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

BJOG. 2018 Jul;125(8):932-942. doi: 10.1111/1471-0528.15015. Epub 2017 Dec 8.


Background: What constitutes respectful maternity care (RMC) operationally in research and programme implementation is often variable.

Objectives: To develop a conceptualisation of RMC.

Search strategy: Key databases, including PubMed, CINAHL, EMBASE, Global Health Library, grey literature, and reference lists of relevant studies.

Selection criteria: Primary 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 analysis: A 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 results: Sixty-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.

Conclusions: This 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 abstract: Understanding respectful maternity care - synthesis of evidence from 67 qualitative studies.

Keywords: Childbirth; dignity; disrespect and abuse; health facility; hesis; qualitative evidence synt; respectful maternity care.

Publication types

  • Systematic Review

MeSH terms

  • Delivery, Obstetric / psychology*
  • Delivery, Obstetric / standards
  • Female
  • Health Facilities / standards*
  • Humans
  • Maternal Health Services / standards
  • Parturition / psychology*
  • Patient Acceptance of Health Care / psychology*
  • Pregnancy
  • Qualitative Research
  • Quality of Health Care
  • Respect*