariate models generally confirmed our hypothesis that increased social marginalization would be associated with decreased experiences of maternity care that was perceived as respectful and protective of individual autonomy. Most notably, AI/AN individuals, individuals who are disabled, and individuals who had at least one social risk factor were more likely to report experiencing identity-related disrespect and violations of their autonomy. Conclusions: In light of the findings that emphasize the importance of patient identity in their experience in the healthcare system, patient-centered and respectful maternity care must be provided within a broader social context that recognizes unequal power dynamics between patient and provider, historical trauma, and marginalization. Provider- and facility-level interventions that improve patient experiences and health outcomes will be more effective if they are contextualized and informed by an understanding of how patients' identities and traumas shape their healthcare experience, health-seeking behaviors, and potential to benefit from clinical interventions and therapies. [ABSTRACT FROM AUTHOR]

Background: In a historic move to ensure comprehensive abortion care, India amended the 1971 Medical Termination of Pregnancy (MTP) Act in 2021, creating an unprecedented opportunity for accelerating safe, respectful, and rights‐based abortion services. The Federation of Obstetric and Gynecological Societies of India (FOGSI), together with World Health Organization (WHO) India and the Ministry of Health and Family Welfare, set up a flagship initiative "Respectful Abortion Care" (RAC) to provide training to obstetricians and gynecologists on the new Act, and also address their values and biases. Methods: Virtual training sessions were organized during the COVID‐19 pandemic to disseminate the amendments made under the MTP Act and address provider values and biases. The primary focus was on private providers as they account for more than half of all abortion services in India (52.9%). The RAC modules were systematically designed and delivered by 690 Master Trainers, trained by FOGSI and WHO. Results: A total of 9051 FOGSI members (22%, with 50% from private clinics) completed the RAC trainings. Pretests and post‐tests were conducted for impact assessment. Significant improvement was seen on knowledge of criteria for termination of pregnancy for significant birth defects (52%–83%). The post‐training survey showed a high level of commitment to promote RAC: >95% were strongly motivated to perform or assist in abortion; 89% reported that the WHO value clarification exercises were helpful in facilitating open discussions on sensitive topics in a comfortable manner; 96% expressed a strong commitment to addressing the issue of respect and confidentiality in abortion care. Conclusion: RAC was a unique initiative around the MTP Act amendment 2021 in India, which demonstrated that collaboration and leadership by professional associations can help motivate providers and lead to improved knowledge and commitment from public and private sector providers. Synopsis: Large‐scale virtual training led to improved knowledge on the new Medical Termination of Pregnancy Act (amendment) 2021, while addressing providers' values and bias to provide respectful abortion care. [ABSTRACT FROM AUTHOR]

Abstract Person‐centred sexual and reproductive health (PCSRH) care refers to care that is respectful of and responsive to people's preferences, needs, and values, and which empowers them to take charge of their own sexual and reproductive health (SRH). It is an important indicator of SRH rights and quality of care. Despite the recognition of the importance of PCSRH, there is a gap in standardized measurement in some SRH services, as well as a lack of guidance on how similar person‐centred care measures could be applied across the SRH continuum. Drawing on validated scales for measuring person‐centred family planning, abortion, prenatal and intrapartum care, we propose a set of items that could be validated in future studies to measure PCSRH in a standardized way. A standardized approach to measurement will help highlight gaps across services and facilitate efforts to improve person‐centred care across the SRH continuum. Patient or Public Contribution This viewpoint is based on a review of validated scales that were developed through expert reviews and cognitive interviews with services users and providers across the different SRH services. They provided feedback on the relevance, clarity, and comprehensiveness of the items in each scale.

Background: Community perceptions of quality of maternal healthcare services-including Person-centered maternity care (PCMC)-influences the health-seeking behavior of women. Yet few studies have examined this quantitatively. This study aims to examine community perceptions of PCMC and its associated factors. Materials and Methods: We used data from a survey on community perceptions of PCMC in Migori County, Kenya conducted in August 2016. Community members were relatives or friends of women aged 15 to 49 years who gave birth in the 9 wk preceding the survey (N = 198). PCMC was measured using a 30-item scale with three sub-scales for dignity and respect, communication and autonomy, and supportive care. PCMC scores were standardized to range from 0 to 100, with higher scores indicative of higher PCMC. Descriptive, bivariate, and multivariate analyses were performed in STATA (version 14). Results: The average total PCMC score was 62 (SD = 15.7), with scores of 74, 63, and 53 for dignity and respect, supportive care, and communication and autonomy, respectively. Controlling for other factors, respondents who were employed and literate had higher PCMC perception scores than those who were less literate and unemployed. Respondents who rated their health as very good had higher PCMC perception scores than those who rated their health as poor. Female respondents who previously gave birth at a health facility had lower perceptions of dignity and respect than those with no prior facility birth. Conclusion: The findings imply that community perceptions of PCMC, particularly related to communication and autonomy, are poor. Given the effects of these perceptions on use of maternal health services, there is a need to improve PCMC.

