Table 2 Interventions and results of the studies that described RMC interventions

Abuya et al. [28]

2015

Kenya

Policy level: continuous dialogue in technical meetings with government, civil society, and professional knowledge network

Community level: training on RMC, community dialogue and counseling and resolution of reported cases by a mediator

Facility level: training in RMC (including values clarification and attitude transformation), counselling for providers (supporting them with coping mechanisms to overcome experiences related to high workload, trauma or critic incidents), mentorship, Quality Improvement teams, Maternity Open Days and D&A monitoring

Interviews pre- and post-intervention (n = 641 and 728) and observations of provider-patient interactions during labour and delivery (n = 677 and 523, respectively)

Interviews: feelings of humiliation or disrespect decreased from 20 to 13% (p = 0.0004), physical abuse was reduced from 4 to 2% (p = 0.024); verbal abuse, from 18 to 11% (p = 0.01); violations of confidentiality, from 4 to 2% (p = 0.021); violations of privacy, from 7 to 6% (p = 0.101); and detainment, from 8 to 1% (p < 0.0001)

Observations: physical abuse decreased from 3.8% to 0.4% (p = 0.003); violations of privacy during examination, from 34 to 13% p < 0.0001); and violations of privacy during delivery, from 92 to 79% p < 0.0001)

Afulani et al. [29]

2019

Ghana

Provider trainings based on methodology developed by PRONTO International: low‐tech, highly realistic simulation and team training with facilitated debriefing, to improve identification and management of obstetric and neonatal emergencies and team functioning

Interviews pre- and post-intervention (n = 215 and 318)

At baseline, 12% felt they were treated respectfully and 8% reported to be treated in a friendly manner, compared to 64% and 65% at endline (p < 0.01 for both differences)

A relative increase of the full‐scale score on person-centered maternity care of 43%, with relative increases of 15% in dignity and respect, 87% in communication and autonomy and 45% in supportive care (all statistically significant, p < 0.001)

Almanza et al. [27]

2022

United States

Roots, where care is delivered by acknowledging the client’s cultural community as a strength, providing racially concordant care as able. It includes 13–15 prenatal visits (for no less than 30 min each) and 4 group classes. Postpartum care includes lactation support with 3 home visits in the first week, and clinic visits at week 2, 4, and 6

Comparing Roots (n = 80) to other BIPOC centers, using the sample of the GVtM (n = 2700)

Autonomy and respect scores were statistically higher for clients receiving culturally centered care at Roots. No statistical significance was found in scores between BIPOC and white clients, however there was a tighter range among BIPOC individuals, showing less variance in their experience of care

Asefa et al. [30]

2020

Ethiopia

Interactive training of service providers deploying various teaching methods (presentations, role plays, demonstrations, case studies, individual readings, video shows and a hospital visit). Placement of wall posters in labour rooms listing universal rights, describing manifestations of mistreatment and presenting guidelines on RMC

Post-partum interviews (n pre- and post-intervention = 198 and 190, respectively)

99.5% and 99% of women reported suffering at least one negative experience

The number of mistreatment components experienced by women was reduced by 18% when the post-intervention group was compared with the pre-intervention group, adjusting for several clinical and sociodemographic variables (p < 0.05). Components: physical abuse, from 16.7% to 8.9% (p = 0.02); non-consented care, from 83.3% to 65.3% (p =  < 0.001); refusal of preference, from 67.7% to 54.7% (p = 0.01). No significant difference was detected for verbal abuse, lack of information, privacy and confidentiality, and neglect and discrimination

Gélinas et al. [33]

2022

Senegal

Communication with communities, sharing the concept in health facilities, improving the working environment, evidence-based care practices and support development activities. Redesign of health facilities to provide natural birthing rooms with accessories (tatami mats, balls, cushions, swings, stepladders, and screens) and essential technical equipment. Staff training: 5S/Kaizen approach and evidence-based medicine with WHO’s standards for normal childbirth

Interviews (n = 20) and direct labour observations (average duration = 5 days/facility, n = 20)

Women who gave birth post-intervention appreciated their experience due to changes such as the opportunity to eat and drink, to be accompanied by a trusted person and to choose their position during childbirth. It was the way in which women were received at the health facility and the attitude of health professionals that were decisive in their level of satisfaction with care

Kujawski et al. [31]

