Case for improving respectful care: results from a cross-sectional survey of person-centred maternity care in rural South Africa.

Introduction: Despite a supportive policy environment, little attention has been paid to how to operationalise respectful maternity care in South Africa. This research provides a quantitative, baseline measure of women's perceptions of person-centred maternity care (PCMC) to identify areas of focus for a participatory intervention with maternity teams. Methods: A facility-based cross-sectional survey of postpartum women within 9 weeks postdelivery in two rural districts of KwaZulu-Natal. 908 postpartum women were recruited from postnatal clinics and neonatal units in the district hospitals. The primary outcome was PCMC measured on 30 items with a 4-point Likert scale (0-3). Mixed-effects linear regression analysis was used to identify predictor variables that were significantly associated with PCMC. Results: The mean PCMC score was 55.5 (SD 13.6) out of 90 and was significantly higher for women who had caesarean deliveries compared with vaginal births (58.0 (SD 12.8) and 54.5 (SD 13.7), respectively). Around one-fifth of women reported verbal abuse at least once. Over half of women felt that their health information would be kept confidential all of the time, less than 15% of women were allowed to have a companion with them during labour or delivery and less than half of women felt they could completely trust their providers all of the time. Attending eight or more antenatal visits, having a caesarean delivery, being in the age group 30-45 and being in the middle wealth quintile were independently associated with a higher PCMC score while delivering at night was associated with a lower score. Conclusion: Women attending rural health facilities experience disrespect and lack of trust in an environment where they have little involvement in decisions about their care and feel unable to ask questions of their providers. These findings support the need for interventions addressing organisational cultures that allow disrespect within maternity units.