Table 6.

List of studies included in this systematic review (2010–2023).

S.No	Title	Author and Year	Sample Size	Country	Study Type	Findings	Limitations	Reference No
01	Respectful maternity care and associated factors among mothers who gave birth in three hospitals of Southwest Ethiopia: A cross-sectional study	Adugna et al., 2023	A total of 348 mothers who gave birth in three hospitals in Southwest Ethiopia	Southwest Ethiopia	Cross-sectional study	A total of 81.2% pregnant women received respectful care overall. Age of the mothers [AOR = 2.54; 95% CI(1.01–6.43)]; prenatal care follow-ups (AOR = 2.86; 95% CI (1.01–8.20); and maternal occupation (AOR = 5.23; 95% CI (1.15–23.72)). The most important elements of respectful maternity care were found to be conversations with the provider concerning the place of delivery during antenatal care follow-up [AOR = 5.58; 95% CI: (2.12–14.70)].	Since the data were gathered in a hospital context, our study may have been influenced by social desirability bias and a fear of reporting abusive care. Another drawback is that some of the ladies were too worn out to reply to several questions because the data were gathered in the early postpartum period.	[31]
02	Respectful maternity care during labor and childbirth and associated factors among women who gave birth at health institutions in the West Shewa zone, Oromia region, Central Ethiopia	Bulto et al., 2020	A total of 567 women	Oromia region, Central Ethiopia	Cross-sectional study	From the RMC categories, 76.5% of the women are shielded from physical harm/ill treatment, and 89.2% received fair care devoid of prejudice. The right of women to knowledge, informed consent, and preference protection was upheld in only 39.3% of cases. Birthing at a medical facility (AOR:5.44), discussion of the delivery location (AOR:4.42), daytime delivery (AOR:5.56), longer length of stay (13 h) (AOR:2.10), and delivery time (AOR:2.10). Participation in decision making (AOR: 8.24), obtaining consent prior to the surgery (AOR: 3.45), unplanned pregnancy at the moment (AOR:5.56), three healthcare professionals present during labor (AOR:2.23), and satisfied with the length of time it took to be seen (AOR:2.08).	Even though the memory bias issue was reduced by performing exit interviews for postpartum mothers right away, the current study is not free of social desirability bias, where some mothers may report the service as having had positive experiences while they are in the medical facilities.	[32]
03	Continuum of care in a maternal, newborn and child health program in Ghana: low completion rate and multiple obstacle factors	Yeji et al., 2015	A total of 1500 mothers with infants	Ghana	Retrospective cross-sectional survey	The continuum of care (CoC) completion rate is low in this study’s site. Only 8.0% of the population had completed CoC. The biggest void, which contributed to the poor CoC, was found between delivery and postnatal care within 48 h after delivery. At six weeks after giving birth, 95% of women had received postnatal care and at least four prenatal visits. A total of 25% of women had postnatal care within 48 h, and 75% had competent assistance with delivery.	This study did not include service availability and other adjustable program factors, which may influence the utilization of MNCH services, such as demand creation efforts, including home visits by CHOs.	[34]
04	Analysis of dropout across the continuum of maternal health care in Tanzania: findings from a cross-sectional household survey	Mohan et al., 2017	A total of 1931 women	Tanzania	Cross-sectional household survey	Dropout from the maternal care continuum was high, especially for the poorest people in rural Tanzania. Only 10% of women reported receiving the ’recommended’ care package (4+ ANC visits, SBA, and 1+ PNC visit), while 1% said they received no care at all. Women’s age (age 20–34 years—OR: 1.77, 95%CI: 1.22–2.56; age 35–49 years—2.03, 1.29–3.2) and awareness of danger indicators (1.75, 1.39–2.1) were also linked favorably with receiving four ANC visits. Women from the fourth (1.66, 1.12–2.47) and highest quintiles of family income (3.4, 2.04–5.66) as well as the top tertile of communities by wealth (2.9, 1.14–7.4) showed a pro-rich bias in facility-based births (a proxy for SBA).	This study is a cross-sectional survey which limits our inference to the associations between independent and outcome variables without the determination of causal direction.	[33]
