Abstract
Issue/problem
Disrespect in childbirth is increasing recognised as a public health and human rights issue across Europe, affecting care experiences, maternal-child outcomes and trust in health systems. In Cyprus, the National Strategy to reduce caesarean sections (highest in EU) has a narrow focus to address underlying systemic and behavioural drivers, limiting its effectiveness.
Description
Through a participatory action process, RESPECT co-developed a Strategy for Respectful Maternity Care (RMC) engaging 35 stakeholders from government, professional bodies, regulatory authorities and civil society. The process explored drivers of sub-optimal care practices and produced actionable recommendations and deliverables through structured workshops, while fostering shared understanding and ownership.
Results
Stakeholders mapped RMC determinants using the socio-ecological and COM-B models, identifying interconnected system-level drivers, including absence of national guidelines, weak quality assurance mechanisms, limited in-service training, and litigation-driven clinical decision-making. Actionable recommendations were organised across four pillars: clinical practice, professional development, women’s’ empowerment and research. Implemented outputs include: a quality checklist for maternity clinics based on the WHO standards, workshops and e-course on RMC rights, shared decision-making training for providers, and research-informed resources, such as the “When standard practice is not Practicing Standards” video and RMC Lexicon, among others.
Lessons
This academia-led project highlights the value of participatory policy development and the need to go beyond single-policy measures. Despite tensions around terminology (e.g. “obstetric violence”), the process enabled dialogue among stakeholder groups and produced context-specific, actionable tools. The project developed a model transferrable to other settings seeking to align with Respectful rights-based Maternity Care.
Key messages
• The RESPECT project produced tangible and sustainable tools and resources for advancing Respectful Maternity Care offering a replicable model linking research with policy, training and practice.
• Inclusive and participatory policy development approaches are essential for building trust, aligning stakeholders and fostering shared ownership of quality improvement efforts in maternity care.