Table 4 Summary of findings table

Population: Healthy women during maternal health care utilisations

Setting: Maternity care units (antenatal, labour and postnatal wards) in Ethiopia, Sudan, Kenya, Tanzania, South Africa, Ghana & India

Intervention: Multi-component RMC intervention

Comparison: usual care

Data sources: all data sources were from women self-report in primary studies— some effect measures were calculated based on summary findings by reviewers if not given in primary articles

Outcomes

Anticipated absolute effects

Single effect size was not pooled, and narrative synthesis of each studies effect measures were given

№ of participants (studies)

Certainty of the evidence (GRADE)

Any form of mistreatment of women

The effect measure from one cluster RCT [22] — aOR = 0.34, 95% CI: (0.21–0.58) (3.2% in intervention groups vs 15.76% in control groups). Observation studies: four pre- and post-studies showed reduction in any forms of mistreatment; aOR = 0.58, 95% CI: ( 0.43, 0.79) (20% before vs 13.2% after intervention) [23], 18% risk reduction— aIRR = 0.82( 95% CI 0.74, 0.91) [34]. Other two pre-post studies showed absolute risk reduction from crude OR of 0.07(95% CI 0.05—0.1) (71.8% vs 15.9%) [37] and OR = 0.08, 95% CI: 0.043—0.17) (18% after intervention vs 70% before intervention) [41]

8680 (5 studies—1 RCT [22] and 4 pre-and-post observational studies [23, 34, 37, 41])

⨁⨁⨁◯ Moderate^a,b

Physical abuse

Effect measures from two cluster RCTs: [22] — (OR: 0.22, 95% CI: 0.05–0.97) (1.8% control vs 0.3% intervention), while the other cluster RCT did not report summary statics but identified it as significant [36]. Pre-and-post studies also showed reduction of physical abuse— (OR 0.5; 95% CI: 0.3–0.9) (4.2% before vs 2.1% after intervention) [23], absolute risk reduction from 16.7% before to 8. 9% after intervention [34], 61% at baseline to 15.4% at the postintervention [37] and from 52 to 1% [41]

7830 (6 studies— 2 cluster RCTs [22, 36] and 4 pre-and-post observational studies [23, 34, 37, 41])

⨁⨁◯◯ Low^a

Verbal abuse

Verbal abuses were decreased with effect measures from pre-and-post studies— (OR 0.6; 95% CI: 0.4–0.8) (18.0% before vs 11.3% after intervention) [23], decreased from 78% to 24.4% [37], 54% to 5% [41]. Even though not significant, non-dignified care was also decreased in one cluster RCT [22] 2.2% vs 11.2% (aOR = 0.58, 95%CI: 0.3–1.1) and in another pre-and-post study by [34]— from 8.6% to 5.8%

5772 (5 studies— 4 pre-and-post observational studies [23, 37, 41] [34] & 1 cluster RCT [22])

⨁⨁⨁◯ Moderate^a

Non-confidential care

Effect measures for decrement of non-confidential care— (OR 0.5; 95% CI: 0.2–0.9) (3.9% before vs 1.8% after intervention) [23], 69% reduced risk, RR = 0.31, 95% CI: (0.26—0.37) (79.5% vs 24.7%) [37] and 98% reduced risk, RR = 0.02 95% CI: (0.01—0.10) (54% vs 1%) [41]

2326 (3 pre-and-post observational studies [23, 37, 41])

⨁⨁◯◯ Low^c

Non-consented care

Effect measures —18% absolute risk reduction (83.3% vs 65.3%, RR = 0.78, 595% CI: (0.70—0.90) [34]. Similarly, Mihret et al. [37] showed 52.9% risk reduction (69.9% vs 17.1%, RR = 0.24, 95% CI: (0.19—0.31) while [41] showed 4% risk reduction from 5 to 1%. Unlike these three studies, Abuya's [23] pre-and-post study highlighted increment of the risk after intervention by 20% (61% vs 81%; aOR = 3.4, 95%CI: 2.5–4.7)

2545 (4 pre-and-post observational studies [23, 34, 37, 41])

⨁⨁◯◯ Low^c

Privacy violated

From pre-and-post study- effect measures showed decrement of privacy violation—52.5% reduction (79.7% to 27.1%; RR = 0.34, 95%CI: (0.28—0.41) [37] and [41]—50.4% reduction (53.1% vs 2.7%; RR = 0.05, 95%CI: (0.02—0.13). Although not significant additional two pre-and-post study also showed reduction in privacy violation—from 7.4% to 5.7%; aOR = 0.69, 95% CI: (0.44 – 1.08) [23] and from 81.8% to 77.4%, RR = 0.95, 95%CI: (0.85 —1.05) [35]

2708 (4 pre-and-post observational studies [23, 35, 37, 41].)

⨁⨁◯◯ Low^c

Respectful maternity care

Two cluster RCTs showed an increment of RMC:—person-centred maternity care score raised by 22.9 points (95%CI: 20.9—25.0) [38] and — aRR 3.44 (2.45—4.84) [22]. Similarly, four pre-and-post studies also showed improvement of RMC related to intervention—18 points increment in RMC: (β = 17.6, 95% CI: (15.6—19.6), a relative increase of 43% from 50 to 72 [33]; increased by 36.4% (38.1% to 74.5%) [39]; respectful care increased from none at baseline to 22.8% at the time of evaluation [40] and 5% increment in RMC (89.7% vs 94.7%) [42]

13,119 (6 studies— 2 cluster RCTs [22, 38] and 4 pre-and-post observational studies [33, 39, 40, 42])

⨁⨁⨁◯ Moderate^a