05	The continuum of care for maternal and newborn health in South Asia: determining the gap and its implications	Alva et al., 2011	Not applicable	Pakistan, Nepal, Bangladesh, India	Review	South Asia shows a decline in service use as women move along the care continuum from pregnancy to childbirth [36]. From “adequate antenatal care” to “adequate delivery care” (0.32) and “adequate child’s immunization” (0.36); from “adequate delivery care” to “adequate postnatal care” (0.78) and “adequate child’s immunization” (0.15)—all along the continuum of care for MNCH—were positively associated and statistically significant at p <0.001. The only route association that was adversely associated and significant at p <0.001 was the one between “adequate postnatal care” and “adequate child’s immunization”	Only 25–40 percent of women have a postnatal care checkup within 2 days of the child’s birth. The availability of postnatal care soon after birth is also limited among births that did not occur in a health facility.	[35]
06	Associations in the continuum of care for maternal, newborn and child health: a population-based study of 12 sub-Saharan Africa countries	Owili et al., 2016	A total of 137,505 women	A total of 12 Sub-Saharan African Countries	Cross-sectional study	South Asia shows a decline in service use as women move along the care continuum from pregnancy to childbirth [36]. From “adequate antenatal care” to “adequate delivery care” (0.32) and “adequate child’s immunization” (0.36); from “adequate delivery care” to “adequate postnatal care” (0.78) and “adequate child’s immunization” (0.15)—all along the continuum of care for MNCH—were positively associated and statistically significant at p <0.001. The only route association that was adversely associated and significant at p <0.001 was the one between “adequate postnatal care” and “adequate child’s immunization”.	At the national level, identifying communities that greatly contribute to the overall disparity in health and a well-laid-out follow-up mechanism from pregnancy through to the child’s immunization program which could improve maternal and infant health outcomes and equity.	[36]
07	Enablers and barriers to respectful maternity Care in Low and Middle-Income Countries: a literature review of qualitative research	Mgawadere et al., 2021	Not applicable	A total of 19 low and middle-income countries in Asia and Africa	Review	Respectful maternity care plays a big role in promoting health-seeking behaviors among pregnant women. However, women experience barriers ranging from provider behaviors, work environment, and health system challenges. Ensuring a dignified and respectful working environment could contribute to an increase in health seeking-behaviors and, consequently, a reduction in maternal mortality.	Despite ensuring quality review by following strict criteria, some studies may be missed; however, this is unlikely because of the robust and exhaustive literature search. Considering the short duration of this review, if the quantitative component was added, it may have identified other enablers and barriers to RMC.	[37]
08	Defining disrespect and abuse of women in childbirth: a research, policy and rights agenda	Freedman et al., 2014	Not applicable	Kenya and the United Republic of Tanzania	Cross-sectional study	The growing global movement to promote respectful maternal care has begun strategically using normative standards defined in the laws and policies. However, our projects recognized that simply promoting abstract standards through advocacy and education—or even through legal enforcement and punishment—is unlikely to solve the problem of disrespect and abuse.	Developing interventions to reduce disrespect and abuse, with clearly articulated theories of change and appropriate strategies to assess implementation, will be critical for building an effective global movement for respectful maternal care.	[51]
09	Exploring evidence for disrespect and abuse in facility-based childbirth: report of a landscape analysis	Bowser et al., 2010	Not applicable	Tanzania, Lebanon, Kenya, Brazil, Sierra Leone, Ghana, Zimbabwe, Peru, Burundi, and the United States	Report	Despite maternal health and human rights stakeholders’ agreed importance of achieving respectful, non-abusive birth care for all women, there has been a relative lack of formal research on this topic.	The report reviews many studies from a wide range of countries. The evidence reviewed, however, does not include a validated measurement method for assessing disrespect in facility-based childbirth and does not provide a prevalence estimate.	[52]
