BACKGROUND : Health professionals are striving to improve respectful care for women, but they fall short in the
domains of effective communication, respectful and dignified care and emotional support during labour. This study
aimed to determine women’s experiences of childbirth with a view to improving respectful clinical care practices in
low-risk, midwife-led obstetric units in the Tshwane District Health District, South Africa.
METHODS : A survey covering all midwife-led units in the district was conducted among 653 new mothers. An
anonymous questionnaire was administered to mothers returning for a three-days-to-six-weeks postnatal follow-up
visit. Mothers were asked about their experiences regarding communication, labour, clinical care and respectful care
during confinement. An ANCOVA was performed to identify the socio-demographic variables that significantly
predicted disrespectful care. Six items representing the different areas of experience were used in the analysis.
RESULTS : Age, language, educational level and length of residence in the district were significantly associated with
disrespectful care (p ≤ 0.01). Overall, the following groups of mothers reported more negative care experiences
during labour: women between the ages of 17 and 24 years; women with limited formal education; and women
from another province or a neighbouring country. Items which attracted fewer positive responses from participants
were the following: 46% of mothers had been welcomed by name on arrival; 47% had been asked to give consent
to a physical examination; and 39% had been offered food or water during labour. With regard to items related to
respectful care, 54% of mothers indicated that all staff members had spoken courteously to them, 48% said they
had been treated with a lot of respect, and 55% were completely satisfied with their treatment.
CONCLUSION : There is a need to improve respectful care through interventions that are integrated into routine care
practices in labour wards. To stop the spiral of abusive obstetric care, the care provided should be culturally
sensitive and should address equity for the most vulnerable and underserved groups. All levels of the health care
system should employ respectful obstetric care practices, matched with support for midwives and improved clinical
governance in maternity facilities.
Additional file 1: Anonymous questionnaire for mothers of newborn
Additional file 2: ANCOVA significant differences of class variables and
graphs of maximum of means within standard error of maximum mean.
Additional file 3: Results of ANCOVA with observations weighted
according to the number of deliveries.
We are grateful to the mothers for their participation and we thank all
healthcare professionals that participated in the study. The following
colleagues are acknowledged for support and encouragement: Jannie Hugo,
Peter Macdonald, Ute Feucht, Lizzy Sithole, Vivian Mfolo, Rinah Skhosana,
Mphai Tshukudu, Myatt Pe, Mothomone Pitsi and Michael Silberbauer. We
thank all research assistants for administering the surveys: Sharlotte Chuene,
Iyander Ngobeni, Thelma Ndlovu, Nyiko Sithole, Cecelia Simba, Albertina
Shabangu, Gillian Moodley, Qhama Mankayi, Irene Mudau, Rebaone
Molebatsi, Kabelo Komana, Errol Baloyi and Sasha Lalla.