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Background: Women's autonomy and respect are crucial for ensuring high-quality maternity care. However, during the COVID-19 pandemic, healthcare workers have had to adapt to new protocols and follow social distancing regulations, which can impact their ability to provide autonomous and respectful care to their patients. Therefore, the objective of this study was to describe how mothers perceive autonomy and respect during their antenatal and childbirth care. Method: This study used a cross-sectional approach to collect data via an online survey from March 2020 to July 2021. Descriptive statistics were used to analyze the data. Results: The majority of the women in this study reported experiencing a moderate level of autonomy (Mean ±SD=31.4±10.08) but low levels of respect during their maternity care (Mean ±SD= 44.99±7.13). Conclusion: The results of this study suggest that, during the COVID-19 pandemic, women are receiving moderate levels of autonomy in decision-making but low levels of respectful care from maternity staff during pregnancy and childbirth. Despite the challenges posed by the pandemic, healthcare workers such as midwives, nurses, and obstetricians should remain mindful of their patients' rights to make decisions about their own health and provide respectful care.

Person‐centred sexual and reproductive health (PCSRH) care refers to care that is respectful of and responsive to people's preferences, needs, and values, and which empowers them to take charge of their own sexual and reproductive health (SRH). It is an important indicator of SRH rights and quality of care. Despite the recognition of the importance of PCSRH, there is a gap in standardized measurement in some SRH services, as well as a lack of guidance on how similar person‐centred care measures could be applied across the SRH continuum. Drawing on validated scales for measuring person‐centred family planning, abortion, prenatal and intrapartum care, we propose a set of items that could be validated in future studies to measure PCSRH in a standardized way. A standardized approach to measurement will help highlight gaps across services and facilitate efforts to improve person‐centred care across the SRH continuum. Patient or Public Contribution: This viewpoint is based on a review of validated scales that were developed through expert reviews and cognitive interviews with services users and providers across the different SRH services. They provided feedback on the relevance, clarity, and comprehensiveness of the items in each scale. [ABSTRACT FROM AUTHOR]

Introduction: In the United States, adverse birth outcomes are most prevalent among Black women and birthing people, who are known to experience increased mistreatment and disrespect in care. The purpose of this paper is to describe findings from a study that used two validated scales to examine factors associated with experiences of person‐centered care during pregnancy and birth among Black birthing people in California. Methods: We used data from 234 Black women and birthing people who were recruited between January and September 2020 as part of a validation study for the Person‐Centered Prenatal Care (PCPC) and the Person‐Centered Maternity Care (PCMC‐US) scales. Bivariate and multivariate analyses were conducted to examine the associations between PCPC and PCMC‐US scores and sociodemographic, health‐related, and care‐related factors. Results: The factors associated with lower PCPC scores were having foreign‐born parents, having public or no insurance, part‐time employment, unstable housing, late start of prenatal care (in the second or third trimester), poorer self‐rated health (less than very good), and lack of continuity of care with prenatal providers. Factors associated with lower PCMC‐US scores were having public insurance, late start of prenatal care, longer length of stay in facility following birth, poorer self‐rated health, lack of continuity of care between prenatal care and birth providers, and racial discordance with birth provider. Conclusions: Our analysis highlights the contributions of intersecting identities as well as health‐related and care‐related factors to Black birthing people's experiences of care in California. Continuity of care and provider racial concordance, in particular, were shown to improve pregnancy and birth experiences. [ABSTRACT FROM AUTHOR]

