Responsive and respectful care across pregnancy, childbirth, and the postpartum period—known as person-centered maternal health care (PCMHC)—is essential to improving outcomes for mothers and babies. Poor quality care, including mistreatment, can cause people to delay care or not seek it at all, leading to poor health outcomes. Addressing women’s experiences before, during, and after pregnancy is critical, as an estimated 700 people die of preventable pregnancy and childbirth-related complications each day.
New research published by Patience Afulani, MBChB, PhD, and colleagues in the US, Ghana, Kenya, and Uganda, used surveys from nearly 2,000 postpartum women in Ghana and Kenya within 12 weeks of birth to understand the landscape of person-centered care during pregnancy and childbirth. They used tools proven to effectively measure experiences throughout that period, including a newly validated scale measuring person-centered postnatal care in low- and middle-income countries.
They found that person-centered care is suboptimal across all phases of maternal care. Communication and autonomy scores were the lowest across every phase. Less than 20% of women received optimal person-centered care at any point during their care. Women with higher socioeconomic status, who received care in health centers or faith-based facilities (compared to public hospitals), and those reporting greater care continuity had higher PCMHC scores.
These findings have important implications for policy, practice, and research across sub-Saharan Africa.
The low scores across phases highlight the need for integrated interventions to strengthen person-centered care throughout pregnancy and childbirth.
Governments should explicitly incorporate PCMHC into their national strategies and standards.
For health systems and facilities, training, mentorship, and supportive supervision should be combined with low-cost facility improvements, such as privacy protections and support for labor companions.
Targeted equity-focused approaches, such as community engagement and reducing provider bias, are essential to ensuring equitable care experiences.
Strengthening continuity of care models will help strengthen provider-patient relationships.
Research that evaluates interventions to improve PCMHC is needed to inform advocacy, practice, and policy.