10	Encountering abuse in health care; lifetime experiences in a postnatal women-a qualitative study	Schroll et al., 2013	A total of 14 women were selected for an interview	Norway	A qualitative study	Whether AHC is experienced in childhood or adulthood, it can influence women’s lives during pregnancy and childbirth. By recognizing the potential existence of AHC, healthcare professionals have a unique opportunity to support women who have experienced AHC.	However, this study’s participants also revealed potential resources for them to confront, comprehend, and manage their experiences. When addressing future strategies for avoiding AHC, it is important to acknowledge the various forms of dehumanization, focusing on the importance of its opposite: empathy.	[28]
11	Put Right Under Obstetric Violence in Post-war Canada	Wood., 2018	Not applicable	Canada	Review	As natural childbirth ideologies attracted growing North American attention from the mid-1940s, many Canadians sought less-medicalized births.	A historical examination of post-war obstetric practice fundamentally demonstrates that criticisms of modern medicalized birth has its historical roots.	[27]
12	Witnessing obstetric violence during Fieldwork: Notes from Latin America	Castro., 2019	Not applicable	Latin America Countries	Review	Finally, I explain that although reporting on the suffering of women will not, on its own, prevent obstetric violence, increasing its visibility through research can contribute to human rights-based advocacy on behalf of women in labor, to the monitoring of human rights standards, and to the creation of accountability measures within health systems to prevent obstetric violence.	In Proyecto Mujer al Centro (Pregnant Women-Centered Care Project), we are studying the associations among obstetric violence, adverse maternal and child health outcomes, and inequity in the right to health—and, by doing so, we aim to dispel the myth that obstetric violence in a health care setting is uneventful.	[22]
13	A qualitative inquiry of health care workers’ narratives on knowledge and sources of information on principles of Respectful Maternity Care (RMC).	Lusambili et al., 2023	Not applicable	Kenya	Cress-sectional	The Respectful Maternity Care Charter was the subject of a qualitative study that looked at HCWs’ understanding of it and their sources of information in Kenya’s rural Kisii and Kilifi counties. The study’s findings are presented in this publication.	Pre-service medical and nursing curricula and continuing clinical education should include the Respectful Maternity Care Charter. Strategies are required at the policy level to help include respectful maternity care in pre-service training curricula.	[54]
14	Transforming intrapartum care: Respectful maternity care	Bohren et al., 2020	Not applicable	Australia	Review	In order to provide respectful care, health facilities and health systems must be structured in a way that supports and respects providers and ensures adequate infrastructure and organization of the maternity ward.	The provision of respectful care may not be prioritized in the same way as the provision of clinical care. More work is needed to understand how respectful care can be provided, particularly in lower-resource contexts, and how non-recommended practices can be removed from clinical settings.	[2]
15	Quality of measures on respectful and disrespectful maternity care: A systematic review	Dhakal et al., 2021	Not applicable	Not applicable	A systematic review	No measure was sufficient to determine women’s experiences of disrespectful and respectful maternity care in low- and middle-income countries. New valid and reliable measures using rigorous approaches to tool development are required.	Interestingly, although most of the measures included in this evaluation were focused on disrespect and abuse, no measures of disrespectful care could be found.	[45]
16	Magnitude of disrespectful and abusive care among women during facility-based childbirth in Shambu town, Horro Guduru Wollega zone, Ethiopia	Bekele et al., 2020	A total of 321 women	Ethiopia	Cross-sectional study	A total of 316 of the 321 sampled respondents took part in this study, representing a response rate of 98.4%. Respect and maltreatment were present in 78.2% of cases (95% CI: 73.5–83.2). Unconsented care (86.1%), non-dignified care (37.3%), lack of privacy (33.9%), physical abuse (21.5%), and neglectful care (13.3%) were the most frequent kinds of disrespect and abuse experienced by the mothers. Respect and abuse during facility-based childbirth were strongly correlated with the mother’s work, an increase in antenatal care visits, and giving birth in a hospital.	This study had a number of limitations, including the fact that it only looked at women’s subjective experiences, that it was conducted in hospitals where social desirability bias might have been present, and that it was a cross-sectional study, which made it impossible to identify cause-and-effect relationships.	[43]
