ArticleSexual and reproductive health matters2020
Imagining maternity care as a complex adaptive system: understanding health system constraints to the promotion of respectful maternity care.
Article in Sexual and reproductive health matters, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers, 2 of them syntheses that pooled it.
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Who cites it
32 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Factors influencing respectful perinatal care among healthcare professionals in low-and middle-resource countries: a systematic review.BMC pregnancy and childbirth · 2024Pooled it
- Overcoming barriers and harnessing facilitators: Respectful maternity care in least-developed countries - a systematic review.Women's health (London, England)Pooled it
- Understanding and Addressing Severe Maternal Morbidity Among Black Women in Texas: Findings From a System Dynamics Group Model Building Study.Journal of racial and ethnic health disparities · 2026Article
- Article
- Complex intervention to improve empathy within maternity services: a mixed methods feasibility study with pilot evaluation.BMJ open quality · 2026Article
- Understanding the role of 'software' in health system capacity for non-communicable disease response: hypertension care in rural Coastal Kenya.Health policy and planning · 2026Article
- Unraveling the link between the mistreatment of women during childbirth and postpartum depression: a prospective longitudinal study in Ethiopia and Guinea.EClinicalMedicine · 2026Article
- 'One woman, one bed': prevalence and factors associated with women's experiences of respectful birth in urban Dar es Salaam, Tanzania - across-sectional survey.Global health action · 2025Article
- Promoting respectful maternity care with the WHO labor care guide and the checklist mnemonic "COPE": A quality improvement project.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2025Article
- Providers' Perceptions of Respectful Maternity Care and Enabling Conditions in a Regional Hospital: A Qualitative Study.International journal of environmental research and public health · 2025Article
- Toward consensus: a Delphi study on the core principles and indicators of respectful maternity care.Reproductive health · 2025Article
- Maternity Care Client and Provider Experiences at Health Facilities in the Eastern Democratic Republic of Congo: Understanding Person-Centered Maternity Care Within Crisis Settings.International journal of women's health · 2025Article
- 'Global health action · 2024Article
- Perspectives of midwives on respectful maternity care.BMC pregnancy and childbirth · 2024Article
- Sleep Disturbances Among Pregnant Women Attending a Maternity Teaching Hospital in Erbil, Iraq.Cureus · 2024Article
- Is MIStreatment of women during facility-based childbirth an independent risk factor for POstpartum Depression in Ethiopia and Guinea? A mixed methods prospective study protocol-MISPOD study.Reproductive health · 2024Article
- Travelling numbers and broken loops: A qualitative systematic review on collecting and reporting maternal and neonatal health data in low-and lower-middle income countries.SSM - population health · 2024Review
- Engaging women to set the research agenda for assisted vaginal birth.Health expectations : an international journal of public participation in health care and health policy · 2024Article
- The mistreatment of women during maternity care and its association with the maternal continuum of care in health facilities.BMC pregnancy and childbirth · 2024Article
- Women's narratives of experiences, drivers and consequences of mistreatment during maternity care in western Ethiopia.PloS one · 2024Article
Corrections and comments
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Evidence of the health system challenges to promoting respectful maternity care (RMC) is limited in Ethiopia and globally. This study investigated the health system constraints to RMC in three Southern Ethiopian hospitals. We conducted a qualitative study (7 focus group discussions (FGDs) with providers of RMC and 12 in-depth interviews with focal persons and managers) before and after the implementation of an RMC intervention. We positioned childbirth services within the health system and applied complex adaptive system theory to analyse the opportunities and constraints to the promotion of RMC. Both system "hardware" and "software" factors influencing the promotion of RMC were identified, and their interaction was complex. The "hardware" factors included bed availability, infrastructure and supplies, financing, and health workforce. "Software" factors encompassed service providers' mindset, staff motivation, and awareness of RMC. Interactions between these factors included privacy breaches for women when birth companions were admitted in labour rooms. Delayed reimbursement following the introduction of fee-exemption for maternity services resulted in depleted revenues, supply shortages, and ultimately disrespectful behaviour among providers. Other financial constraints, including the insufficient and delayed release of funds, also led to complex interactions with the motivation of staff and the availability of workforce and supplies, resulting in poor adherence to RMC guidance. Interventions aimed at improving only behavioural components fall short of mitigating the mistreatment of women. System-wide interventions are required to address the complex interactions that constraint RMC.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.