Respectful maternity care and associated factors during facility-based childbirth among Somali refugee women in the Melkadida refugee camps, Ethiopia. Mixed-methods study
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Date
2025-07
Authors
Bare,Kader
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Publisher
Addis Ababa University
Abstract
Backgrounds: Respectful maternity care is a fundamental human right for all women that protects women’s dignity, privacy and autonomy while promoting the utilization of maternity health service. How-ever, in humanitarian settings respectful maternity care remains underprioritized and has received limited attention in both research and practice. Despite Ethiopia hosting one of Africa’s largest refugee populations, evidence on the status of respectful maternity care in refugee settings is scarce, particularly in the Melkadida refugee camps.
Objective: This study aimed to assess the status of respectful maternity care and associated factors during facility-based childbirth among Somali refugee women who gave birth at health facilities in the Melkadida refugee camps, Ethiopia.
Methods: A facility-based convergent mixed-methods study was conducted among Somali refugee women who gave birth at refugee health centers, healthcare providers and community leaders in Melkadida refugee camps, Ethiopia, from March 1 to March 30, 2025. The quantitative data were collected through a pre-tested structured questionnaire from 417 systematically selected women. The qualitative data were collected through a semi-structured in-depth interview guide with 16 purposively selected participants. The quanti-tative data were cleaned and coded with Microsoft Excel and analyzed with statistical package for social science (SPSS) version 27. Descriptive statistics summarized data. Bivariate and multivariable logistic re-gression analyses were performed to identify factors associated with respectful maternity care. The quali-tative data were analyzed by using thematic analysis with the support of open code software version 4.02.
Results: In this study 417 women participated with the response rate of 98.6%. The overall magnitude of respectful maternity care was 18.7% (95% CI: 15% - 22.44%). Women aged 25-29 years [AOR= 3.458, 95% CI: 1.547, 7.730], Women who had four or more ANC visits [AOR = 3.765, 95% CI: 1.844, 7.687], daytime delivery [AOR = 2.203, 95% CI: 1.134, 4.280], less than 12 hours post-delivery stay at health facility [AOR = 3.82, 95% CI: 1.783, 8.178], deliveries attended by male providers [AOR = 3.197, 95% CI: 1.686, 6.446], and moderate and poorly maintained facilities [AOR = 0.397, 95% CI: 0.178, 0.889] and [AOR = 0.09, 95% ci: 0.033, 0.245] were factors significantly associated with respectful maternity care. Identified key barriers included poor facility infrastructure, staff shortage, shortage of medications and sup-plies, insufficient provider training, less experienced staff, lack of accountability, lack of compassion, poor communication and deprioritizing of respectful maternity care.
Conclusion: The findings revealed a critically low level of respectful maternity care in the Melakdida ref-ugee camps. Policymakers and stakeholders should strength health facility infrastructures, ensure resource availability, enhance providers training and implement robust monitoring and accountability mechanisms to improve the quality and respectful maternity care provision.
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Keywords
Respectful maternity care, disrespect, refugee, childbirth, Melkadida refugee camps