Respectful maternity care in low- and middle-income countries: a narrative review of evidence, implementation challenges, and future directions

Abstract

Respectful maternity care (RMC) is increasingly recognized as a fundamental component of quality maternal healthcare and a basic human right. Despite global efforts to maximize facility-based deliveries, widespread institutional mistreatment, abuse, and neglect continue to compromise maternal safety and undermine public trust in healthcare systems. This narrative review offers a timely, comprehensive synthesis of evidence from low- and middle-income countries (LMICs) between 2015 and 2026. It provides a critical assessment of the multi-level architecture shaping RMC by mapping how individual provider behaviors, facility infrastructure, systemic health policies, and deep-seated socio-cultural norms intersect to influence childbirth experiences. Methods: A narrative review framework was utilized to evaluate peer-reviewed articles, international agency reports, and national policy documents published from 2015 to 2026. A structured, four-stage screening process was deployed to select and map core clinical and structural literature regarding RMC implementation, barriers, facilitators, and outcomes across diverse LMIC settings. Results: The evidence synthesis was organized into four main areas: defining the dimensions of RMC; examining the consequences of mistreatment; identifying structural and system-level barriers; and describing facilitators of respectful care. Respectful maternity care was associated with greater maternal satisfaction, trust, and utilization of facility-based maternity services; however, implementation was constrained by workforce shortages, professional burnout, inadequate infrastructure, and weak accountability mechanisms. The review also proposes an actionable framework that links interconnected barriers, including facility-level overcrowding and socio-cultural power imbalances, with context-specific, multilevel intervention strategies. This framework provides a practical approach for translating human-rights principles into everyday maternity-care practice. Conclusion: Respectful maternity care is a critical component of quality maternal healthcare and a fundamental human-rights concern. Sustainable improvement requires context-sensitive, multilevel strategies that address provider behavior, facility conditions, health-system constraints, community engagement, and accountability. This review provides a synthesis of evidence that may inform clinicians, policymakers, researchers, and other stakeholders seeking to strengthen respectful maternity care across diverse LMIC settings. The proposed actionable framework may support context-specific implementation planning, although further research is needed to evaluate and refine its feasibility and validity.