Respectful care during childbirth in health facilities globally: a qualitative evidence synthesis

BackgroundWhat constitutes respectful maternity care (RMC) operationally in research and programme implementation is often variable. ObjectivesTo develop a conceptualisation of RMC. Search strategyKey databases, including PubMed, CINAHL, EMBASE, Global Health Library, grey literature, and reference lists of relevant studies. Selection criteriaPrimary qualitative studies focusing on care occurring during labour, childbirth, and/or immediately postpartum in health facilities, without any restrictions on locations or publication date. Data collection and analysisA combined inductive and deductive approach was used to synthesise the data; the GRADE CERQual approach was used to assess the level of confidence in review findings. Main resultsSixty-seven studies from 32 countries met our inclusion criteria. Twelve domains of RMC were synthesised: being free from harm and mistreatment; maintaining privacy and confidentiality; preserving women's dignity; prospective provision of information and seeking of informed consent; ensuring continuous access to family and community support; enhancing quality of physical environment and resources; providing equitable maternity care; engaging with effective communication; respecting women's choices that strengthen their capabilities to give birth; availability of competent and motivated human resources; provision of efficient and effective care; and continuity of care. Globally, women's perspectives of what constitutes RMC are quite consistent. ConclusionsThis review presents an evidence-based typology of RMC in health facilities globally, and demonstrates that the concept is broader than a reduction of disrespectful care or mistreatment of women during childbirth. Innovative approaches should be developed and tested to integrate RMC as a routine component of quality maternal and newborn care programmes. Tweetable abstractUnderstanding respectful maternity care - synthesis of evidence from 67 qualitative studies. Tweetable abstract Understanding respectful maternity care - synthesis of evidence from 67 qualitative studies.