Beyond the Delivery Room: Why Respectful Maternity Care Matters
"New research reveals gaps in person-centered maternity care in low-income countries, highlighting the need for dignity and respect during childbirth."
Childbirth should be a moment of joy and empowerment, but for many women in low-income countries, it's marred by disrespect, abuse, and neglect within healthcare facilities. While skilled care during childbirth is critical for preventing maternal deaths, a new study reveals that quality care extends far beyond medical expertise. It emphasizes the urgent need for 'person-centered maternity care' (PCMC)—care that is respectful, responsive, and tailored to the individual needs and values of each woman.
Previous research has largely focused on documenting instances of mistreatment. This latest study, published in The Lancet Global Health, takes a broader approach by measuring PCMC across four different settings in Kenya, Ghana, and India. The findings paint a concerning picture: women are consistently missing out on essential elements of respectful and supportive care during childbirth, regardless of the setting.
This article explores the key findings of this important study, highlighting specific gaps in PCMC and what can be done to ensure that every woman experiences a safe and dignified childbirth.
Why Respectful Care Matters
Respectful maternity care places dignity, communication, equity, and patient participation alongside clinical safety. Its impact may include stronger relationships between patients and providers, greater satisfaction with birth experiences, and increased trust in health systems. However, the scale of these effects varies across settings, and broader evidence is still developing.
Promise and Measurement Gaps
Respectful maternity care is described as a rational, person-centered approach intended to improve equitable intrapartum and postpartum care. Research cited by the National Center for Biotechnology Information and the National Institute for Children’s Health Quality links respectful care with stronger patient-provider relationships, better clinical outcomes, higher birth satisfaction, and increased trust in health systems. Yet RMC lacks a standard definition and clear measurement method, while evidence remains insufficient on whether implementation strategies improve maternal or infant health outcomes.
From Recognition to Accountability
The history of respectful maternity care reflects a growing effort to place respect, dignity, and accountability within maternal and newborn health. A major milestone was the 2014 WHO statement on preventing and eliminating disrespect and abuse during childbirth; the WHO compendium published in 2025 marked 10 years since that statement. Historical accounts also suggest that understanding this development can inform policies and guidance, particularly for populations disproportionately affected by disrespectful care.
What Does Disrespectful Maternity Care Look Like?
The study, which involved over 3,600 women, used a validated scale to assess PCMC across three key domains: dignity and respect, communication and autonomy, and supportive care. While the average PCMC scores varied across the study sites, the lowest scores consistently fell within communication and autonomy. This suggests a systemic failure to involve women in decisions about their care and treat them with basic courtesy.
- Lack of Introduction: A staggering 90% of women across all countries reported that healthcare providers never introduced themselves.
- No Permission for Procedures: In India, 73% of women said providers never asked permission before performing medical procedures.
- Unexplained Procedures: Over 60% of women in Ghana and India reported that providers did not explain the purpose of examinations or procedures.
- Medication Without Explanation: Nearly 60% of women in India were given medications without any explanation.
- Inability to Ask Questions: Over half of women in Ghana felt unable to ask questions about their care.
- Verbal and Physical Abuse: While less prevalent, 16% of women reported verbal abuse, and 3% reported physical abuse.
An Evolving Evidence Base
Recent research continues to examine how respectful maternity care is defined, measured, and implemented. The evidence base appears promising but remains uneven, particularly regarding which strategies reliably improve maternal and infant outcomes. Future reviews will need to clarify effective approaches across different care settings and populations.
Systemic Barriers and Provider Perspectives
Critiques of respectful maternity care must be considered alongside the broader U.S. maternal health crisis, including barriers to healthcare access and unequal health outcomes. A systematic review of healthcare providers’ perceptions emphasizes that providers hold important insights into respectful and disrespectful care during childbirth. These perspectives suggest that failures may reflect both patient-facing practices and wider conditions affecting the delivery of maternity services.
Care Across Contexts
The WHO’s 2025 compendium is designed to support practical implementation of respectful maternal and newborn care across different contexts. Evidence from low- and middle-income countries indicates a direct association between income and maternity care, with care described as substandard compared with high-income countries. At the same time, evidence for medical tools that can enhance respectful maternity care remains sparse, reinforcing the need for context-sensitive research and practice frameworks.
The Path Forward: Towards Respectful and Responsive Maternity Care
The study's authors emphasize that simply preventing abuse is not enough. True person-centered care requires a proactive approach to ensuring dignity, respect, and open communication throughout the childbirth process. This includes simple yet impactful steps such as introducing oneself, explaining procedures, and actively involving women in decision-making.
Respect as a Safety Principle
Current scholarship treats respectful maternity care as a contributor to high-quality and safe care, including for marginalized patient populations. Research is examining how RMC is defined, measured, and implemented, while provider-focused studies are exploring perspectives on care for Black patients in hospitals, clinics, and birth centers. Interpretation remains shaped by researchers’ lived experiences and by persistent gaps in evidence about effective implementation.
Building Better Evidence
The next phase of respectful maternity care will likely focus on developing clearer definitions, reliable measures, and practical implementation strategies. Research may also need to test how these approaches work across different health systems and communities. Progress will depend on connecting patient experience with clinical quality and accountability.
Care Within Larger Systems
WHO reports that mistreatment may arise from broader working environments and policy structures, with health workers themselves often under systemic pressure. Its 2025 global guide gathers evidence, practical tools, and actions for strengthening respectful care across the full range of maternal and newborn services. Other research argues that respectful maternity care must be paired with broader socioeconomic improvements to reduce postpartum mental health inequities, while recent commentary characterizes disrespect, neglect, and abuse as signs of deeper systemic failures that compromise rights and dignity.
Dignity in Practice
Respectful maternity care matters because pregnancy and childbirth involve both clinical needs and deeply personal experiences. Care that recognizes dignity, communication, and individual preferences can shape how patients understand and remember their care. Its real-world value ultimately depends on whether these principles are consistently reflected in everyday interactions.
To create meaningful change, the researchers recommend:
Healthcare providers must be trained on the importance of PCMC, patient rights, and effective communication strategies. Clear measurement and accountability mechanisms are needed to reinforce PCMC practices. Ultimately, improving maternity care requires a comprehensive approach that strengthens healthcare systems and empowers women to demand respectful and responsive care.