Development and optimisation of a respectful maternal and newborn care bundle in Malawi and Tanzania: A mixed methods study

Background Disrespectful maternity care, which remains prevalent primarily in low- and middle-income countries, has a detrimental effect on women's childbirth experiences and deters them from seeking care at health facilities. Yet interventions to reduce it are limited, and focus less on the newborn. We conducted a study to co-develop with key stakeholders a maternal and newborn respectful care bundle (a group of evidence -based interventions) to reduce disrespectful care in Malawi and Tanzania. Methods A mixed-methods study guided by an Appreciative Inquiry approach and Behaviour Change Wheel was conducted during the pre-implementation phase of a larger intervention development and evaluation study. The intervention development process comprised three stages: formative research, intervention co-designing, and intervention refinement to ensure contextual relevance and acceptability. Methods included interviews with women, community surveys, focus group discussions with healthcare workers, and a Nominal Group Technique to achieve consensus, observations and interviews during optimisation. Community Engagement and Involvement group of women representatives ensured women’s perspectives throughout. Results This process resulted into the identification of an intervention bundle which has five components: 1. Valuing staff, 2. Training and mentorship 3. Privacy and confidentiality 4. Supportive leadership and 5. Community engagement and involvement. Behaviour change techniques and Respectful Care Champions were incorporated within the intervention strategies. Conclusion The resulting Respectful Maternal and Newborn Care bundle identified through a multi-stage process is an evidence-based, multi-component intervention with potential to reduce disrespectful care. Its participatory development supports cultural acceptability. Findings from its implementation and evaluation will be reported elsewhere.