Sage Journals: Discover world-class research

Abstract

Background:

Person-centered maternity care (PCMC) is a model that prioritizes respect, dignity, and responsiveness to each woman’s needs, values, and preferences during childbirth. It promotes open communication and personalized care, which is crucial for improving maternal satisfaction and increasing hospital-based deliveries. While recognized as a key element of quality maternal care, the implementation of PCMC varies across different countries. This review aims to assess the pooled mean score and key predictors of PCMC in Ethiopia.

Objectives:

This review aims to assess the pooled mean score and key predictors of PCMC in Ethiopia.

Design:

Systematic review and meta-analysis.

Data sources and methods:

This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. A comprehensive search was performed in international databases, and registers including: PubMed, Cochrane Library, Google Scholar, HINARI, Scopus, Web of Science, and African Journals Online databases. The quality of included studies was evaluated using the Joanna Briggs Institute tool. Heterogeneity was measured with the I² statistic and its p-value, and publication bias was examined through funnel plots and Egger’s test. A random effects model was applied to compute the pooled mean score of PCMC, and adjusted β with results presented as 95% confidence interval (CI).

Results:

Seven studies, involving 3383 women, were included in the review. The pooled mean PCMC score was 56.75% (95% CI: 55.08, 58.41). The highest scores were reported in Oromia (60.2) and Addis Ababa (59.2), while the lowest was in South Gondar (52.3). Key factors influencing PCMC included educational status (β: −2.7, 95% CI: −3.98, −1.45), complications during childbirth (β: −5.34, 95% CI: −7.24, −3.44), and time of delivery (β: −3.10, 95% CI: −4.10, −2.11).

Conclusion:

The pooled mean score of PCMC in Ethiopia is lower than in many other countries. Key determinants include women’s education, complications during childbirth, and the timing of delivery. Addressing these factors is crucial for improving the quality of PCMC in Ethiopia.

PROSPERO registration number:

CRD42024603854.

Keywords

person-centered maternity care dignified care autonomy supportive care time of delivery Ethiopia

Introduction

Maternal and neonatal mortality rates (MNMRs) remain unacceptably high in many low- and middle-income countries (LMICs).^1,2 In response to this critical issue, the World Health Organization (WHO) has strongly advocated for the delivery of high-quality care throughout pregnancy, childbirth, and the postnatal period as a key strategy to reduce mortality and morbidity in LMICs.³ Delivering high-quality maternity care requires more than just focusing on clinical components; it must also encompass respectful and dignified care.⁴ While the clinical aspects of care are central to reducing high mortality rates, addressing both dimensions is essential for comprehensive improvement.^4,5

Person-centered maternity care (PCMC) is a vital element of quality care throughout the pregnancy and childbirth journey; it has been identified as a promising factor in reducing MNMR, and the low utilization of facility-based deliveries.⁶ PCMC is a core component of quality maternity care, highlighted in the WHO recommendations for a positive childbirth experience.⁷ PCMC focuses on delivering childbirth care that is respectful, responsive, and compassionate.^6,8 This approach to care is gaining recognition as a crucial aspect of healthcare quality, particularly in maternity services.⁹ Effective PCMC ensures care that respects and responds to the preferences, needs, and values of individual women and their families.¹⁰

The core elements of PCMC include dignified and respectful treatment, effective communication and autonomy, and supportive care.¹¹ Evidence suggests that higher levels of PCMC are associated with improved maternal and neonatal outcomes. For example, studies have found that women who report better PCMC experiences are significantly less likely to experience maternal morbidity (by 62%) and neonatal morbidity (by 26%).¹² Additionally, receiving high-quality PCMC has been linked to a 61% reduction in neonatal complications compared to those who receive poor PCMC.¹³ Despite the acknowledged importance of PCMC, there is extensive evidence of poor implementation worldwide, often seen in the mistreatment of women during childbirth.¹⁴

The person-centered approach is a cost-effective strategy applicable in both developed and less-developed settings, significantly enhancing the quality of maternity care.¹⁵ It prioritizing respectful, responsive, and individualized care tailored to women’s unique needs, it fosters compassionate communication and support.¹⁶ This leads to improved maternal and neonatal outcomes, making it a promising solution for enhancing care across diverse healthcare environments, regardless of available resources.¹⁷ Implementation of PCMC is suboptimal and inequitable globally, particularly in communication and autonomy, mean PCMC scores were generally lower in Africa, moderate in Asia, and higher in the United States.⁶ Evidence indicates that the implementation of PCMC in LMICs is inadequate, with average scores for PCMC practices not exceeding 50%. In this region, communication and respect for women’s autonomy are often lacking, underscoring a significant gap in PCMC delivery. Additionally, the quality of PCMC varies based on women’s socioeconomic status and the type of healthcare facility where they give birth, revealing disparities in the provision of dignified and supportive care.¹¹

In Ethiopia, various individual studies conducted in different regions have reported that the mean score for implementing PCMC ranges from 19.07 out of 39 to 65.8 out of 90.^18–20. However, these studies have produced inconsistent results with significant variability, complicating efforts to draw general conclusions at the national level. To address this gap and establish robust evidence for best practices, a systematic review and meta-analysis has been proposed. The objective of this review is to assess and consolidate the available data, ultimately estimating the overall prevalence (mean score) of PCMC and identifying its potential predictors in Ethiopia.

