Factors associated with respectful maternity care reported by patients in selected health facilities in Musanze District, Rwanda: a facility-based cross-sectional study.

Abstract

Background: Respectful maternity care (RMC) is an essential strategy to scale up mothers' positive experiences during childbirth. However, few studies have been conducted to quantify the practice in Rwanda. The main objective of this study was to determine the proportion of the RMC approach in health facilities and associated factors in Musanze District in Rwanda.

Methods: This is a health facility-based cross-sectional study conducted among 335 women who delivered at eight healthcare facilities including hospital and health centers in Musanze District between March to May 2024. We used simple random sampling to select health centers and included all participants who satisfied the inclusion criteria until the predetermined sample size was reached. The proportion of RMC as an outcome variable was calculated from the 30-item PCMC Scale, and RMC was considered to have been received if a woman responded "2 = yes, most of the time" and "3 = yes, all the time" to all the 30 items. We used multivariate logistic regression to identify factors associated with the provision of RMC such as employment status, parity, and place of delivery. The results were reported using odds ratios with the 95% CI. Variables were proved statistically significant based on p < 0.05.

Results: 335 participants were enrolled in this study. The majority of respondents were between 25-34 years (54.0%) and married (74.3%). The proportion of respectful maternity care was 65.1% (95% CI: 59.7-70.2). Being employed was associated with receiving RMC [AOR = 17.75, 95%CI:8.06-39.06, p < 0.001]. Primiparous women compared to multiparous had higher odds of receiving RMC [AOR = 5.15, 95%CI:2.07-12.79, p < 0.001]. Cesarean deliveries were associated with a greater likelihood of RMC compared to those who delivered vaginally [AOR = 6.00, 95%CI:2.40-15.03, p-value = 0.003]. Women who delivered at health centers were more likely to receive RMC than those who delivered in hospitals [AOR = 3.72, 95% CI: 1.41-9.83, p = 0.008]. Daytime deliveries were more likely to receive RMC than nighttime deliveries (AOR = 3.11, 95% CI: 1.52-6.37, p = 0.002). Additionally, women with insurance other than Rwanda's Community Based Health Insurance had higher odds of receiving RMC (AOR = 4.46, 95% CI: 1.88-10.61, p < 0.001).

Conclusion: The level of respectful maternity care in Musanze District was found to be 65.1%. Interventions to improve respectful maternity care should focus on training healthcare providers about its components, including dignity and respect, autonomy and communication, and social support, in addition to educating the community to request quality care. These findings call upon policy makers to involve different stakeholders to come up with interventions to improve quality of care during childbirth.