Abstract
Background: Globally, substantial health inequities exist with regard to maternal, newborn and reproductive health. Lack of access to good quality care-across its many dimensions-is a key factor driving these inequities. Significant global efforts have been made towards improving the quality of care within facilities for maternal and reproductive health. However, one critically overlooked aspect of quality improvement activities is person-centered care. Main body: The objective of this paper is to review existing literature and theories related to person-centered reproductive health care to develop a framework for improving the quality of reproductive health, particularly in low and middle-income countries. This paper proposes the Person-Centered Care Framework for Reproductive Health Equity, which describes three levels of interdependent contexts for women's reproductive health: societal and community determinants of health equity, women's health-seeking behaviors, and the quality of care within the walls of the facility. It lays out eight domains of person-centered care for maternal and reproductive health. Conclusions: Person-centered care has been shown to improve outcomes; yet, there is no consensus on definitions and measures in the area of women's reproductive health care. The proposed Framework reviews essential aspects of person-centered reproductive health care.
Highlights
Every day, 830 women die from preventable causes related to pregnancy and childbirth, with 99% of all deaths occurring in low and middle-income countries (LMICs)[1]
The objective of this paper is to review theories related to person-centered reproductive health care (PCRHC), and to develop a framework as it relates to improving the quality of reproductive health, in LMICs
This paper proposes a new framework called the “Person-Centered Care Framework for Reproductive Health Equity” that lays out the dimensions of person-centered care (PCC) and the ways in which it links with clinical quality of care in facilities and broader factors at the community and national level
Summary
830 women die from preventable causes related to pregnancy and childbirth, with 99% of all deaths occurring in low and middle-income countries (LMICs)[1]. Addressing the social and cultural determinants of health is important in eliminating health inequities—the systematic differences in health status of different population groups that are avoidable or unnecessary[41] While these frameworks are useful in understanding quality of care, they neglect how women may experience differential treatment based on their social status, influences of communities, and more distal factors, such as gender and violence norms and women’s roles in society. In settings where women have low status in the household or community, or there is societal acceptance of differential treatment or discrimination based on socio-economic status, such as racial/ ethnic minority groups or social statuses, it is possible that there is more normative acceptance of poor treatment of women in the health facility These determinants of health equity influence women’s healthseeking behaviors, including expectations of and decision to seek care. Women’s experiences of care, whether positive or negative, will be fed back to their sisters, neighbors, daughters, and friends, influencing community perceptions of facilities, expectations of care, and whether a woman chooses to go to a facility or not[53]
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