Abstract Background Postpartum haemorrhage (PPH) is one of the major complications of childbirth which may result in maternal morbidity and mortality, especially in low and middle-income countries like Nigeria. Midwives play a vital role in preventing and managing PPH in Nigerian rural communities. The aim of this study is to understand the experiences of midwives in rural maternity care settings in order to provide appropriate support and improve practice. Methods An exploratory, qualitative study of a purposive sample of 15 practicing midwives was carried out using semi-structured interviews from November 2018 to February 2019. Data were transcribed verbatim and analyzed using content analysis. Results Four themes were identified: 1. interventions for preventing PPH; 2. approaches to managing PPH; 3. challenges of preventing and managing PPH and 4. ways of supporting midwives to overcome these challenges in rural health care settings. Midwives employed various strategies, such as antenatal education, diagnosis and treatment of anaemia to counteract complications from possible PPH. Understanding PPH as a life-threatening condition enabled the midwives to provide holistic and effective management that sometimes involved a multidisciplinary team approach. Inadequate resources and delay in seeking health care, however, militate against their efforts. The midwives also identified the need for continuing education and training to enhance their standards of care. Conclusion These midwives in Nigerian rural health care settings engage in preventive practices and active management of PPH though not without barriers, such as inadequate resources. There is a need for midwives in rural areas to have cultural competence, be provided with adequate resources and participate in ongoing education in order to be more effective.

BACKGROUND:Low use of maternal health services, as well as poor quality care, contribute to the high maternal mortality in sub-Saharan Africa (SSA). In particular, poor person-centered maternity care (PCMC), which captures user experience, contributes both directly to pregnancy outcomes and indirectly through decreased demand for services. While many studies have examined disparities in use of maternal health services, few have examined disparities in quality of care, and none to our knowledge has empirically examined disparities in PCMC in SSA. The aim of this study is to examine factors associated with PCMC, particularly the role of household wealth, personal empowerment, and type of facility. METHODS:Data are from a survey conducted in western Kenya in 2016, with women aged 15 to 49 years who delivered in the 9 weeks preceding the survey (N = 877). PCMC is operationalized as a summative score based on responses to 30 items in the PCMC scale capturing dignity and respect, communication and autonomy, and supportive care. RESULTS:We find that net of other factors; wealthier, employed, literate, and married women report higher PCMC than poorer, unemployed, illiterate, and unmarried women respectively. Also, women who have experienced domestic violence report lower PCMC than those who have never experienced domestic violence. In addition, women who delivered in health centers and private facilities reported higher PCMC than those who delivered in public hospitals. The effect of employment and facility type is conditional on wealth, and is strongest for the poorest women. Poor women who are unemployed and poor women who deliver in higher-level facilities receive the lowest quality PCMC. CONCLUSIONS:The findings imply the most disadvantaged women receive the lowest quality PCMC, especially when they seek care in higher-level facilities. Interventions to reduce disparities in PCMC are essential to improve maternal outcomes among disadvantaged groups.

Background: Limited research captures the intersectional and nuanced experiences of lesbian, gay, bisexual, transgender, queer, two‐spirit, and other sexual and gender‐minoritized (LGBTQ2S+) people when accessing perinatal care services, including care for pregnancy, birth, abortion, and/or pregnancy loss. Methods: We describe the participatory research methods used to develop the Birth Includes Us survey, an online survey study to capture experiences of respectful perinatal care for LGBTQ2S+ individuals. From 2019 to 2021, our research team in collaboration with a multi‐stakeholder Community Steering Council identified, adapted, and/or designed survey items which were reviewed and then content validated by community members with lived experience. Results: The final survey instrument spans the perinatal care experience, from preconception to early parenthood, and includes items to capture experiences of care across different pregnancy roles (eg, pregnant person, partner/co‐parent, intended parent using surrogacy) and pregnancy outcomes (eg, live birth, stillbirth, miscarriage, and abortion). Three validated measures of respectful perinatal care are included, as well as measures to assess experiences of racism, discrimination, and bias across intersections of identity. Discussion and Conclusions: By centering diverse perspectives in the review process, the Birth Includes Us instrument is the first survey to assess the range of experiences within LGBTQ2S+ communities. This instrument is ready for implementation in studies that seek to examine geographic and identity‐based perinatal health outcomes and care experiences among LGBTQ2S+ people. [ABSTRACT FROM AUTHOR]

The need for respectful bereavement care following a stillbirth has been poorly recognised within global public health initiatives. To date, there has been no comprehensive cataloguing of providers that support parents after stillbirth, nor any review of the challenges they face. We aimed to identify providers (organisations and point persons) that support bereaved parents worldwide and to investigate the challenges they face. A systematic global online search was done to identify providers of support after stillbirth. Subsets of providers were surveyed and interviewed. These were purposively sampled to achieve diversity in geography, organisation size and point person role. Challenges in providing support in six key areas -- stigma, funding, reach, policy, workforce, and advocacy -- were analysed thematically. Overall, 621 providers from 75 countries were identified. No support providers were identified in 123 countries, and in the 6 countries that carry almost half of the global burden of stillbirths, only 8 support providers were found. Support providers faced challenges in accessing funding, reaching key populations, and training and retaining staff, while complex policies hampered bereavement care. Support providers were challenged by silence and stigma around stillbirth. Overcoming these challenges requires collaboration, effort, and political will at local and international scales. [ABSTRACT FROM AUTHOR]

