Respectful maternity care in Israel during the Covid-19 pandemic: a cross-sectional study of associations between childbirth care practices and women’s perceptions of care

Exposure to disrespectful maternity care and perceptions of respectful maternity care among nursing and midwifery pre-registration students in China: A national cross-sectional study

Effects of empathy on the perspectives of respectful and disrespectful maternity care among nursing and midwifery students in China: A cross-sectional study.

IntroductionRespectful maternity care (RMC) is fundamental to women’s and families’ experience of care and their decision about where to give birth. Studies from multiple countries describe the mistreatment of women during facility-based childbirth, though only a small number of studies from Guatemala have been published. Less information is available on women’s negative and positive experiences of childbirth care and health workers’ perceptions and experiences of providing maternity care.MethodsAs part of a program implemented in the Western Highlands of Guatemala to improve quality of reproductive maternal newborn and child health care, a mixed methods assessment was conducted in three hospitals and surrounding areas to understand women’s and health workers’ experience and perceptions of maternity care. The quantitative component included a survey of 31 maternity health workers and 140 women who had recently given birth in these hospitals. The qualitative component included in-depth interviews (IDIs) and focus group discussions (FGDs) with women and maternity health workers and managers.ResultsWomen reported a mix of positive and negative experiences of childbirth care related to interpersonal and health system factors. 81% of surveyed women reported that health workers had treated them with respect while 21.4% of women reported verbal abuse. Fifty-five percent and 12% of women, respectively, reported not having access to a private toilet and bath or shower. During IDIs and FGDs, many women described higher rates of verbal abuse directed at women who do not speak Spanish. A regression analysis of survey results indicated that speaking Ixil or K’iche at home was associated with a higher likelihood of women being treated negatively during childbirth in a facility. Health worker survey results corroborated negative aspects of care described by women and also reported mistreatment of health workers by clients and families (70.9%) and colleagues (48.2%).ConclusionsThis study adds to the literature on women’s experience of institutional childbirth and factors that influence this experience by triangulating experience and perceptions of both women and health workers. This assessment highlights opportunities to address mistreatment of both women and health workers and to build on positive care attributes to strengthen RMC for all women.

The World Health Organization has recommended intrapartum care for a positive childbirth experience through respectful care based on women-centered care. This study aimed to explore women's experiences of facility-based childbirth to gain insights into their perceptions of women-centered care, including humanized childbirth and respectful maternity care during intrapartum care. Used the Joanna Briggs Institute method as the framework for this meta-synthesis, we searched the PubMed, EMBASE, CINAHL, PsycINFO, and LILCAS databases, and included qualitative studies and interviews of women's experiences and perceptions of women-centered care during facility-based childbirth published from 1990 to 2020 in English. Study quality was assessed using the Critical Appraisal Skills Programme checklist. NVivo software was used for data extraction and synthesis. There were 22 studies from 19 countries that met the established inclusion criteria. Five categories of experiences of facility-based childbirth and perceptions of women-centered care from the synthesized voices of women were generated: (i) value of women through childbirth; (ii) overwhelmed by unpleasant childbearing experiences; (iii) a sense of being respected and valued; (iv) a sense of being disrespected and abused; and (v) inadequate systems and resources. Our meta-synthesis indicated that respectful and helpful interaction between women and healthcare providers produced positive perceptions among women. This study emphasizes the importance of respectful interactions and intrapersonal experiences. Strong systems and positive environments lead to positive interactions between women and healthcare providers. Future studies need to consider cultural and economic differences in women-centered care and respectful care for childbirth in different contexts.

BackgroundDespite recognition of the adverse impacts of the mistreatment of women during pregnancy, labour and birth, there remains limited evidence on interventions that could reduce mistreatment and build a culture of respectful maternity care (RMC) in health facilities. The sustainability of effective individual interventions and their adaptability to various global contexts remain uncertain. In this systematic review, we aimed to synthesise the best available evidence that has been shown to be effective in reducing the mistreatment of women and/or enhancing RMC during women’s maternity care in health facilities.MethodsWe searched the online databases PubMed, CINAHL, EBSCO Nursing/Academic Edition, Embase, African Journals Online (AJOL), Scopus, Web of Science, and grey literature using predetermined search strategies. We included cluster randomized controlled trials (RCTs) and pre-and-post observational studies and appraised them using JBI critical appraisal checklists. The findings were synthesised narratively without conducting a meta-analysis. The certainty of evidence was assessed using GRADE criteria.ResultsFrom the 1493 identified records, 11 studies from six sub-Sahara African countries and one study from India were included: three cluster RCTs and nine pre- and post-studies. We identified diverse interventions implemented via various approaches including individual health care providers, health systems, and policy amendments. Moderate certainty evidence from two cluster RCTs and four pre- and post-studies suggests that multi-component interventions can reduce the odds of mistreatment that women may experience in health facilities, with odds of reduction ranging from 18 per cent to 66 per cent. Similarly, women’s perceptions of maternity care as respectful increased in moderate certainty evidence from two cluster RCTs and five pre- and post-studies with reported increases ranging from 5 per cent to 50 per cent.ConclusionsMulti-component interventions that address attitudes and behaviors of health care providers, motivate staff, engage the local community, and alleviate health facility and system constraints have been found to effectively reduce mistreatment of women and/or increase respectful maternity care. Such interventions which go beyond a single focus like staff training appear to be more likely to bring about change. Therefore, future interventions should consider diverse approaches that incorporate these components to improve maternal care.