Methods

Systematic review registration, data sources, and search strategies

This systematic review had designed to estimate the pooled prevalence (mean score) of PCMC and its predictors in Ethiopia. The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO), with a registration ID: CRD42024603854. All published articles were searched in major international databases such as PubMed, Cochrane Library, Google Scholar, HINARI, Scopus, Web of Science, and African Journals Online databases. For this review, the Condition, Context,

Population (CoCoPop) search strategy was used. The CoCoPop framework is a tool used to structure research questions and guide literature searches, particularly in systematic reviews focused on prevalence and observational data. It stands for Condition (the health issue or phenomenon of interest), Context (the setting or environment in which the issue occurs), and Population (the group of people being studied). Conditions: PCMC, context: Ethiopia, population: pregnant/childbearing women. PCMC in Ethiopia is the outcome of interest. The primary outcome was the magnitude of PCMC in Ethiopia. The secondary outcomes were: the predictors of PCMC. The research question is: What is the magnitude of PCMC in Ethiopia? And what are the key predictors of PCMC in Ethiopia. For each selected CoCoPop component, the electronic databases were searched using keywords and the medical subject heading (MeSH) terms. The search terms were combined by the Boolean operators “OR” and “AND” were used to structure the search effectively (Supplemental Material S1).

Eligibility criteria and study selection

This review included studies conducted using cross-sectional, cohort, or case–control designs that reported on the prevalence, magnitude, determinants, associated factors, or predictors of person-, individual-, women-, or patient-centered maternity care specifically using the standardized 30-item PCMC scale developed by Afulani among women who gave birth in health facilities in Ethiopia who gave birth in health facilities.²¹ Subsequently All English language published articles in Ethiopia released between January 2016 and November 5, 2025 were retrieved to these systematic reviews and meta-analysis. All identified articles from the databases and search engines were exported to EndNote 20 for management. First, through review of title, abstract and full paper was done by three reviewers (TNK, KAA, and SAG) independently. Any disagreement with the reviewers was settled by discussion and the involvement of a third reviewer as necessary. Subsequently, a full-text analysis of potentially qualifying studies including identification of duplicated records was done. In cases of duplication, only the full-text version of the article was retained for analysis.

Quality assessment and data abstraction

This systematic review and meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 checklist (Supplemental Material S2). The Joanna Briggs Institute (JBI) quality assessment tool was employed to evaluate the quality of the included studies. Quality appraisal was performed independently by two reviewers (TNK and KAA) to minimize bias and enhance the reliability and credibility of the findings. Specifically, the JBI critical appraisal checklist for analytical cross-sectional studies consisted of eight clearly defined criteria aimed at assessing methodological and overall quality of the studies. Each criterion provided four distinct options: “yes,” “no,” “unclear,” and “not applicable.” The maximum score achievable with the JBI tool was 8 (based on the sum of “yes” responses). To determine the quality of each study, a good-quality article were the one that fulfills most of the JBI criteria with minimal concerns about bias, confounding, or other methodological issues.^22,23 Consequently, to ensure the validity of the systematic review findings, primary studies classified as good quality were included (Supplemental Material S3). Then, two reviewers (TNK and KAA) independently extracted the pertinent data from the selected articles using a standardized data extraction format prepared in Microsoft Excel. The data extraction format included primary author, publication year, study setting, study period, sample size, the mean score of PCMC and mean score of each three components of PCMC (dignity and respect, communication and autonomy, and supportive care) as reported in the primary studies. All primary studies included in this review assessed PCMC using the standardized 30-item PCMC scale developed by Afulani et al. This scale comprises 30 items divided into three domains and is typically scored on a 4-point Likert scale ranging from 0 to 3 per item, yielding a total possible score of 90. All of the included studies reported both the mean total PCMC score out of 90 and the corresponding normalized score on a percentage scale (out of 100%) to facilitate interpretation and comparison. Since the standard reporting format for PCMC is the mean score out of 90, we used this format for analysis. Both overall and domain-specific PCMC mean scores were used to interpret the level of PCMC in each context and enabled a more nuanced synthesis of findings across studies. And the selected predictors of PCMC (adjusted beta coefficient with confidence interval (CI), extracted directly from the multivariable linear regression analyses reported in each of the individual primary studies. These coefficients represent the adjusted associations between the selected predictors and the PCMC score as reported by the original study authors) were taken based on the available articles (Supplemental Material S4). Then it was exported to STATA version 17 (StataCorp LLC, Texas, USA) for analysis.

