Respectful maternity care in Israel during the Covid-19 pandemic: a cross-sectional study of associations between childbirth care practices and women's perceptions of care.

BACKGROUND: Respectful maternity care is a crucial part of quality care and is associated with better health outcomes. Early in the Covid-19 pandemic, reports from across the world indicated that infection containment measures were often implemented in ways that resulted in disrespectful care of women during facility-based childbirths in violation of evidence-based practices. This study aimed to explore the associations between childbirth care practices and perceptions of care as satisfactory and respectful among women who delivered in Israeli hospitals during the first six months of the Covid-19 pandemic. METHODS: A cross-sectional self-administered online survey was conducted to explore women's perceptions of maternity care using an adapted version of the WHO Community Survey Tool for measuring how women are treated during facility-based childbirth. Multivariate logistic regression models evaluated the associations between sociodemographic characteristics, obstetric information, and measurements of childbirth experiences and women's perceptions of receiving respectful and satisfactory care. RESULTS: The responses of 981 women were included in the analysis. While the majority of women perceived the care they received as both respectful (86.54%) and satisfactory (80.22%), almost 3 in 4 women (72.68%) reported experiencing at least one type of disrespectful care. Positive communication with the medical staff and respect for autonomy were associated with a more positive birth experience for women. Women were more likely to perceive their care as respectful if they did not feel ignored (AOR = 40.11;22.87-70.34). Perception of satisfactory care was more likely among women who had the opportunity to discuss preferences with the medical staff (AOR = 10.15; 6.93-14.86). Having Covid-19 procedures explained increased the likelihood of reporting respectful and satisfactory care (AOR = 2.89;1.91-4.36; AOR = 2.83;2.01-4). CONCLUSION: Understanding which care practices are associated with women's perceptions of care at facility-based births is critical to ensuring quality care. The findings of this study can inform future work and research aimed at enhancing respectful maternity care during times of crisis and beyond.

Global Research Priorities for Understanding and Improving Respectful Care for Newborns: A Modified Delphi Study.

INTRODUCTION: As the respectful maternity care agenda expands, it is necessary to understand what the priorities are for improving respectful, dignified, and high-quality care for newborns. To catalyze and inform a developing research field, we undertook a prioritization exercise to identify global research questions. METHODS: We used a modified Delphi process to identify potential research priorities for understanding and addressing respectful care for newborns. Based on a literature review and expert discussions, we sent an open-ended questionnaire to participants in Round 1. The results were consolidated and used to create the Round 2 questionnaire, which asked participants to rank the preliminary list of research questions in 3 categories (descriptive, implementation, and measurement). Responses were weighted by rank and collated to generate a prioritized, consensus-based list of research questions. FINDINGS: Round 1 resulted in 70 research questions from 25 respondents, and 52 participants completed the Round 2 ranked survey. Most participants identified themselves as researchers (53.2%), program designers, implementers, or evaluators (56.5%). More than half of the participants reported working primarily in low-income countries (66%). Top descriptive questions were on understanding manifestations and definitions of disrespectful care among newborns and which perceptions and beliefs held by health workers affect the quality of care provided. Top implementation questions were around how to promote respectful care as a standard, challenges faced by health facilities, and identification of effective advocacy strategies. Top measurement questions were on quantitative and qualitative metrics and the impact of experiences on health outcomes. CONCLUSIONS: This study developed, for the first time, a prioritized list of research questions focusing exclusively on respectful care for newborns. The study highlighted the absence of agreed-upon terminology and tools needed to advance both theoretical and practical efforts. This list should guide researchers and other stakeholders in developing further research.