Introduction: European countries have recently received many migrants from Ukraine. Women's life experiences and expectations shape their perception of maternity care and childbirth. Our study aimed to explore how newly arrived Ukrainian refugee women experience their maternity care in Norway., Methods: Social media were used to recruit eight women meeting the criteria of being newly arrived Ukrainian refugee women. Semi-structured interviews, three face-to-face and five video-calls, were performed between December 2023 and January 2024. We used Braun and Clarke for thematic analysis., Results: Three main themes were identified: healthcare in country of origin, high-quality care in the new country, and challenges as a refugee. Women reported that in their home country, the cost of maternity care had a significant impact on the quality of care they received with a tendency toward overmedicalization, as access to certain services often depended on payment. Participants described instances of feeling disrespected by healthcare staff in their home country, in contrast to their experiences in Norway. Women reported that in Norway they experienced a high level of professionalism among healthcare staff and a well-functioning healthcare system with good physical conditions. Challenges that the women struggled with were communication and barriers to accessing services., Conclusions: Being treated professionally and with respect played a central role in creating a positive experience and mitigated the negative experiences of problems with communication and navigation in an unfamiliar healthcare system. Future research could investigate the use of written information to aid migrants in understanding the maternity services and some of the vocabulary., Competing Interests: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was reported., (© 2025 Lukasse M. et al.)

Objective: Migration of pregnant women can be challenging. Access to adequate and respectful care may not be possible. We aimed to assess the maternity care that immigrant women receive and their satisfaction with the care they experience., Methods: This multicenter prospective study was conducted in a tertiary public hospital and a private hospital in Istanbul between April 2023 and July 2023. A face-to-face questionnaire was completed in the postpartum department by obstetricians and translators., Results: In total, 267 patients participated in this study. A majority of these patients delivered at the public hospital (75%). Approximately 21% of all deliveries in both hospitals were with foreign mothers. A majority of the patients (82%) in the public hospital said they easily reached midwives, nurses, and an obstetrician, while this number rose to 100% in the private hospital. Patients in the private hospital had a higher average number of obstetrician visits compared to those in the public hospital, which was statistically significant (P < 0.05). Patients in the public hospital were significantly less informed about various maternity topics than those in the private hospital group (P < 0.001 for all topics). Most patients said their ideas and thoughts were taken seriously by the health care providers (80% and 97% in the public and private hospitals, respectively). Almost all patients recommended giving birth in the same hospital (94% vs. 96%, public and private hospitals, respectively), while around 99% recommended giving birth in Turkey., Conclusion: Immigrant women are overall satisfied with the care they receive in both public and private hospitals. They have easier access to obstetricians in private hospitals, as well as being more informed on maternal health issues. Clinical efforts should focus on patient education in antenatal care., (© 2025 International Federation of Gynecology and Obstetrics.)

Abstract Background Compassionate respectful, and caring (CRC) creates a pleasant environment for health workforce (HWF), customers, and families. For the past five years, the Ethiopian Ministry of Health (EMoH) has developed a CRC plan to improve person-centered care. Therefore, we aimed to assess the implementation status of CRC and associated factors in the 16 model health facilities (MHFs) in Ethiopia. Methods A cross-sectional study was employed from February to April 2021. A structured and semi-structured questionnaire was used to assess the level of CRC implementation in model health care facilities. Epi-data version 4.3 and SPSS version 26 software were used for data entry and analysis, respectively. Binary logistic regressions analysis was used and significance was obtained at the odds ratio with a 95% confidence interval and P-value

Background: Despite the tenets of rights‐based, person‐centered maternity care, racialized groups, low‐income people, and people who receive Medicaid insurance in the United States experience mistreatment, discrimination, and disrespectful care more often than people with higher income or who identify as white. This study aimed to explore the relationship between the presence of a doula (a person who provides continuous support during childbirth) and respectful care during birth, especially for groups made vulnerable by systemic inequality. Methods: We used data from 1977 women interviewed in the Listening to Mothers in California survey (2018). Respondents who reported high levels of decision making, support, and communication during childbirth were classified as having "high" respectful care. To examine associations between respectful care and self‐reported doula support, we conducted multivariable logistic regressions. Interactions by race/ethnicity and private or Medi‐Cal (Medicaid) insurance status were assessed. Results: Overall, we found higher odds of respectful care among women supported by a doula than those without such support (odds ratios [OR]: 1.4, 95% CI: 1.0–1.8). By race/ethnicity, the association was largest for non‐Hispanic Black women (2.7 [1.1–6.7]) and Asian/Pacific Islander women (2.3 [0.9–5.6]). Doula support predicts higher odds of respectful care among women with Medi‐Cal (1.8 [1.3–2.5]), but not private insurance. Conclusions: Doula support was associated with high respectful care, particularly for low‐income and certain racial/ethnic groups in California. Policies supporting the expansion of doulas for low‐income and marginalized groups are consistent with the right to respectful care and may address disparities in maternal experiences. [ABSTRACT FROM AUTHOR]

