Person-centered maternity care during childbirth in low- and middle-income countries: A systematic review and meta-analysis

Background Person-centered maternity care (PCMC) is defined as providing respectful, responsive, and compassionate care to all women and their families' preferences, needs, and values during childbirth. However, women are subjected to non-dignified and abusive care by maternity health professionals at healthcare facilities, either intentionally or unintentionally, during childbirth. It is a global issue, particularly more prevalent and underreported in low- and middle-income countries. Disrespect and mistreatment of childbearing women are recognized as violations of fundamental rights. Therefore, this systematic review and meta-analysis determined the overall prevalence of PCMC in low- and middle-income countries (LMICs) and identified its determinant factors. Methods This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The study protocol for this review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (ID CRD42024523532). We conducted a systematic and comprehensive search using major electronic databases, including PubMed, Hinari, Scopus, and Embase. In addition, we searched Google Scholar for pertinent studies. The data were extracted using Microsoft Excel and analyzed using Stata software version 17. The methodological quality of the included studies was assessed using the Joanna Briggs Institute’s (JBI) critical appraisal tool. Publication bias was assessed using the funnel plot and Egger’s test. A random-effects model using the Der Simonian Laird method was used to estimate the pooled prevalence of person-centered maternity care. The I-squared test was performed to assess statistical heterogeneity among the included papers. Results This systematic review and meta-analysis study includes 20 eligible studies with a total of 9,817 study participants. The pooled prevalence of person-centered maternity care during childbirth in LMICs was 56.61% (95% CI: 50.88, 62.33). Regarding the sub-domains of PCMC, the highest prevalence was found in the dignity and respectful care sub-domain (70.76%), whereas the lowest prevalence was observed in the autonomy and communication sub-dimension (49.19%). Maternal age, marital status, level of education, household wealth, employment status, number of births, antenatal follow-up, type of birth facility, time of childbirth, early initiation of antenatal care, birth assisted by skilled birth attendants, domestic violence, gender of skilled birth attendant, decision-making ability, presence of birth companion, and obstetric complications have shown a significant association with PCMC across different studies. Conclusions The findings of this review indicated that the pooled prevalence of person-centered maternity care in LMICs remains low compared to WHO recommendations on intrapartum care for a positive childbirth experience. These findings underline the need for evidence-based, contextually tailored interventions to enhance person-centered maternity care across diverse settings. Efforts should focus on improving access to skilled birth attendants, strengthening health facility capacity, promoting birth companionship, enhancing antenatal and intrapartum care, and addressing broader sociodemographic determinants influencing PCMC. Collaboration among maternity healthcare workers (midwives, maternity nurses, obstetricians, and gynecologists), health managers, and researchers is essential to improve PCMC throughout the childbirth process.