Publication bias and statistical analysis

The publication bias was assessed using the funnel plot and Egger’s tests with a p-value of less than 0.05 declared as publication bias.^24,25 I² statistic was employed to assess heterogeneity among studies and a p-value less than 0.05 and I² ⩾70% was used to declare heterogeneity. As a result of moderate heterogeneity, the random effects model was used as a method of analysis to estimate the pooled effect. The effect of selected determinant variables was analyzed using separate categories of meta-analysis. The findings of the meta-analysis were presented using forest plot and adjusted β-value with its 95% CI. Additionally, we performed a sensitivity analysis to assess whether the pooled prevalence estimates were influenced by individual studies.

Results

Study identification and characteristics of included studies

This systematic review and meta-analysis included published studies on PCMC and determinant of PCMC in Ethiopia using international electronic databases. The initial search yielded 4394 articles, both published and unpublished. After removing 126 duplicates, 4268 articles remained for title and abstract screening, which led to the exclusion of 4200 articles. A total of 68 full-text articles were then assessed based on predefined inclusion and exclusion criteria. Of these, 61 were excluded for not addressing the primary outcomes of interest or for not using the appropriate operational definition of PCMC. Many of these studies focused on respectful maternity care, which is a component of PCMC but does not cover the full scope, leading to their exclusion to avoid bias in the PCMC implementation. Additionally, three studies were excluded because they focused on person-centered abortion care rather than childbirth care,^26–28 and one study was excluded as it was focused on person-centered ante natal care.²⁹ One particular study on PCMC was excluded from the meta-analysis because it used a 13-item PCMC scale, differing from the 30-item scale recommended by other studies; this study reported a mean PCMC score of 19.01.²⁰ Ultimately, seven cross-sectional studies met the criteria and were included in the final quantitative meta-analysis (Figure 1).

Figure 1.

Flowchart of study selection for systematic review and metanalysis on PCMC and its predictors among women who gave birth in Ethiopia.

Characteristics of the included studies

All seven studies included in the review were cross-sectional in design, each reporting both the magnitude and determinants of PCMC among women who had given birth. The studies collectively involved 3383 women in Ethiopia between 2020 and 2024. The largest sample size (763) was from a study conducted in South Gondar, Amhara region, whereas the smallest sample (317) came from a study in Dessie, also in the Amhara region.^30,31 The studies were conducted across four regions of Ethiopia: four in the Amhara region,^30–33 one from Southern Nations, Nationalities and Peoples region (SNNPR),³⁴ one from Addis Ababa,¹⁹ and the remained one was from Oromia (Table 1).¹⁸

Table 1.

The characteristics of the included studies on PCMC during childbirth and its predictors among women who gave birth in Ethiopia.

Author	Year of publication	Study setting	Study design	Sample size	Mean score of PCMC
Dagnaw et al.³⁵	2020	Amhara	Cross-sectional	317	58
Tarekegne et al.¹⁹	2022	Addis Ababa	Cross-sectional	384	59.2
Kehali et al.³³	2022	Amhara	Cross-sectional	379	64
Alelign et al.³²	2022	Amhara	Cross-sectional	387	56.83
Getahun et al.³⁴	2022	SNNPR	Cross-sectional	581	56
Dagnaw et al.³⁰	2024	Amhara	Cross-sectional	763	52.33
Kabale et al.¹⁸	2024	Oromia	Cross-sectional	572	60.2

PCMC: person-centered maternity care; SNNPR: Southern Nations, Nationalities and Peoples region.

PCMC in Ethiopia

The meta-analysis of the seven studies showed that the pooled mean score of PCMC among women who gave birth in Ethiopia was 57.92 (95% CI: 55.01, 60.83). A random effect model was used because there is moderate heterogeneity (I² = 66.6%, p = 0.006; Figure 2).

Figure 2.

The pooled mean score of person-centered maternity care during childbirth in Ethiopia.

Subgroup analysis

Subgroup analysis of the mean scores of PCMC across different regions in Ethiopia. The finding of the subgroup analysis reveals consistent PCMC scores within Addis Ababa, Oromia, and SNNPR, but significant variability within the Amhara region (I² = 79.8%). The overall analysis suggests a moderate level of heterogeneity across all studies, but no significant differences between the regional subgroups (p = 0.513; Figure 3).

Figure 3.

Findings of the subgroup analysis by study setting on person-centered maternity care during childbirth in Ethiopia.

Sensitivity analysis

The sensitivity analysis revealed that no single study exerted undue influence on the overall estimate of PCMC prevalence among Ethiopian women. The pooled estimate remained stable, with values close to the overall combined estimate of 57.92%, regardless of which study was excluded. The CI for each omitted study also showed consistency, ranging from approximately 54.2%–61.8%. The estimates varied slightly, from a low of 57.52% when Kabale et al. was excluded, to a high of 58.99% when Dagnaw et al. was excluded. This analysis confirms that the pooled PCMC prevalence estimate of 57.92% is robust and stable. Excluding any one study did not cause significant fluctuations in the overall estimate, with the revised values staying within a narrow range (57.52%–58.99%). Therefore, the meta-analysis results of this studies are reliable and not overly influenced by any individual study, supporting the validity of the pooled PCMC prevalence estimate in Ethiopia (Table 2 and Figure 4).

