Respectful and dignified maternity care in West Africa: a systematic review of evidence, gaps, and implications for practice.

BACKGROUND

Respectful patient care is a fundamental pillar of quality healthcare and is integral to the well-being and satisfaction of patients. However, there is a growing recognition of the disrespect and abusiveness of patients seeking care. Studies have reported that women's experiences of disrespectful and abusive care during childbirth significantly impacted their utilization of these services.

OBJECTIVE

This systematic review aims to provide a comprehensive evaluation of the practices of respectful and dignified maternity care in West Africa.

METHODS

The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement checklist and was registered in PROSPERO. Research articles were systematically retrieved from four databases: PubMed, Scopus, EMBASE, and PsycINFO, and through manual searches of reference lists. A two-stage screening process was employed, followed by quality assessment using the Joanna Briggs Institute (JBI) critical appraisal checklist for cross-sectional studies.

RESULTS

The review included 17 studies predominantly from Ghana and Nigeria, with one study spanning multiple countries. Most studies utilized qualitative methods and focused on women of reproductive age, practising midwives, and midwifery students. Findings revealed high levels of mistreatment during childbirth, including physical and verbal abuse, non-consented care, and dignity violations. Midwives showed varying levels of awareness and practice regarding respectful maternity care, with structural barriers within healthcare systems exacerbating mistreatment. Women reported experiencing disrespect and abuse, influenced by factors like age, marital status, and facility type. Midwifery students also identified issues of mistreatment and highlighted discrepancies between understanding the importance of respectful care and actual practice. We, however, did not find any literature addressing interprofessional respectful and dignified maternity care.

CONCLUSION

The review reveals widespread mistreatment and disrespect during childbirth, including physical and verbal abuse, non-consented care, and dignity violations. Systemic barriers like staffing shortages and inadequate supplies exacerbate these issues, underscoring the pressing need for structural reforms in healthcare systems.