Background
The World Health Organization (WHO) identifies respectful maternity care (RMC) as a key component of patient-centered care, focusing on the individuality of women 2. This care respects dignity, privacy, and confidentiality, protects from injury and maltreatment, and allows for informed decision-making with continuous support throughout labor and delivery (1).
Providing high-quality, respectful, compassionate, and evidence-based care is critical for the well-being of every mother and family (2, 3). This approach to care ultimately contributes to the positive experience envisioned by all women (4–6).
Despite global health efforts to improve maternal and newborn outcomes, maternal and child mortality remains a significant health problem. Nearly 287,000 women die annually from preventable causes worldwide, and almost 95% of these global deaths occur in low and middle-income countries (LMICS), with Sub-Saharan Africa (SSA) accounting for 70% (7). The Sustainable Development Goal (SDG) #3 targets the reduction of the global maternal mortality ratio (MMR) to less than 70 per 100,000 births by 2030 (8). However, strategies to improve access, utilization, and increase skilled birth attendance (9) continue to encounter many challenges.
Research shows women face various forms of disrespect and mistreatment throughout pregnancy and delivery (10–12), including physical, psychological, verbal, or sexual abuse, stigma, discrimination, detention in institutions, extortion, lack of supportive care, insufficient communication, and low care standards (13–15).
An unfortunate consequence of disrespectful care is decreased access to and usage of healthcare services (16). This hampers the progress toward reducing MMR, particularly in poor and LMICs (17–21) by reducing the likelihood of women using facility-based maternity care(10, 18, 22).
In Ghana, though skilled birth attendance rates have steadily increased over the years (23, 24), the lack of respectful treatment in healthcare facilities has been identified as a significant impediment to healthcare usage (17, 25–28). It is essential to evaluate care delivery strategies, as RMC plays a critical role in attaining care adherence among pregnant women and generally improves healthcare utilization for meeting global targets (9, 16, 29–31).
Predictably, threats to public health and human rights have prompted the current recognition and global discourse surrounding RMC. In 2015, WHO issued a global mandate urging concerted efforts worldwide to eliminate disrespect and abuse during facility-based care (32). The emphasis is to consistently and critically assess and evaluate the quality of care offered to pregnant women (33). This extends to the standard of care and the ethical conduct of midwifery practice (19, 20, 34, 35).
The White Ribbon Alliance (WRA) initiated seven rights for childbearing women to foster RMC. These are principles grounded on dignity, confidentiality, autonomy, respect, equity, culturally sensitive communication, information sharing, and shared decision-making void of ill-treatment, stigma, and discrimination (36, 37). It also aims at identifying strategies to enhance respectful care at every patient-provider interaction (34, 38).
Although a standardized approach to measuring mistreatment is still evolving (29), scholarly investigations have broadened our understanding of quality RMC. These studies have revealed that RMC encompasses more than the mere absence of mistreatment (19).
Group Antenatal Care
Group antenatal care (G-ANC) uses objective clinical evaluation and treatment, nonhierarchical participatory learning, and peer support to offer context-specific care for women (39). This behavior-based support model promotes patient involvement through health literacy and self-efficacy (40). While standard ANC emphasizes provider-patient interaction to raise women's awareness, G-ANC presents health information in a culturally appropriate way to create group strength. Based on the WHO Recommendations on Antenatal Care for a Positive Pregnancy Experience (6), G-ANC places women at the center of service delivery to improve access, engagement, and satisfaction.
Developing innovative ways of incorporating RMC into routine antenatal care is paramount. Approaches like the G-ANC model, aimed at enhancing RMC and improving maternal and neonatal health outcomes, can potentially improve and increase facility-based care.
A cluster randomized controlled trial (RCT) of G-ANC was conducted in Ghana with overarching aims to determine the difference between groups in birth preparedness, care seeking, and birth outcomes. The objective of this study is to examine the experience of care between women in the intervention and control groups quantitatively and qualitatively with those participating in G-ANC.