Table 2.

The sensitivity analysis report on person-centered maternity care among women who gave birth in Ethiopia.

Study omitted	Estimate	95% confidence interval
Dagnaw et al.³¹	57.934	54.592, 61.276
Kehali and colleagues³³	56.890	54.337, 59.443
Tarekegne et al.¹⁹	57.744	54.397, 61.090
Alelign et al.³²	58.119	54.733, 61.505
Getahun et al.³⁴	58.295	54.848, 61.743
Dagnaw et al.³⁰	58.996	56.682, 61.310
Kabale et al.¹⁸	57.524	54.219, 60.829
Combined	57.920	55.005, 60.834

Figure 4.

Leave-one-out sensitivity analysis plot of person-centered maternity care during childbirth in Ethiopia.

Publication bias

A funnel plot and Egger’s test were used to assess potential publication bias in this meta-analysis. While the funnel plot appears slightly asymmetric upon visual inspection, the statistical results from Egger’s test indicate no significant publication bias, with a p-value of 0.164. Therefore, the systematic review and meta-analysis do not show evidence of significant publication bias. The slight asymmetry in the funnel plot is likely due to the small number of studies included in the meta-analysis, rather than actual publication bias (Figure 5).

Figure 5.

Funnel plot assessing publication bias for person-centered maternity care during childbirth in Ethiopia.

Distribution of the PCMC subscale in Ethiopia

PCMC is assessed using three major subscales: dignity and respect (6 items, maximum score of 18), communication and autonomy (9 items, maximum score of 27), and supportive care (15 items, maximum score of 45), giving a total of 30 items and a maximum score of 90. This review found that, in Ethiopia, supportive care is provided less effectively compared to the other two subscales, indicating a gap in the implementation of comprehensive PCMC.

Dignity and respect

The mean score for implementing dignity and respect during childbirth in Ethiopia is 13.78 out of 18. This score reflects the overall level of attention and priority given to ensuring that women are treated with dignity and respect throughout the childbirth process in the country. The practice of maintaining dignity and respect during childbirth is critical to promoting a positive birth experience, as it encompasses the recognition of a woman’s autonomy, cultural preferences, and personal needs (Figure 6).

Figure 6.

The pooled mean score of dignified and respectful care during childbirth in Ethiopia.

Communication and autonomy

The mean score for the implementation of communication and autonomy during childbirth in Ethiopia is 15.68 out of 27. This score indicates the extent to which women are involved in decision-making and whether they experience clear, respectful communication during childbirth. Improving communication and autonomy can also foster trust in the healthcare system and promote more positive experiences for women giving birth (Figure 7).

Figure 7.

The pooled mean score of communication and autonomy during childbirth care in Ethiopia.

Supportive care

The mean score for implementing supportive care during childbirth in Ethiopia is 26.27 out of 45. This score reflects the level of support that women receive during labor and delivery, including emotional, physical, and informational support. Supportive care would contribute to a more positive birth experience, improved maternal and neonatal outcomes, and greater satisfaction with the care provided. It could also help in building trust in healthcare services, encouraging women to seek professional care during childbirth and ensuring that their needs are met in a respectful and supportive manner (Figure 8).

Figure 8.

The pooled mean score of supportive care during childbirth in Ethiopia.

Predictors of PCMC in Ethiopia

This meta-analysis identified three significant factors that are strongly associated with PCMC in Ethiopia. These factors include the time of delivery (day or night), the educational status of the women, and complications during the childbirth process.

Time of delivery

Women who gave birth at night in Ethiopia had significantly lower PCMC scores compared to those who delivered during the day. On average, their scores were 3.10 points lower on the 90-point PCMC scale (adjusted β value of −3.10, 95% CI: −4.10, −2.11). This significant difference highlights a disparity in the quality of maternity care based on the time of delivery. Improving PCMC for night-time deliveries requires targeted interventions, such as ensuring adequate staffing levels, providing additional support during night shifts, and training staff to maintain high-quality, patient-centered care at all times (Figure 9).

Figure 9.

Relationship between time of delivery and person-centered maternity care during childbirth in Ethiopia.

Educational status of the women

Women without formal education in Ethiopia had significantly lower PCMC scores than those with formal compared to women with formal education. On average, their PCMC scores were 2.70 points lower on the 90-point scale (adjusted β value of −2.7, 95% CI: −3.98, −1.45). This suggests a significant disparity in the quality of maternity care based on a woman’s educational status. Addressing this disparity requires focused interventions, such as health education programs that empower women with information about their maternity care rights and options, as well as training healthcare providers to offer equitable, respectful care regardless of a woman’s educational background (Figure 10).

Figure 10.

Relationship between educational status of women and person-centered maternity care during childbirth in Ethiopia.