Background: Globally, less attention has been given to the abuse and disrespect observed during maternity care. Person-centered maternity care is providing care that is respectful and responsive to individual women's preferences and needs and that their values guide all clinical decisions during childbirth. In Ethiopia, person-centered health care is one of the factors that increase client satisfaction and health service utilization. Therefore, we aimed to determine the level of person-centered maternity care among mothers who gave birth in health facilities of South Wollo Zone public hospitals, Northeastern, Ethiopia, 2019 using a mixed-method study. Methods: An institution-based cross-sectional study was conducted using both qualitative and quantitative data collection methods. Three hundred sixty-nine study participants were selected for the quantitative study using simple random sampling. Twelve study participants were selected for the qualitative study using purposive sampling. The quantitative data was coded and entered into Epi data 4.4 version and the analysis was carried out using Statistical Package for Social Sciences version 23. Descriptive statics was presented using tables and figures. Thematic analysis was used for qualitative data and presented with the quantitative result through triangulation. Result: The Percentage mean score of the person-centered maternity care scale of the respondents was 64% of the total expected score. Whereas, the percentage means score sub-scales were 81.9%, for dignity and respect, 56.4% for communication and autonomy and 61.6% for supportive care. Most mothers who participated in an in-depth interview reported that there is not enough bed, delivery coach and bedpan in government hospitals. Conclusion and recommendations: Person-centered maternity care in health facilities of South Wollo Zone public hospitals is low. Therefore, responsible health sectors should work to improve the quality of care through effective communication between clients and providers and a supportive environment is crucial to succeeding in increasing the uptake of high-quality facility-based births. [ABSTRACT FROM AUTHOR]

Abstract Background The burden of maternal and neonatal morbidity and mortality is a global health concern with the highest burden documented after childbirth in women and babies living in sub-Saharan Africa. To date, there is limited information on the quality of postnatal care and/or whether evidence-based interventions to improve postnatal care in a way that meets the specific health needs of each mother and her baby have been lacking. There is also limited data related to how quality of care (respectful or disrespectful) influences women's decision to access postnatal care. Objective To systematically review available qualitative evidence for how quality of care (respectful or disrespectful) influences perceptions and experiences of, and decisions to, access postnatal care for women living in sub-Saharan Africa. Search strategy CINAHL plus, Cochrane library, Global Health, Medline, PubMed, Web of Science were searched from 2009—2019. Grey literature was searched on Google Scholar. Selection criteria Qualitative literature in English describing women’s perceptions and experiences of the quality of care they received after childbirth and how this influenced their perceptions of and decisions to access postnatal care. Data analysis Thematic analysis was performed to extract subthemes and themes. Outcomes were themes from the qualitative data used to form a thematic synthesis. Results Fifteen studies were included with data from 985 women interviewed face-to-face across eight countries. Descriptions of respectful care included healthcare providers being kind, supportive and attentive to women’s needs. Women described preferring healthcare services where the healthcare providers communicated in a respectful and caring manner. Descriptions of disrespectful care included verbal and/or physical abuse and power imbalances between women and healthcare providers. Some women were denied postnatal care when attending a healthcare facility after giving birth at home. There is evidence to suggest that vulnerable women (adolescents; women with poor socioeconomic status; women who are HIV positive) are more likely to receive disrespectful care. Conclusions This systematic review describes how aspects of respectful and disrespectful maternity care influence women’s perceptions and experiences of, and decisions to access postnatal care services. There is a need for a renewed focus to prioritise respectful maternity care and to sustainably provide good quality postnatal care to all women and their babies in a way that meets their expectations and health needs.

