Focusing on what works for person-centred maternity care

Abstract

Background Several qualitative studies have described disrespectful, abusive, and neglectful treatment of women
during facility-based childbirth, but few studies document the extent of person-centred maternity care (PCMC)—ie,
responsive and respectful maternity care—in low-income and middle-income countries. In this Article, we present
descriptive statistics on PCMC in four settings across three low-income and middle-income countries, and we
examine key factors associated with PCMC in each setting.

Methods We examined data from four cross-sectional surveys with 3625 women aged 15–49 years who had recently
given birth in Kenya, Ghana, and India (surveys were done from August, 2016, to October, 2017). The Kenya data were
collected from a rural county (n=877) and from seven health facilities in two urban counties (n=530); the Ghana data
were from five rural health facilities in the northern region (n=200); and the India data were from 40 health facilities
in Uttar Pradesh (n=2018). The PCMC measure used was a previously validated scale with subscales for dignity and
respect, communication and autonomy, and supportive care. We analysed the data using descriptive statistics and
bivariate and multivariate regressions to examine predictors of PCMC.

Findings The highest mean PCMC score was found in urban Kenya (60·2 [SD 12·3] out of 90), and the lowest in rural
Ghana (46·5 [6·9]). Across sites, the lowest scores were in communication and autonomy (from 8·3 [3.3] out of 27 in
Ghana to 15·1 [5·9] in urban Kenya). 3280 (90%) of the total 3625 women across all countries reported that providers
never introduced themselves, and 2076 (57%) women (1475 [73%] of 1980 in India) reported providers never asked
permission before performing medical procedures. 120 (60%) of 200 women in Ghana and 1393 (69%) of 1980 women
in India reported that providers did not explain the purpose of examinations or procedures, and 116 (58%) women in
Ghana and 1162 (58%) in India reported they did not receive explanations on medications they were given; additionally,
104 (52%) women in Ghana did not feel able to ask questions. Overall, 576 (16%) women across all countries reported
verbal abuse, and 108 (3%) reported physical abuse. PCMC varied by socioeconomic status and type of facility in three
settings (ie, rural and urban Kenya, and India).

Interpretation Regardless of the setting, women are not getting adequate PCMC. Efforts are needed to improve the
quality of facility-based maternity care.