Levels and determinants of person-centred maternity care among women living in urban informal settlements: evidence from client exit surveys in Nairobi, Lusaka and Ouagadougou.

Background: Sub-Saharan Africa's rapid urbanisation has led to the sprawling of urban informal settlements. The urban poorest women are more likely to experience worse health outcomes and poor treatment during childbirth. This study measures levels of person-centred maternity care (PCMC) and identifies determinants of PCMC among women living in urban informal settlements in Nairobi, Lusaka and Ouagadougou.

Methods: We conducted phone, home-based or facility-based exit surveys of women discharged from childbirth care in facilities serving urban informal settlements. We estimated overall and domain-specific PCMC scores covering dignity and respect, communication and autonomy, and supportive care. We ran multilevel linear regression models to identify structural, intermediary and health systems factors associated with PCMC.

Results: We included 1249 women discharged from childbirth care: the majority were aged 20-34 years and were unemployed. In Lusaka and Nairobi, over 65% of women had secondary education, and over half gave birth in a hospital, whereas in Ouagadougou one-third had secondary education and 30.4% gave birth in a hospital. The mean PCMC score ranged from 57.1% in Lusaka to 73.8% in Ouagadougou. Across cities, women reported high dignity and respect mean scores (73.5%-84.3%), whereas communication and autonomy mean scores were consistently poor (47.6%-63.2%). In Ouagadougou, women with formal employment, those who delivered in a private for-profit facility, and whose newborn received postnatal care before discharge reported significantly higher PCMC. In Nairobi and Lusaka, women who were attended by a physician during childbirth, and those whose newborn was checked before discharge reported significantly higher PCMC.

Conclusions: Women living in urban informal settlements experience inadequate PCMC and report poor communication with health providers. Select health systems and provision of care factors are associated with PCMC in this context. Quality improvement efforts are needed to enhance PCMC and ensure women's continuity in care seeking.