Objective: To quantify parents' experiences of respectful care around stillbirth globally. Design: Multi‐country, online, cross‐sectional survey. Setting and population: Self‐identified bereaved parents (n = 3769) of stillborn babies from 44 high‐ and middle‐income countries. Methods: Parents' perspectives of seven aspects of care quality, factors associated with respectful care and seven bereavement care practices were compared across geographical regions using descriptive statistics. Respectful care was compared between country‐income groups using multivariable logistic regression. Main outcome measures: Self‐reported experience of care around the time of stillbirth. Results: A quarter (25.4%) of 3769 respondents reported disrespectful care after stillbirth and 23.5% reported disrespectful care of their baby. Gestation less than 30 weeks and primiparity were associated with disrespect. Reported respectful care was lower in middle‐income countries than in high‐income countries (adjusted odds ratio 0.35, 95% CI 0.29–0.42, p < 0.01). In many countries, aspects of care quality need improvement, such as ensuring families have enough time with providers. Participating respondents from Latin America and southern Europe reported lower satisfaction across all aspects of care quality compared with northern Europe. Unmet need for memory‐making activities in middle‐income countries was high. Conclusions: Many parents experience disrespectful care around stillbirth. Provider training and system‐level support to address practical barriers are urgently needed. However, some practices (which are important to parents) can be readily implemented such as memory‐making activities and referring to the baby by name. One in four experience disrespectful care after stillbirth. Parents want more time with providers and their babies, to talk and memory‐make. One in four experience disrespectful care after stillbirth. Parents want more time with providers and their babies, to talk and memory‐make. Linked article: This article is commented on by Mehali Patel, pp. 1740 in this issue. To view this minicommentary visit https://doi.org/10.1111/1471-0528.17146. Linked article: This article is commented on by Susannah H. Leisher, pp. 1741‐1742 in this issue. To view this minicommentary visit https://doi.org/10.1111/1471-0528.17157. [ABSTRACT FROM AUTHOR]

Some childbearing women/birthing people prioritize out of maternity care organizational guidelines' approaches to childbirth as a way of optimizing their chances of a normal physiological birth. Currently, there is little known about the experiences of midwives who support their choices. To explore the experiences of UK midwives employed by the NHS, who self-defined as supportive of women's alternative physiological birthing choices. A narrative inquiry was used to collect and analyse professional stories of practice via self-written narratives and interviews. Forty-five midwives from across the UK were recruited. Three overarching storylines were developed with nine sub-themes. 'Stories of distress' highlights challenging experiences due to poor supportive working environments, ranging from small persistent challenges to extreme situations. Conversely, 'Stories of fulfilment' offers a positive counter-narrative where midwives worked in supportive working environments enabling woman-centred care unencumbered by organisational constraints. 'Stories of transition' abridge these two polarized themes. The midwives' experiences were mediated by their socio-cultural working contexts. Negative experiences were characterised by a misalignment between the midwives' philosophy and organisational cultures, with significant consequences for the midwives. Conversely, examples of good organisational culture and practice reveal that it is possible for organisations to fulfil their obligations for safe and positive maternity care for both childbearing women who make alternative birthing choices, and for attending staff. This highlights what is feasible and achievable within maternity organisations and offers transferable insights for organisational support of out-of-guideline care that can be adapted across the UK and beyond. [ABSTRACT FROM AUTHOR]

Abstract Background Having a companion of choice throughout childbirth is an important component of good quality and respectful maternity care for women and has become standard in many countries. However, there are only a few examples of birth companionship being implemented in government health systems in low-income countries. To learn if birth companionship was feasible, acceptable and led to improved quality of care in these settings, we implemented a pilot project using 9 intervention and 6 comparison sites (all government health facilities) in a rural region of Tanzania. Methods The pilot was developed and implemented in Kigoma, Tanzania between July 2016 and December 2018. Women delivering at intervention sites were given the choice of having a birth companion with them during childbirth. We evaluated the pilot with: (a) project data; (b) focus group discussions; (c) structured and semi-structured interviews; and (d) service statistics. Results More than 80% of women delivering at intervention sites had a birth companion who provided support during childbirth, including comforting women and staying by their side. Most women interviewed at intervention sites were very satisfied with having a companion during childbirth (96–99%). Most women at the intervention sites also reported that the presence of a companion improved their labor, delivery and postpartum experience (82–97%). Health providers also found companions very helpful because they assisted with their workload, alerted the provider about changes in the woman’s status, and provided emotional support to the woman. When comparing intervention and comparison sites, providers at intervention sites were significantly more likely to: respond to women who called for help (p = 0.003), interact in a friendly way (p