Complication during the childbirth process

Women who experienced complications during childbirth, either affecting themselves or their newborns, had significantly lower PCMC scores compared to those without complications. On average, their PCMC scores were 5.34 points lower on the 90-point scale (adjusted β value of −5.34, 95% CI: −7.24, −3.44). This significant difference highlights how the presence of complications can negatively impact the quality of care received. By improving the balance between clinical care and person-centered care during complications, the healthcare system can ensure that women receive holistic care that addresses both their medical and emotional needs, ultimately improving their childbirth experience and outcomes (Figure 11).

Figure 11.

Relationship between complications during the childbirth process and person-centered maternity care during childbirth in Ethiopia.

Discussion

This systematic review and meta-analysis found that the pooled mean score of PCMC in Ethiopia is 57.92 (95% CI: 55.01, 60.83). This result aligns with similar studies conducted in other LMICs, such as a peri-urban setting in Kenya (58.2 out of 90), India (54), and Nigeria (55.13).^11,36,37 The consistency of these findings across diverse geographic regions suggests that there are shared challenges in implementing PCMC in resource-constrained settings.

However, the pooled mean score for PCMC in Ethiopia (57.92) is higher than scores reported in studies conducted in rural Kenya (24.2 out of 39),³⁸ Ghana (46.5 out of 90), Sierra Leone (38.2 out of 90),⁶ and Massachusetts, United States (47.80 out of 90).⁹ These differences may be attributed to variations in sociodemographic characteristics and contextual factors that affect the implementation of PCMC. In the case of Kenya, the study was conducted in a rural setting where women may have limited awareness of their reproductive rights during childbirth. This lack of knowledge can hinder their ability to demand or expect PCMC, as they may not fully understand what constitutes respectful and supportive care. Additionally, rural healthcare facilities often face more significant resource constraints, further limiting the delivery of high-quality, person-centered care. In the study from the United States, the focus was solely on primipara women (first-time mothers), a population that may have different needs and expectations compared to multiparous women. First-time mothers may have less experience with the healthcare system and may not advocate for themselves as confidently, potentially affecting their ability to receive PCMC. Additionally, the stress and uncertainty of a first childbirth experience could influence the quality of care they perceive, even in a high-resource setting like Massachusetts. These contextual differences may explain why the review found a higher mean score of PCMC in Ethiopia compared to these other regions.

The findings of this review show that the pooled mean score for PCMC implementation in Ethiopia (57.92) is lower than the global range (60%–90% out of 100)⁶ as well as lower than studies conducted in urban areas of Kenya (60.9% out of 100)¹¹ and Ghana (66.8% out of 100).³⁸ Several factors may contribute to this difference, including variations in sociodemographic characteristics and disparities in the healthcare systems between Ethiopia and other regions. Another possible reason for the lower score in Ethiopia could be the variation in the implementation of healthcare policies and guidelines aimed at improving maternal care. Countries with better PCMC scores may have more advanced policies or stronger enforcement of standards for respectful maternity care, contributing to higher levels of care and patient satisfaction.

The finding of this review found that women without formal education tended to have lower PCMC scores compared to those with formal education. This is consistent with similar findings from a study conducted in Kenya.^21,35 One possible explanation for this disparity is that women who lack formal education may be less aware of their rights during childbirth. As a result, they may not feel empowered to ask healthcare providers about the procedures being performed during labor and delivery. This lack of communication and advocacy could lead to lower-quality, less personalized care for women without formal education, as they may not actively engage in decisions or express their preferences during childbirth. Consequently, healthcare providers may offer less PCMC to these women compared to their more educated counterparts. This highlights the need for improved education and empowerment programs for all women, particularly those with limited formal education, to ensure they are informed and confident in asserting their rights during childbirth.

The results of this review showed that women who gave birth during the night had PCMC scores that were significantly lower than those who delivered during day time. This finding is in line with a study conducted in Kenya.²¹ The possible explanation for this difference is that fewer healthcare providers are available during night shifts, creating a mismatch between the number of patients and the available staff. Additionally, since a significant proportion of deliveries occur at night, the workload on the limited staff is disproportionately high, leading to compromised care.³⁹ This lack of adequate staffing and resources may contribute to the lower quality of PCMC provided to women during night deliveries. Such findings highlight the importance of ensuring adequate staffing and resources during all hours, particularly at night, to maintain the quality of care and ensure that every woman receives respectful, supportive, and individualized care, regardless of when she gives birth.

Women who experienced complications during pregnancy and childbirth were significantly less likely to receive PCMC compared to those with smooth pregnancies and deliveries. This finding aligns with studies conducted in Kenya, Ghana, and other LMICs.^{35,38,40–42} The possible explanation is that women with complicated deliveries and poor birth outcomes may feel disappointed or distressed, which can hinder open communication with healthcare providers. This breakdown in communication can negatively impact the delivery of person-centered care, as the emotional and psychological needs of these women may not be adequately addressed during the birthing process. Furthermore, the focus on managing medical complications might lead providers to prioritize clinical interventions over compassionate, respectful, and individualized care, further contributing to lower PCMC scores among this group. Perceived lower PCMC scores could be influenced by the emotional response to a negative or traumatic birth experience, even if the actual care provided was technically appropriate and responsive. In such cases, lower PCMC scores might not necessarily reflect poor-quality care, but rather a mismatch between expectations and outcomes, or a lack of emotional closure. Ensuring emotional support and open dialog during such critical moments is essential to maintaining person-centered care, even in high-pressure situations.

