Review provides potential framework for addressing disrespect in maternal care

A systemic review evaluating 37 studies relating to respectful maternal care (RMC) found that current research addressing this topic lacks a "gold standard" method for measuring respectful maternity carel. The authors also found that only one study addressed clinical outcomes for birthing patients and no studies addressed the relationship between RMC and infant health. The review is published in Annals of Internal Medicine.

Maternal mortality is worse in the United States than other comparable nations, especially for non-Hispanic Black women, for whom maternal mortality rates are 69.9 per 100,000 live births compared with 26.6 per 100,000 live births for non-Hispanic white women. Emerging research suggests that lack RMC contributes to maternal morbidity and mortality.

Researchers from Oregon Health & Science University conducted a systemic review of 37 studies to define RMC, evaluate the validity of tools to measure RMC, the relationship of RMC with maternal and infant health outcomes, and strategies for implementation of RMC.

The authors identified 12 frameworks for defining RMC that were categorized according to disrespect and abuse or rights-based frameworks. Twelve tools to measure RMC were validated in 24 studies based on content validity, construct validity, and internal consistency. They noted there were no gold standard tools for evaluating criterion validity. Additionally, there was only one trial that examined the effectiveness of RMC for improving maternal outcomes and it provided insufficient evidence.

There were no studies of RMC effectiveness for improving infant health outcomes and no studies evaluating the effectiveness of RMC implementation strategies.

An accompanying editorial by authors from the Weill Cornell School of Medicine suggests that the results of this review should guide development of a standard definition of RMC and a framework to address disrespect in maternity care.

The authors also note that at the policy level, this review highlights the importance and necessity of prioritizing the evaluation of efforts to implement RMC, underscoring its integral role in health care quality for birthing persons. The authors also advise that health researchers working with patients and communities should be funded to develop and test measurement tools, along with implementing a series of interventions to provide RMC for birthing persons.