Abstract Background Provision of high-quality family planning (FP) services improves access to contraceptives. Negative experiences in maternal health have been documented worldwide and likely occur in other services including FP. This study aims to quantify disrespectful care for adult and adolescent women accessing FP in Malawi. Methods We used simulated clients (SCs) to measure disrespectful care in a census of public facilities in six districts of Malawi in 2018. SCs visited one provider in each of the 112 facilities: two SCs visits (one adult and one adolescent case scenario) or 224 SC visits total. We measured disrespectful care using a quantitative tool and field notes and report the prevalence and 95% confidence intervals for the indicators and by SC case scenarios contextualized with quotes from the field notes. Results Some SCs (12%) were refused care mostly because they did not agree to receive a HIV test or vaccination, or less commonly because the clinic was closed during operating hours. Over half (59%) of the visits did not have privacy. The SCs were not asked their contraceptive preference in 57% of the visits, 28% reported they were not greeted respectfully, and 20% reported interruptions. In 18% of the visits the SCs reported humiliation such as verbal abuse. Adults SCs received poorer counseling compared to the adolescent SCs with no other differences found. Conclusions We documented instances of refusal of care, lack of privacy, poor client centered care and humiliating treatment by providers. We recommend continued effort to improve quality of care with an emphasis on client treatment, regular quality assessments that include measurement of disrespectful care, and more research on practices to reduce it.

Abstract Background Focused antenatal care is the most significant and inclusive care given to pregnant women to promote and maintain the optimal health of the mother and the fetus. Providing respectful care during focused antenatal care is believed to be the most important cost-effective interventions to increase maternity service utilization. Therefore, this study was aimed to assess respectful focused antenatal care and associated factors among pregnant women who visit Shashemene town public hospitals, Oromia region, Ethiopia, 2019. Methods Institution-based cross-sectional study was conducted from July-August, 2019. A total of 423 pregnant mothers were selected using a systematic sampling technique. Data were collected using structured and pre-tested interviewer-administered questionnaires. Data entry and analysis were made using Epi Info version™ 7 and Statistical Package for Social Science (SPSS) version 24.0 respectively. Both bivariate and multivariate logistic regression analyses were used to identify associated factors. Statistical significance was declared at a p value of

Background: Postpartum haemorrhage (PPH) is one of the major complications of childbirth which may result in maternal morbidity and mortality, especially in low and middle-income countries like Nigeria. Midwives play a vital role in preventing and managing PPH in Nigerian rural communities. The aim of this study is to understand the experiences of midwives in rural maternity care settings in order to provide appropriate support and improve practice.Methods: An exploratory, qualitative study of a purposive sample of 15 practicing midwives was carried out using semi-structured interviews from November 2018 to February 2019. Data were transcribed verbatim and analyzed using content analysis.Results: Four themes were identified: 1. interventions for preventing PPH; 2. approaches to managing PPH; 3. challenges of preventing and managing PPH and 4. ways of supporting midwives to overcome these challenges in rural health care settings. Midwives employed various strategies, such as antenatal education, diagnosis and treatment of anaemia to counteract complications from possible PPH. Understanding PPH as a life-threatening condition enabled the midwives to provide holistic and effective management that sometimes involved a multidisciplinary team approach. Inadequate resources and delay in seeking health care, however, militate against their efforts. The midwives also identified the need for continuing education and training to enhance their standards of care.Conclusion: These midwives in Nigerian rural health care settings engage in preventive practices and active management of PPH though not without barriers, such as inadequate resources. There is a need for midwives in rural areas to have cultural competence, be provided with adequate resources and participate in ongoing education in order to be more effective. [ABSTRACT FROM AUTHOR]

Background: The COVID pandemic exposed many inadequacies in the maternity care system in the United States. Maternity care protocols put in place during this crisis often did not include input from childbearing people or follow prepandemic guidelines for high‐quality care. Departure from standard maternity care practices led to unfavorable and traumatic experiences for childbearing people. This study aimed to identify what childbearing people needed to achieve a positive birth experience during the pandemic. Methods: This mixed‐methods, cross‐sectional study was conducted among individuals who gave birth during the COVID pandemic from 3/1/2020 to 11/1/2020. Participants were sampled via a Web‐based questionnaire that was distributed nationally. Descriptive and bivariate statistics were analyzed. Thematic and content analyses of qualitative data were based on narrative information provided by participants. Qualitative and convergent quantitative data were reported. Results: Participants (n = 707) from 46 states and the District of Columbia completed the questionnaire with 394 contributing qualitative data about their experiences. Qualitative findings reflected women's priorities for (a) the option of community birth, (b) access to midwives, (c) the right to an advocate at birth, and (d) the need for transparent and affirming communication. Quantitative data reinforced these findings. Participants with a midwife provider felt significantly better informed. Those who gave birth in a community setting (at home or in a freestanding birth center) also reported significantly higher satisfaction and felt better informed. Participants of color (BIPOC) were significantly less satisfied and more stressed while pregnant and giving birth during the pandemic. Conclusions: High‐quality maternity care places childbearing people at the center of care. Prioritizing the needs of childbearing people, in COVID times or otherwise, is critical for improving their experiences and delivering efficacious and safe care. [ABSTRACT FROM AUTHOR]

