Carolyn Hastie

Background: Disrespectful care violates women’s rights, delays care-seeking and contributes to preventable adverse birth outcomes. Although Respectful Maternity Care (RMC) is a key strategy for improving maternal and neonatal health, evidence on factors affecting its implementation in least-developed countries remains poorly synthesised. Objective: To assess the barriers and facilitators of RMC in low-income countries. Design: Systematic review synthesising evidence from qualitative and mixed-methods studies was conducted. Data sources and methods: A systematic search was conducted across major databases, including Scopus, Web of Science, PubMed, CINAHL, and Embase. Eligibility criteria were defined using the SPIDER framework. Studies published between 2015 and 2025 were included. Methodological quality was assessed using JBI SUMARI for qualitative studies and the QATSDD tool for mixed-methods studies. SPIDER framework was applied to support eligibility criteria. The review followed PRISMA guidelines. The data were synthesised using thematic analysis and applied to the Socio-Ecological Model. Results: Forty-eight studies conducted in least-developed countries were analysed, consisting of 36 qualitative studies and 12 mixed-methods studies. Barriers and facilitators to RMC were identified at individual (knowledge, attitude, skills), interpersonal, organizational (resources, infrastructures), policy (guidelines, education), and socio-cultural level (norms, cultures). Conclusion: Strengthening RMC is crucial for reducing maternal and neonatal mortality. The review highlights the need for supportive policies, improved infrastructure, and targeted provider training. Future research should develop and validate context-specific RMC principles and indicators to strengthen providers’ understanding and skills for practice in least-developed countries. Registration: The protocol was registered with PROSPERO (CRD42023443998).

Measuring women’s experiences of Respectful Maternity Care (RMC) requires valid and reliable tools. Although several RMC tools exist, their methodolo

Background: Health facility-based childbirth services are essential for reducing maternal and neonatal mortality. Yet, these services remain underutilized in many low- and middle-income countries (LMICs), including Papua New Guinea (PNG), where birthing at home or in village settings continue to predominate. This study investigated the determinants of non-utilization of health facilities for childbirth among women in PNG. Methods: Data from a weighted sample of 6,432 women using the 2016–2018 PNG Demographic and Health Survey (DHS) were analyzed. Descriptive statistics and multivariate logistic regression analyses were conducted to determine the factors associated with the non-utilization of health facilities for childbirth. The adjusted odds ratios (AOR) with their corresponding 95% confidence intervals (CI) were computed using the Statistical Package for Social Sciences, version 30.0. Results: Overall, 58.3% (95% CI: 57.0–59.5) of women did not give birth in a health facility. Women were more likely to give birth at home or in the village if they had no formal education (AOR: 1.48; 95% CI: 1.11–2.09), lived in rural areas (AOR: 1.31; 95% CI: 1.11–1.75), were from the Southern (AOR: 1.05; 95% CI: 1.01–1.54), or Momase (AOR: 1.06; 95% CI: 1.02–1.83) regions, made their own healthcare decisions (AOR: 1.21; 95% CI: 1.10–4.14), had these decisions made by their husbands (AOR: 1.69; 95% CI: 1.13–2.63), walked to a health facility (AOR: 1.01; 95% CI: 1.00–1.67), or traveled more than 24 hours to access care (AOR: 1.02; 95% CI: 1.39–2.70), and had no antenatal care visits during pregnancy (AOR: 1.08; 95% CI: 1.04–1.51). Conclusions: Over half of the women in this study did not utilize health facilities for childbirth. Demographic and health service-related factors influenced the non-utilization of facility-based childbirth, highlighting the need to scale up maternal health services. Increasing uptake of facility-based childbirth requires coordinated system-level efforts and incentive-based interventions that promote antenatal care and skilled birth attendance, especially for rural women. Male-inclusive strategies in maternal health decision-making are critical for improving women’s access to and utilization of facility-based childbirth services.