IntroductionDespite the existing reports on mistreatment and disrespectful maternal care, few studies have investigated interventions to mitigate this issue. The present study aims to assess the impact of consulting midwives on maternal rights charter on perception of respectful maternity care and postpartum blues among postpartum women in two hospitals in southern Iran.MethodologyThis quasi-experimental study was conducted on 437 postpartum women (217 mothers before the intervention and 220 mothers after the intervention) and 44 midwives working in the maternity ward of two hospitals affiliated to Bushehr University of Medical Sciences in 2023–2024. The hospitals were randomly divided into control and intervention groups. The mothers and midwives were selected using convenience and census sampling methods, respectively. Initially, the first sampling phase of postpartum women was conducted. Then, midwives in the intervention group received consultation on patient rights charter in groups of 3–4 individuals over three sessions. After the intervention, the second phase of sampling of postpartum women was conducted. Data collection tools included questionnaires assessing women’s perception of respectful maternity care and postpartum blues. The data were analyzed using descriptive and analytical statistical tests in SPSS 20.0.ResultsAfter performing the intervention on midwives, the mean score of postpartum respectful maternity care from the perspectives of the mothers in the intervention and control hospitals were 91.08 ± 5.51 and 68.34 ± 10.81 respectively (P < 0.001). Also, the mean scores of postpartum blues in the intervention and control hospitals were 12.88 ± 4.66 and 14.85 ± 5.94 respectively (P = 0.007). Multivariable linear regression analysis revealed that consulting with midwives regarding the Maternal Rights Charter, led to an increase in respectful maternity care (β coefficient = 0.780, 95% C.I. = 19.796). ~ 24.541) and decreased postpartum blues (β coefficient = -0.172, 95% C.I. = -3.318 ~ -0.390) from the perspectives of the mothers.ConclusionConsulting midwives on patient rights charter was positively correlated with mothers’ perception of respectful maternity care and negatively correlated with postpartum blues, indicating the positive effect of intervention on increasing women’s satisfaction and reducing postpartum blues. It is recommended that this consultation be included in midwives’ continuing education programs.Clinical trial numberNot applicable.

BackgroundThe interest of the global community in improving women’s experiences with childbirth has led to interventions such as facility-based childbirth and the use of skilled birth attendants. However, reports of low facility and skilled birth attendants use continue to exist in literature because of disrespectful and abusive care directed at women during childbirth.The present systematic review examined the question “What are the understanding and justification for disrespect and abuse directed at women by Health Professionals during childbirth or intrapartum care?” MethodsElectronic search was conducted from January 2000 to January 2021 across CINAHL, OVID, PUBMED, PSYINFO databases. The retrieved studies were then filtered through a stringent inclusion and exclusion criteria. Thirteen studies were included in this review; extracted and synthesized using Thomas and Harden’s (2008) thematic synthesis method. ResultsThree key themes were identified- providers related factors, women related factors, health system related factors. Sub-themes included classification and description, authority and control, reciprocity, providers attitude, rationalization, socio-economic inequalities, lack of assertiveness and inadequate resources. ConclusionThe study demonstrated that HPs were aware and understood the various forms of D&AC. However, they provided justifications such as an act to save mother and baby’s life, lack of assertiveness from labouring women and inadequate work resources for their actions. This highlights the need for various stakeholders involved in care during childbirth to reignite commitments to international standards on respectful maternity care and patient safety, such as training of staff and education of women on the process of labour and birth.