Limitation of the review

One key limitation of this systematic review and meta-analysis on PCMC is the small number of the included studies, with only seven studies drawn from four regions of the country. This limited sample size may weaken the comprehensiveness of the findings, as it fails to capture potential variations in PCMC practices across other regions. Consequently, the results may not fully represent the national picture, reducing the generalizability of the conclusions. Expanding future research to include a wider range of regions would provide a more accurate assessment of PCMC across the country, enabling a deeper understanding of the factors affecting its implementation. Additionally, although all included primary studies employed probability sampling techniques primarily simple random and systematic sampling, there remains a potential risk of selection bias, which may affect the representativeness of the study populations. Furthermore, the measurement of PCMC in the included primary studies relied exclusively on self-reported data, which is inherently prone to response bias. Women may not accurately recall all aspects of their birth experiences, or they may hesitate to report negative experiences due to fear of judgment or social desirability bias. This limitation should be considered when interpreting the findings, and future research may benefit from complementing self-report measures with qualitative methods or direct observations to enhance validity.

Conclusion

The mean score of PCMC in Ethiopia is lower compared to many studies conducted in other regions. Key factors contributing to this include women’s educational status, complications during childbirth, and the time of delivery, particularly at night. These factors have been consistently supported by various studies as significant contributors to the lower levels of PCMC. To address these challenges, it is essential to prioritize the improvement of respectful, dignified, and women-centered care in maternity services. We recommend that stakeholders, including policymakers, healthcare institutions, and community leaders, take steps to enhance the training and support for healthcare providers to fully implement PCMC practices. Additionally, empowering women to actively participate in decision-making during their childbirth process is crucial to fostering a more collaborative and respectful care environment. By addressing these areas, Ethiopia can improve the quality of maternal care and ensure better health outcomes for women.

Supplemental Material

sj-docx-1-whe-10.1177_17455057251392349 – Supplemental material for Person-centered maternity care during childbirth and its predictors in Ethiopia: Systematic review and meta-analysis

Supplemental material, sj-docx-1-whe-10.1177_17455057251392349 for Person-centered maternity care during childbirth and its predictors in Ethiopia: Systematic review and meta-analysis by Tirusew Nigussie Kebede, Kidist Ayalew Abebe, Leweyehu Alemaw Mengstie, Moges Sisay Chekole, Sewunnet Azezew Getahun, Tebabere Moltot Kitaw, Birhan Tsegaw Taye and Solomon Hailemeskel Beshah in Women's Health

Supplemental Material

sj-docx-2-whe-10.1177_17455057251392349 – Supplemental material for Person-centered maternity care during childbirth and its predictors in Ethiopia: Systematic review and meta-analysis

Supplemental material, sj-docx-2-whe-10.1177_17455057251392349 for Person-centered maternity care during childbirth and its predictors in Ethiopia: Systematic review and meta-analysis by Tirusew Nigussie Kebede, Kidist Ayalew Abebe, Leweyehu Alemaw Mengstie, Moges Sisay Chekole, Sewunnet Azezew Getahun, Tebabere Moltot Kitaw, Birhan Tsegaw Taye and Solomon Hailemeskel Beshah in Women's Health

Supplemental Material

sj-docx-3-whe-10.1177_17455057251392349 – Supplemental material for Person-centered maternity care during childbirth and its predictors in Ethiopia: Systematic review and meta-analysis

Supplemental material, sj-docx-3-whe-10.1177_17455057251392349 for Person-centered maternity care during childbirth and its predictors in Ethiopia: Systematic review and meta-analysis by Tirusew Nigussie Kebede, Kidist Ayalew Abebe, Leweyehu Alemaw Mengstie, Moges Sisay Chekole, Sewunnet Azezew Getahun, Tebabere Moltot Kitaw, Birhan Tsegaw Taye and Solomon Hailemeskel Beshah in Women's Health

Supplemental Material

sj-xlsx-4-whe-10.1177_17455057251392349 – Supplemental material for Person-centered maternity care during childbirth and its predictors in Ethiopia: Systematic review and meta-analysis

Supplemental material, sj-xlsx-4-whe-10.1177_17455057251392349 for Person-centered maternity care during childbirth and its predictors in Ethiopia: Systematic review and meta-analysis by Tirusew Nigussie Kebede, Kidist Ayalew Abebe, Leweyehu Alemaw Mengstie, Moges Sisay Chekole, Sewunnet Azezew Getahun, Tebabere Moltot Kitaw, Birhan Tsegaw Taye and Solomon Hailemeskel Beshah in Women's Health

Footnotes

Acknowledgements

We would like to express our sincere gratitude to Asrat Woldeyes Health Science Campus, Debre Berhan University for providing us with the time and institutional support (unlimited internet access) to conduct this systematic review and meta-analysis. We also extend our appreciation to the authors of the primary studies included in this review, particularly those who contributed to the development and application of the PCMC framework. Their valuable work laid the foundation for our analysis and significantly contributed to the advancement of evidence-based maternal healthcare practices.