17	Disrespect and abuse during childbirth in district Gujrat, Pakistan: A quest for respectful maternity care	Azher et al., 2018	A total of 360 women	Pakistan	Cross-sectional study	According to an objective assessment, almost all women (99.7%) experienced D and A during labor. However, only 27.2% of respondents “reported D & A” in terms of their subjective experiences. Facility-based childbirth (OR = 13.49; 10.10–100.16) and lower socioeconomic strata (OR = 2.89; 1.63–5.11) were the primary predictors of reported D and A. In comparison to private health institutions, the chance of reporting D and A was twice as high in public facilities. Women who had previously reported D and A were more likely to choose to give birth somewhere different the second time around (OR = 4.37, 95% CI = 2.41–7.90).	The data used for this study came from women who lived in rural areas; statistics in urban areas can differ slightly. However, given that the women in our sample sought care from both urban and rural health facilities, we anticipate a slight variation. This study’s main weakness was the relatively small percentage of women who gave birth at home and the tiny percentage of them who reported D and A, which led to smaller cell sizes and wider confidence intervals in statistical analysis.	[38]
18	Respectful maternity care and its relationship with childbirth experience in Iranian women: a prospective cohort study	Khadije Hajizadeh., 2020	A total of 334 postpartum women	Tabriz and Iran	Prospective cohort study	The mean score for respectful maternity care was 62.58, with a range of 15 to 75, while the average score for the entire delivery experience was 3.29, with a range of 1 to 4. A statistically significant direct link between respectful maternity care and a satisfying birthing experience was discovered after accounting for sociodemographic and obstetrical factors (p 0.001).	Attrition bias and response bias (failure to report occurrences because of feelings of shame and embarrassment or the perception that abusive care is standard care) were two potential biases in this study. We reduced the attrition bias by making timely phone calls (twice a week) to accurately follow-up. The interviews were performed in a private space with participants given assurances of confidentiality and anonymity in order to reduce response bias.	[39]
19	Respectful Maternity Care: Fundamental Human Rights in Labour and Delivery	Adeyemo., 2022	A total of 17 women between the age of 31 and 63	Magu District and Tanzania	Population-based study	The experiences women have with maternal health services reflect a number of variables pertaining to subpar care and violations of many human rights principles. Women identified a variety of methods that the services may provide that would respect human rights principles and acknowledge the existence of subpar treatment. Being respected, receiving the necessary information, and receiving quality medical care were among the major themes.	Emotional support, information gathering, and respectful maternity care prioritize newborns’ rights.	[46]
20	Respectful maternity care and associated factors among mothers who gave birth at public health institutions in South Gondar Zone, Northwest Ethiopia 2021	Ferede et al., 2022	A total of 611women	Ethopia	A multicenter institutional-based cross-sectional study design	Only 39.4% of women (95% confidence interval: 35.4–43.2) received considerate maternity care, according to this study. Having a high school diploma (adjusted odds ratio 2.47, 95% confidence interval: 1.35–4.50), and receiving follow-up prenatal care adjusted the odds that the pregnancy that was intended (adjusted odds ratio: 3.21, 95% confidence interval: 0.098, 0.03–0.34). Daytime delivery (adjusted odds ratio: 0.47, 95% confidence interval: 0.25–0.89), cesarean section (adjusted odds ratio: 0.69–6.08), and other factors. Respectful maternity care was substantially linked with (adjusted odds ratio: 1.9, 95% confidence interval: 1.33–2.72).	It is important to keep in mind the significant limitations of this study when interpreting the results. It was ideal to investigate respectful maternity care using qualitative research and observational data collection methods. The bias toward social desirability can exist. To lessen social desirability bias, each eligible woman was approached in private in a room apart from the maternity unit on the hospital premises.	[40]