Background Respectful care during childbirth has been described as “a universal human right that encompasses the principles of ethics and respect for women's feelings, dignity, choices, and preferences.” Many women experience a lack of respectful and abusive care during childbirth across the globe. Objective This study aimed to determine women's perception of respectful maternity care (RMC) during facility-based childbirth. Method A descriptive cross-sectional study was conducted among 150 mothers admitted to the maternity ward of Nepal Medical College and Teaching Hospital using a purposive sampling technique. Data were collected through an interview technique by using a validated tool containing 15 items each measured on a scale of 5. Statistical Package for Social Science (SPSS) version 16 was used for data analysis. Frequency, percentage, mean score, standard deviation, chi-square test, and binary logistic regression were used to analyze descriptive and inferential statistics. Results In total, 84.7% of the women reported that they have experienced overall RMC services with a mean score ± SD (61.70 ± 12.12). Though the majority of the women reported that they have experienced RMC services, they also revealed that they have experienced disrespectful care in various forms such as being shouted upon (30.0%), being slapped (18.7%), delayed service provision (22.7%), and not talking positively about pain and relief during childbirth (28.0%). Likewise, length of stay, parity, and time of delivery were found as factors that influenced friendly care (COR = 0.383, 95% CI: 0.157–0.934), abuse-free care (COR = 3.663, 95% CI: 1.607–8.349), and timely care (COR = 2.050, 95% CI: 1.031–4.076) dimensions of RMC, respectively. Conclusion Even though RMC emphasizes eliminating disrespectful and abusive environment from health facilities, 15.0% of participants perceived that they have not experienced overall RMC services. So, the health facility should focus on the interventions which ensure that every woman receives this basic human dignity during one of the most vulnerable times in their lives.

An increasing body of evidence has revealed disrespectful and abusive care in facility-based childbirth as a barrier to maternal and child health. Providers have noted subpar work environments, inadequate staffing, and negative attitudes toward marginalized groups as barriers to respectful care. What has not been studied is the impact of disaster and violence on the delivery of respectful maternity care. The purpose of this study was to evaluate the state of obstetrical care in a maternity hospital in Odessa, Ukraine during a time of military invasion. We surveyed 202 maternity care providers who have worked at Odessa City Maternity Hospital № 5 for at least one year. Measurements and topics covered in the questionnaires included respectful care practices performed; types of disrespectful behaviors witnessed; the impact of war on the provision of respectful maternity care; post-traumatic stress; and attitudes about consent in obstetriccare. Fifty percent of respondents believed disrespect was an issue in the field of obstetrics. A slight majority (55.0 %) reported that the frequency of disrespect and abuse remained the same before and after the invasion, while 32.2 % reported a lower frequency and 9.4 % reported a higher frequency of disrespect. There was little change in reported performance of respectful maternity care before and after the full-scale invasion. Reported effects of war on respectful maternity care were minimal. However, the relatively low knowledge of disrespect and the large spread of frequency of reported respectful behavior indicate an opportunity for training.

The need to provide woman-centred maternity services which take account of womens' views and specifically address their need for choice, control and continuity has been advocated and team midwifery has been suggested as one of the ways to achieve these objectives. This paper explores women's descriptions of their maternity care experiences in England, specifically focusing on: their experiences of communication; being informed and making choices; being involved in the process of care; and their own perceptions of care. It is suggested that the midwife-woman relationship is an important aspect of satisfaction which needs greater recognition. Analysis of the data highlighted the importance of the quality of women's relationships with caregivers. Findings revealed how positive relationships facilitated conditions which influenced satisfaction with care and suggest that, for the development of genuine woman-centred services where women exercise informed choice, and are involved in, and have some control over, the process of care, the nature and quality of the midwife-woman relationship must be accepted as an integral and crucial aspect of the service.

: Introduction: One major threat to achieving the Sustainable Development Goals is the refusal of about one-third of pregnant and postpartum women to access maternity care from health facilities. Evidence suggests that women who do not access maternity care have reported to have experienced or witnessed disrespectful maternity care at health facilities. The aim of this study is to investigate the knowledge, perception and challenges of promoting respectful maternity care by midwives. Method: A descriptive cross-sectional study was carried out in 6 selected government hospitals in FCT. A stratified random sampling technique was used in classifying FCT into 6 strata. The hospitals were selected using simple random sampling from each stratum. Then, the Purposive Non-probability sampling technique was used to select 112 midwives working in the maternity units at the study hospitals. Data were collected using a well-structured questionnaire. Results: The percentage of midwives that expressed knowledge of respectful maternity care and its components is 84.6%. 71.2% expressed positive perceptions of respectful maternity care. 58.4% identified challenges related to promotion of respectful maternity care. The average percentage of respondents acknowledging the prospects and opportunities for promoting respectful maternity care is 89.6%. Conclusion: Midwives generally exhibit a positive attitude towards respectful maternity care. A significant proportion of midwives have undergone training on RMC, possess a deep understanding of its key components, and feel confident in their ability to apply the principles of respectful care in their daily practice. However, despite this positive outlook, challenges persist in the provision of respectful maternity care.