ORCID iDs

Tirusew Nigussie Kebede

Moges Sisay Chekole

Solomon Hailemeskel Beshah

Ethical considerations

Not applicable.

Consent to participate

Not applicable.

Consent for publication

Not applicable.

Author contributions

Tirusew Nigussie Kebede and Kidist Ayalew Abebe: Contributed to the conception and development of the study protocol.

Tirusew Nigussie Kebede and Kidist Ayalew Abebe: Extracted data from the eligible articles. All authors participated in the formal analysis and in drafting the initial version of the manuscript.

Leweyehu Alemaw Mengstie, Moges Sisay Chekole, Solomon Hailemeskel Beshah, Tebabere Moltot Kitaw, Birhan Tsegaw Taye, and Sewnnet Azezew Getahun: Contributed to the interpretation of findings and critically revised the manuscript for important intellectual content.

All authors were involved in reviewing and editing the manuscript and approved the final version for submission.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data availability statement

All data generated or analyzed during this systematic review and meta-analysis are fully included within the manuscript and Supplemental Material.

Supplemental material

Supplemental material for this article is available online.

References

WHO. Maternal mortality, https://www.who.int/news-room/fact-sheets/detail/maternal-mortality#:~:text=The%20major%20complications%20that%20account,pre%2Declampsia%20and%20eclampsia)%3B (2024).

WHO. Newborn mortality, https://www.who.int/news-room/fact-sheets/detail/newborn-mortality (2024).

WHO. Service delivery with quality, https://www.who.int/teams/maternal-newborn-child-adolescent-health-and-ageing/maternal-health/service-delivery-with-quality (2019).

. Reducing maternal mortality in the United States. JAMA 2018; 320(12): 1237–1238.

Wong

Kitsantas

. A review of maternal mortality and quality of care in the USA. J Matern Fetal Neonatal Med 2020; 33(19): 3355–3367.

Odiase

Smith

Ogunfunmi

, et al. (2024, October 18). Person‑Centered Maternity Care: A Global Systematic Review (SSRN 4990485). http://dx.doi.org/10.2139/ssrn.4990485

World Health Organization. WHO recommendations on intrapartum care for a positive childbirth experience. World Health Organization, 2018.

Metrics for Management. PCMC (Person Centered Maternity Care), https://m4mgmt.org/person-centered-maternity-care/ (2019).

Attanasio

Ranchoff

Paterno

, et al. Person-centered maternity care and health outcomes at 1 and 6 months postpartum. J Womens Health (Larchmt) 2022; 31(10): 1411–1421.

10.

Sudhinaraset

Afulani

Diamond-Smith

, et al. Advancing a conceptual model to improve maternal health quality: the person-centered care framework for reproductive health equity. Gates Open Res 2017; 1: 1.

11.

Afulani

Phillips

Aborigo

, et al. Person-centred maternity care in low-income and middle-income countries: analysis of data from Kenya, Ghana, and India. Lancet Glob Health 2019; 7(1): e96–e109.

12.

Sudhinaraset

Landrian

Golub

, et al. Person-centered maternity care and postnatal health: associations with maternal and newborn health outcomes. AJOG Glob Rep 2021; 1(1): 100005.

13.

Sudhinaraset

Landrian

Afulani

, et al. Association between person-centered maternity care and newborn complications in Kenya. Int J Gynecol Obstet 2020; 148(1): 27–34.

14.

Bohren

Vogel

Hunter

, et al. The mistreatment of women during childbirth in health facilities globally: a mixed-methods systematic review. PLoS Med 2015; 12(6): e1001847.

15.

Rubashkin

Warnock

Diamond-Smith

. A systematic review of person-centered care interventions to improve quality of facility-based delivery. Reprod Health 2018; 15: 1–22.

16.

Afulani

Diamond-Smith

Golub

, et al. Development of a tool to measure person-centered maternity care in developing settings: validation in a rural and urban Kenyan population. Reprod Health 2017; 14: 1–18.

17.

Koblinsky

Moyer

Calvert

, et al. Quality maternity care for every woman, everywhere: a call to action. Lancet 2016; 388(10057): 2307–2320.

18.

Kabale

Bekele

Gonfa

, et al. Person-centered maternity care during childbirth and associated factors at public hospitals in central Ethiopia. SAGE Open Med 2024; 12: 20503121241257790.

19.

Tarekegne

Giru

Mekonnen

. Person-centered maternity care during childbirth and associated factors at selected public hospitals in Addis Ababa, Ethiopia, 2021: a cross-sectional study. Reprod Health 2022; 19(1): 199.

