Carolyn Smith Hughes

UC San Francisco

“Respectful maternity care (RMC) reporting among health care providers in Malawi”

Over the past decade, there has been increased attention on disrespect, abuse, and neglect in childbirth, and development of interventions to improve experience and quality of care. However, most studies focus solely on women’s perspectives. In our study, we describe self-reported provision of respectful maternity care (RMC) among health care providers in Malawi and identify areas to improve quality of care. We surveyed health workers (n=288) in 25 birth facilities in Malawi. Providers were interviewed to assess their knowledge and experiences regarding maternity care, including provision of RMC. We then used multilevel mixed-effects modeling to develop predictive models for RMC. While self-reported physical and verbal abuse was low, measures related to communication, autonomy, and supportive care indicate opportunities to improve how providers engage with and respond to women. Associations between RMC and provider and workplace factors – including provider confidence, emotional exhaustion, and relationship with supervisors – may indicate that RMC interventions that are inclusive of interprofessional mentoring, teamwork, and communication may support providers, reduce stress, and improve experiences for women.


My research is centered on clinical and experience-based factors that affect maternal and newborn outcomes. In this study that focuses on health care provider reporting of respectful maternity care, we found that health worker confidence, stress, and workplace culture have substantial effects on quality of care.

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