PurposeUnderstanding the contextualized perspectives of stakeholders involved in maternal health care is critical to promoting respectful maternity care. This study explored maternal, provider, institutional, community, and policy level drivers of disrespectful maternity care in Southeast Nigeria. This study also identified multi-stakeholder perspectives on solutions to implementing respectful maternity care in health facilities.Materials and MethodsThis was a mixed-methods cross-sectional study conducted in two urban cities of Ebonyi State, South-eastern Nigeria. Data were collected using semi-structured questionnaires, focus group discussions, and key informant interviews with mothers, providers, senior facility obstetric decision-makers, ministry of health policymaker, and community members. Quantitative data and qualitative data were analysed using SPSS version 20 and manual thematic analysis, respectively.ResultsMaternal level drivers were poor antenatal clinic attendance, uncooperative clients, non-provision of birthing materials, and low awareness of rights. Provider factors included work overload/stress, training gaps, desire for good obstetric outcome, under-remuneration and under-appreciation. Institutional drivers were poor work environments including poorly designed wards for privacy, stressful hospital protocols, and non-provision of work equipment. Community-level drivers were poor female autonomy, empowerment, and normalization of disrespect and abuse during childbirth. The absence of targeted policies and the high cost of maternal health services were identified as policy-related drivers.ConclusionA variety of multi-level drivers of disrespectful maternity care were identified. A diverse and inclusive multi-stakeholder approach should underline efforts to mitigate disrespectful maternity care and promote respectful, equitable, and quality maternal health care.

This systematic review aimed to critique the process of development and psychometric properties of tools measuring respectful or disrespectful maternity care experienced by women during labor and birth in low- and middle-income countries. The MEDLINE, Embase, CINAHL, Web of Science, PubMed, and Cochrane Library electronic databases were systematically searched from their inception to February 2020. Methodological quality was assessed using the COnsensus-based Standards for the selection of health Measurement INstruments checklist. Six tools measuring respectful maternity care during the intrapartum period were identified. Measurement error, cross-cultural validity, and responsiveness were not evaluated by any tool developers, while structural validity, internal consistency, and hypothesis testing were the most frequently assessed measurement properties. Interestingly, this review could not identify any measures of disrespectful care even though most included measures focused on disrespect and abuse. No measure was of sufficient quality to determine women's experiences of disrespectful and respectful maternity care in low- and middle-income countries. New valid and reliable measures using rigorous approaches to tool development are required.

ObjectiveThe purpose of this qualitative study was to explore clients’ and midwives’ perceptions of compassionate and respectful care during facility-based delivery in Bishoftu District, the regional state of Oromia, Ethiopia.SettingPublic...

BackgroundDisrespect and abuse (D&A) during facility-based births remains widespread in low- and middle-income countries (LMICs). This disproportionately impacts women from marginalized social strata. Respectful Maternity Care (RMC), as articulated in the 2014 World Health Organization (WHO) statement, constitutes both a fundamental human right and a quality care imperative. However, women’s experiences of RMC are not uniform and are influenced by intersecting social identities such as caste, class, ethnicity, age, disability, marital status, language, literacy, and migrant status.ObjectivesThis review aimed to (1) quantify and compare the prevalence of disrespect and abuse (D&A) across social subgroups in LMICs; (2) identify social and systemic determinants such as poverty, education, migration status, and provider bias, that influence women’s experiences of respectful or disrespectful maternity care; (3) synthesize qualitative insights to understand how intersecting identities shape women’s childbirth experiences; and (4) develop a conceptual model explaining how identity factors and health‑system level drivers interact to produce inequities.MethodsWe conducted a systematic review following PRISMA guidelines. We synthesized literature on intersectional experiences of RMC and D&A in LMICs. Searches spanned five databases and key grey literature sources. The data extraction was finalized in April 2025. Eligible studies were published between 2014 (coinciding with the release of the WHO RMC statement) and 2025. Eligible studies included peer-reviewed primary research and high-quality systematic or scoping reviews that provided identity-disaggregated evidence on respectful or disrespectful maternity care in facility-based childbirth settings in LMICs. A thematic narrative synthesis integrated quantitative and qualitative findings. .ResultsSeventeen studies across 15 LMICs were included. Women with intersecting vulnerabilities, especially those who were young, impoverished, unmarried, disabled, lower caste/ethnic minority backgrounds, or migrants, were consistently more susceptible to experience neglect, non-consented care, verbal abuse, or exclusion from decision-making processes. These patterns indicate systemic injustices rather than individual occurrences. Key explanatory mechanisms included social stigma, provider biases about who is “deserving” of care, and communication obstacles. Disability, migration status, socio-economic status, and religion were under-explored in the literature despite being linked to discrimination.ConclusionThis review highlights that intersectional inequities substantially influence women’s experiences of respectful maternity care in LMICs. However, causal inference is limited by study heterogeneity and uneven representation of identity factors.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12884-025-08566-0.