20.

Stierman

Zimmerman

Shiferaw

, et al. Understanding variation in person-centered maternity care: results from a household survey of postpartum women in 6 regions of Ethiopia. AJOG Glob Rep 2023; 3(1): 100140.

21.

Afulani

Sayi

Montagu

. Predictors of person-centered maternity care: the role of socioeconomic status, empowerment, and facility type. BMC Health Serv Res 2018; 18: 360.

22.

JBI. Critical appraisal tool. Analytical cross sectional studies, https://jbi.global/critical-appraisal-tools (2020).

23.

Joanna Briggs Institute. Checklist for case control studies: critical appraisal tools for use in JBI Systematic Reviews. Joanna Briggs Institute, (2017)

24.

Begg

Mazumdar

. Operating characteristics of a rank correlation test for publication bias. Biometrics 1994: 1088–1101.

25.

Egger

Smith

Schneider

, et al. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997; 315(7109): 629–634.

26.

Chekol

McCaffrey

Dijkerman

, et al. Person-centered abortion care in public health facilities across four regions of Ethiopia: a cross-sectional quantitative study of client experiences. Front Reprod Health 2024; 6: 1331682.

27.

Chekol

McCaffrey

Dijkerman

, et al. Client’s experiences on the provision of person-centered abortion care in public health facilities across four regions of Ethiopia: a cross-sectional study. Front Reprod Health 2023; 6: 1331682.

28.

Fekadu

Berhe

Belgu

, et al. Professionalism, stigma, and willingness to provide patient-centered safe abortion counseling and care: a mixed methods study of Ethiopian midwives. Reprod Health 2022; 19(Suppl 1): 197.

29.

Demeke

Fisseha

Gebremariam

. Levels of person centered antenatal care among pregnant women in public and private health facilities in Western Hararghe Zone, Ethiopia: an institution based comparative mixed method study design. medRxiv 2024;2024:2024.11.23.24317821.

30.

Dagnaw

Bizuneh

Kassie

. Person-centered maternity care and associated factors among women who give birth at public hospitals in South Gondar zone, North West Ethiopia, 2023. PLoS One 2024; 19(8): e0303389.

31.

Dagnaw

Tiruneh

Azanaw

, et al. Determinants of person-centered maternity care at the selected health facilities of Dessie town, Northeastern, Ethiopia: community-based cross-sectional study. BMC Pregnancy Childbirth 2020; 20: 1–10.

32.

Alelign

Melesse

Beka

, et al. Person-centered maternity care during childbirth and associated factors among mothers who gave birth at public health institutions of Debre Markos town, Northwest Ethiopia, 2022: a cross-sectional study. SAGE Open Med 2024; 12: 20503121231225352.

33.

Dagnaw

Kehali

Agago

, et al. Person-centered maternity care among mothers who gave Birth in South Wollo Zone Public hospitals, Northeastern Ethiopia: a mixed-method study. Health Serv Insights 2022; 15: 11786329221127946.

34.

Getahun

Muluneh

Seneshaw

, et al. Person-centered care during childbirth and associated factors among mothers who gave birth at health facilities in Hawassa city administration Sidama Region, Southern Ethiopia. BMC Pregnancy Childbirth 2022; 22(1): 584.

35.

Dagnaw

Tiruneh

Azanaw

36.

Oluoch-Aridi

Afulani

Makanga

, et al. Examining person-centered maternity care in a peri-urban setting in Embakasi, Nairobi, Kenya. PLoS One 2021; 16(10): e0257542.

37.

Ogbuabor

Nwankwor

. Person-Centred maternity care in a poor-resource setting: evidence from a cross-sectional study in Enugu State, Nigeria. Int J Public Health 2020; 66: 612894.

38.

Kiti

Prata

Afulani

. Continuous labor support and person-centered maternity care: a cross-sectional study with women in rural Kenya. Matern Child Health J 2022; 26(1): 205–216.

39.

Martin

Cortina-Borja

Newburn

, et al. Timing of singleton births by onset of labour and mode of birth in NHS maternity units in England, 2005–2014: a study of linked birth registration, birth notification, and hospital episode data. PLoS One 2018; 13(6): e0198183.

40.

Afulani

Okiring

Aborigo

, et al. Provider implicit and explicit bias in person-centered maternity care: a cross-sectional study with maternity providers in Northern Ghana. BMC Health Serv Res 2023; 23(1): 254.

41.

Afulani

Getahun

Ongeri

, et al. A cluster randomized controlled trial to assess the impact of the ‘Caring for Providers to Improve Patient Experience’ intervention on person-centered maternity care in Kenya and Ghana: study protocol. Research Square; 2024.

42.

Kim

J-H

Bell

Ratcliffe

, et al. Predictors of patient-reported quality of care in low-and middle-income countries: a four-country survey of person-centered care. Int J Qual Health Care 2021; 33(3): mzab110.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.01 MB

0.03 MB

0.01 MB