2017

Tanzania

Maternity ward improvements, including moving the admissions area to a private room, using curtains for delivery and for physical examinations, posting supply stock outs to ensure transparency and build trust, and continuous customer satisfaction exit surveys. At facility management level, counseling of staff who continued to exhibit disrespectful behaviours and best practice sharing with other wards and the regional hospital

Interviews (n = 2983) before and after in two different facilities (the intervention and control group)

The intervention was associated with a 66% reduced odds of a woman experiencing D&A (p < 0.0001). The biggest reductions were for physical abuse (adjusted OR: 0.22, 0.05–0.97, p = 0.003) and neglect (0.36, 0.19–0.71, p = 0.045)

Molina et al. [26]

2019

Mexico

Implementation of an adapted version of the WHO Safe Childbirth Checklist with a mobile application to incorporate RMC (allowing birth companions, asking women about their preferred delivery position, and emphasizing clear communication regarding the care plan). Monthly clinical training courses for clinicians. Budget to fill supply gaps for essential medications and equipment, funds for gasoline to facilitate travel for women in need of referral and lodging in an existing patient hostel with food vouchers for pregnant women and their birth companion

Synchronised data of the mobile application (n = 384), and surveys (n = 221) and semi-structured interviews with birthing women (n = 28) and companions (n = 13)

384 (85.9%) women were attended by staff that used the adapted SCC during delivery. Adherence with offering a birth companion (OR: 3.06, 1.40–6.68, p < 0.01), free choice of birth position (2.75, 1.21–6.26, p = 0.02), and immediate skin-to-skin contact (4.53, 1.97–10.39, p < 0.01) improved 6–8 months after implementation. The 221 respondents of the survey were highly satisfied with their experience at the hospital, with a median satisfaction score of 10/10 versus 9/10 for the previous delivery. The prevalent narrative was that quality of care at the hospital had improved over time, and women were satisfied

Oosthuizen et al. [32]

2020

South Africa

CLEVER package: Clinical care and obstetric triage, Labour ward management to resolve the withholding of care, Elimination of barriers to meet basic human needs, Verification of care (monitoring, evaluation and feedback), Emergency obstetric simulation training, and RMC to improve birthing women’s experiences; implemented with a period for creating awareness and a core group of activities aimed at behavioural change

Interviews before (n = 653) and after (n = 679) in 10 different facilities (5 intervention sites and 5 control comparisons)

For consent to examination, being spoken nicely and treated respectfully during labour, and being satisfied with the treatment received, there were significant positive changes from baseline to end-line regarding the intervention group units (OR: 2.3, 3.2, 4.3 and 4; p = 0.0018, 0.0009, < 0.0001 and < 0.0001, respectively)

Ratcliffe et al. [34]

2016

Tanzania

Open Birth Days for pregnant women (complementing the antenatal care sessions) and RMC Workshops for providers (adapting the WHO Health Workers for Change curriculum)

Pre- and post-tests with participants in Open Birth Days (n = 362) and with attendants to the RMC Workshop (n = 76), direct labour observations (n = 459), structured community follow-up interviews (n = 149) and structured interviews with providers (n = 55)

During community follow-up interviews, 75.8% of women reported being very satisfied with their delivery experience compared to only 12.9% at baseline. At baseline, quality of care was rated as “excellent” (0%) or “very good” (2.9%), with an increase to 22.8% and 40.3% respectively at evaluation. Patient satisfaction with provision of health care improved, from 10% of women reporting “very satisfied” to 76.5%

Smith et al. [35]

2022

Zambia

BETTER pain management toolkit (Breathe, Encourage, Turn, Think, and Rub), including pain management technique posters, massage balls and a pain management manual with a partograph guide. Feedback box to empower clients to regularly assess clinic performance. Provider–client promise document on agreed behaviours during labour and delivery. Reflection workshop for providers to build an intention to change care as a facility introducing solutions. Fresh start funds to generate a sense of agency in changing the experience of care

Surveys with health facility providers (n = 33 and 35) and post-partum women (n = 60 and 92) before and after the intervention, interviews at endline (n = 5) and direct labour observations (n = 10). Each intervention site was matched to a similar comparison facility

Clients at implementation facilities were 15% less likely to experience any form of D&A compared to clients at comparison facilities (p = 0.01). Providers at intervention facilities reported greater use of more evidence-based pain management techniques at endline relative to baseline (p = 0.003). Though not statistically significant, findings suggested that providers in intervention facilities were more likely to be more empathetic towards clients (p = 0.07). Both clients and providers at intervention facilities found utility in the feedback box