21	A negative birth experience: prevalence and risk factors in a national sample	Smith., 2023	A total of 2541 women	Sweden	Longitudinal cohort study	Only 7% women had a negative birth experience. Moreover, factors related to unexpected medical problems were as follows: emergency operative delivery, induction, augmentation of labor, and infant transfer to neonatal care; related to the woman’s social life, such as unwanted pregnancy and lack of support from partner; related to the woman’s feelings during labor, such as pain and lack of control; and related to easier to influence by the caregivers.	Public health initiatives have evaluated nonmedical factors to determine whether they have a broader influence on physical health than traditional medicine, especially in reproductive care.	[44]
22	Magnitude and associated factors of disrespect and abusive care among laboring mothers at public health facilities in Borena District, South Wollo, Ethiopia	Maldie, 2021	A total of 374 women	Ethiopia	Facility-based cross-sectional study	During facility-based deliveries, nearly four out of five (79.4%) women reported at least one sort of disrespect or maltreatment. Non-consented care was the most commonly reported form of disrespect and maltreatment (63.7%). There was a significant association between the wealth index [AOR = 3.27; 95% CI: (1.47, 7.25)], type of health facility [AOR = 1.96; 95% CI: (1.01, 3.78)], presence of companion(s) [AOR = 0.05; 95% CI: (0.02, 0.12)], and presence of complications [AOR = 2.65; 95% CI: (1.17, 5.99)].	The cross-sectional design of this study made it challenging to establish temporal correlations between explanatory variables and the outcome variable, as well as its quantitative design, which was based solely on interviews and excluded other forms of data collecting.	[50]
23	Respectful Maternity Care and Associated Factors Among Women Who Attended Delivery Services in Referral Hospitals in Northwest Amhara, Ethiopia: A Cross-Sectional Study	Yosef et al., 2020	A total of 410 women who gave birth	Northwest Amhara, and Ethiopia	Cross-sectional study	The proportion of women who had respectful maternity care as a whole was 56.3%. Adjusted odds ratios (AOR) of 2.53 (95% CI: 1.094, 5.867), 2.46 (95% CI: 1.349, 4.482), and 3.092 (95% CI: 1.676, 5.725) for the antenatal care follow-up and above were found to be substantially linked with respectful maternity care.	This study had a number of limitations, including the fact that it only examined the subjective experiences of women, the fact that it was carried out in hospitals where social desirability bias was a possibility, and the fact that it was a cross-sectional study, which precluded the identification of cause-and-effect links.	[41]
24	Direct observation of respectful maternity care in five countries: a cross-sectional study of health facilities in East and Southern Africa	Rosen et al., 2015	A total of 2164 women	Ethiopia, Kenya, Madagascar, Rwanda, and the United Republic of Tanzania	Cross-sectional study	Overall, it is encouraging to see that clinicians treated women with respect and care, yet many of them had unpleasant contacts with them and did not know much about their care. During this study, we saw women being abused verbally and physically. In the unstructured remarks, abandonment and neglect were the forms of disrespect and abuse that were most frequently cited. Except for the Tanzania mainland survey, which had a more evenly distributed mix of facilities with health centers and clinics. Observations were conducted predominantly at hospitals in all countries (80% of deliveries or greater were at hospitals). The majority of deliveries that were observed were carried out by female midwives and nurses (87%). A total of 20% of consumers in Ethiopia received medical assistance from doctors, whereas in Madagascar it was just 19%. In 5% of observations, services were provided by nursing and medical students as well as untrained helpers.	The fact that the data collection method was not created, especially to research RMC, constitutes a limitation of this study. Respectful treatment throughout the second and third stage of labor or postpartum was not included on the checklist, and some ideas such as mother detention and consent for operations were completely unaddressed.	[42]