Modified Conceptual Framework for Respectful Maternity Care for Promoting Quality in Health Facilities

Abstract

Background: Respectful Maternity Care (RMC) is fundamental to improving maternal and neonatal health outcomes, yet mistreatment during childbirth remains widespread. Existing frameworks address either interpersonal mistreatment, structural delays, or quality standards, but often lack integration and clear evaluation pathways. Objective: This study presents a modified conceptual framework for RMC that unites training evaluation, systemic barriers, and patient experiences to guide quality improvement in Level 5 health facilities. Methods: The framework integrates three models: Kirkpatrick’s training evaluation model (linking provider learning to outcomes), Bowser & Hill’s landscape analysis (categorising disrespect and abuse), and the Three Delays model (addressing barriers to care). Principal Component Analysis (PCA) is proposed to enhance analytic rigour and weighting of variables. Results: The integrated framework demonstrates how provider training (reaction, learning, behaviour, results) influences women’s experiences of autonomy, dignity, and supportive environments, ultimately reducing delays and improving maternal and neonatal outcomes. Resource requirements—including staff training, supervision, and infrastructure—and cultural adaptations, such as respecting local birthing norms and promoting birth companionship, are essential for effective application. Recommendations: The framework guides implementation through structured steps: baseline assessments, stakeholder engagement, resource allocation, context-sensitive training protocols, and continuous monitoring and evaluation using Kirkpatrick’s four levels. Conclusion: By synthesising interpersonal, systemic, and evaluative dimensions, this model offers a robust and actionable tool for advancing RMC in resource-intensive settings. It provides policymakers, facility managers, and practitioners with a pathway to institutionalise respectful, equitable, and high-quality maternity care.