Amanuel Yosef, Adane Kebede, Nigusu Worku Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, EthiopiaCorrespondence: Nigusu WorkuUniversity of Gondar, P.O. Box 196, Gondar, EthiopiaEmail nigusuworku29@gmail.comBackground: Disrespectful and abusive care is a violation of women rights to self-determination, health, life, body integrity, and privacy. Providing respectful maternity care (RMC) during labour and delivery is one of the enhancing factors and targets in the Ethiopian health sector strategic plan to promote facility delivery. However, providing respectful maternity care is still a major challenge in the Ethiopia health-care system. This study aimed to assess respectful maternity care and associated factors among women who attended delivery services in Northwest Amhara, referral hospitals, Ethiopia.Methods: Health-facility-based cross-sectional study was conducted at Northwest Amhara, referral hospitals from March 1 to April 1, 2020. A systematic random sampling technique was used to identify study participants in the referral hospitals. A total of 410 women who gave birth were enrolled in the study. A pre-tested and structured questionnaire was used for data collection. The data were collected during the exit interview. Data were cleaned and entered into Epi data version 3.1 and exported to SPSS version 23 for further analysis. Both bi-variable and multi-variable logistic regressions were employed in the analysis. Variables with a p-value of less than 0.05 were used to declare as statistically significantly associated with the dependent variable.Results: The overall magnitude of women who have received respectful maternity care was 56.3%. Four and above antenatal care follow-up adjusted odds ratio (AOR) 3.092 (95% CI: 1.676, 5.725), previous history of facility delivery AOR 2.53 (95% CI: 1.094, 5.867), and delivery time AOR 2.46 (95% CI: 1.349, 4.482) were found significantly associated with respectful maternity care.Conclusion: The overall magnitude of respectful maternity care was low as compared to international and national standards. This study showed that respectful maternity care among women who gave birth was influenced by the number of antenatal care visits, previous history of facility delivery, and delivery time.Keywords: respectful care, maternity, delivery service, northwest Amhara, Ethiopia

Abstract Background South Sudan has one of the highest maternal mortality ratios in the world, at 789 deaths per 100,000 live births. The majority of these deaths are due to complications during labor and delivery. Institutional delivery under the care of skilled attendants is a proven, effective intervention to avert some deaths. The aim was to determine the prevalence and explore the factors that affect utilization of health facilities for routine delivery and postnatal care in Torit County, South Sudan. Methods A convergent parallel mixed method design combined a community survey among women who had delivered in the previous 12 months selected through a multistage sampling technique (n = 418) with an exploratory descriptive qualitative study. Interviews (n = 19) were conducted with policymakers, staff from non-governmental organizations and health workers. Focus group discussions (n = 12) were conducted among men and women within the communities. Bivariate and multivariate logistic regression were conducted to determine independent factors associated with institutional delivery. Thematic analysis was undertaken for the qualitative data. Results Of 418 participants who had delivered in the previous 12 months, 27.7% had institutional deliveries and 22.5% attended postnatal care at least once within 42 days following delivery. Four or more antenatal care visits increased institutional delivery 5 times (p

Objective: To describe perceptions of supportive factors for reducing the risk of maternal mortality among women with substance use disorders (SUDs) in a rural setting., Design: Qualitative descriptive design., Setting/local Problem: Participants were recruited from a rural setting in a U.S. Midwest state where rates of maternal substance use and maternal mortality are high., Participants: Sixteen participants were recruited from a maternal residential substance use treatment center., Intervention/measurements: Semistructured interviews were used during which participants described their perceptions of maternal mortality and their related experiences. We analyzed the transcribed interviews using a basic inductive content analysis to yield themes and subthemes., Results: We identified three main themes: Social Networks, Respectful Perinatal Care, and Residential Substance Use Treatment., Conclusion: Our findings suggest that nurses and other health care providers should be knowledgeable of resources to increase the social networks of women with SUD, recognize and manage the biases and judgments they may hold against women with SUD, and advocate for and refer women with SUD to residential substance use treatment., (Copyright © 2024 AWHONN. Published by Elsevier Inc. All rights reserved.)