Respectful childbirth in Dar es Salaam: prevalence and drivers

Respectful childbirth encompasses women’s rights to dignity, privacy, informed consent, clear communication, non-discrimination, and freedom from mistreatment during labor and birth. These elements are embedded in global quality-of-care frameworks and influence satisfaction, utilization, and trust in health services. In high-volume urban facilities, achieving these standards can be challenging due to staffing constraints, space limitations, and variable adherence to protocols. The concept of one woman, one bed is a practical signal of privacy and facility readiness in crowded labor wards.

This cross-sectional survey in urban Dar es Salaam provides updated estimates of respectful childbirth experiences and identifies factors associated with positive experiences. It centers on what women report at discharge or shortly after birth, capturing interpersonal care, communication, autonomy, and environmental conditions. The findings, described on PubMed, are relevant for maternal health stakeholders who require timely, facility-level signals to guide quality improvement and service planning (https://pubmed.ncbi.nlm.nih.gov/41133293/).

The analysis aligns with a broader programmatic emphasis on respectful maternity care and complements clinical safety indicators by focusing on women’s experiences during facility-based birth. In doing so, it addresses a recognized need to quantify the prevalence of respectful care and clarify determinants at both individual and facility levels. The emphasis on one woman, one bed underscores how physical infrastructure and ward organization influence privacy and perceived respect.

Design, setting, and population

The work uses a cross-sectional survey approach, capturing women’s experiences around the time of discharge after facility-based birth. The setting is urban Dar es Salaam, where maternity units often manage large daily volumes and a mix of spontaneous labor, referral cases, and varying acuity. Such environments require streamlined processes to preserve privacy, ensure informed consent, and maintain effective communication amid workflow pressures.

The population includes women who recently gave birth in participating facilities. Recruitment typically occurs post-delivery to allow women to reflect on interpersonal interactions, the physical environment, and any constraints they encountered during labor and postpartum recovery. Because the survey is cross-sectional and facility-based, the sample reflects women who reached and delivered in these facilities rather than the broader pregnant population. This approach helps generate practical, service-specific signals for ward managers and district leadership but does not capture experiences outside facility settings.

Data collection focuses on reported experiences in key respectful care domains: dignity and non-abusive treatment; privacy and confidentiality; informed consent and decision-making; communication and emotional support; non-discrimination; and supportive companionship where allowed. In addition, the survey captures elements of the labor ward environment, including the presence of privacy measures and the availability of space to meet the one woman, one bed standard.

By using standardized questions that map to recognized respectful care domains, the survey enables comparisons across subgroups and highlights facility-level patterns. Because the design is observational and cross-sectional, the results can identify associations but not causation. Nonetheless, the output is valuable for near-term monitoring and for informing targeted quality improvement actions within facilities that contributed data.

Primary measures and key results

The survey quantifies the prevalence of respectful childbirth experiences from the woman’s perspective. Core measures include whether women felt treated with dignity, whether staff maintained privacy during examinations and delivery, whether consent was obtained before procedures, whether explanations were provided in understandable terms, whether women perceived non-discrimination, and whether birth companionship was permitted and facilitated. Facility readiness indicators include spatial arrangements and the consistent availability of a bed for each woman during labor and postpartum recovery.

Key outputs from the survey are presented as proportions of women reporting positive experiences across domains. While exact figures vary by facility and subgroup, the results establish an overall prevalence of respectful experiences and identify areas where women’s reports indicate gaps. The prominence of one woman, one bed in the survey reflects persistent constraints in space and bed turnover that can impact privacy, comfort, and dignity, particularly at peak times in busy urban wards.

• Prevalence of dignity and non-abusive care: Women report whether they were treated respectfully, free from shouting, scolding, or other abusive behaviors.
• Privacy and confidentiality: Women indicate whether privacy was maintained during examinations and procedures, and whether physical measures such as curtains or screens were used consistently.
• Informed consent: Reports cover whether staff sought permission before procedures and whether choices were explained.
• Communication quality: Women describe clarity of explanations, responsiveness to questions, and the perceived empathy of staff.
• Non-discrimination: Women note whether they perceived differential treatment based on age, parity, socioeconomic status, or other characteristics.
• Companionship: Where permitted, women report whether a companion of choice was allowed and supported during labor and birth.
• Environmental readiness: The one woman, one bed standard signals whether spacing and bed availability were sufficient to support privacy and basic comfort.

Beyond overall prevalence, the survey examines factors associated with respectful experiences. These determinants span individual characteristics, such as parity and prior facility exposure, as well as facility and provider factors, including staffing patterns, patient load, physical space, and adherence to protocols that embed consent and communication into routine care. Where available, the analysis considers time-of-day and day-of-week variation, reflecting how workload may influence women’s experiences.

Across domains, patterns typically show that facility organization and provider communication practices are strongly associated with reported respect. Facilities that consistently manage patient flow to ensure one woman, one bed are better positioned to use privacy curtains, minimize unnecessary exposure, and reduce crowding-related stressors that can undermine respectful interactions. When consent and communication are built into the care pathway, women are better informed and more likely to characterize their experience as respectful.

The survey’s emphasis on reported experience highlights the value of client feedback in routine maternity metrics. While clinical outcomes remain central, experience measures are sensitive to deficiencies in space, staffing, and workflow that may not immediately appear in maternal or neonatal complication rates. Tracking both domains together can help ward managers and district teams prioritize practical changes that women perceive as meaningful.

Immediate relevance for services and monitoring

For program managers and clinicians in urban Dar es Salaam, these results provide a current snapshot of respectful childbirth and its drivers in busy facilities. The survey supports facility teams in identifying which domains perform well and where gaps are most salient. Results can be integrated into existing dashboards or used during regular review meetings to align staffing, space management, and communication protocols with the observed patterns of experience.

At the facility level, the prominence of one woman, one bed underscores the role of physical space in facilitating privacy and dignity. Where infrastructure is constrained, simple changes in bed allocation, use of privacy screens, and adherence to consistent bedside protocols for consent and communication can support improvements in experience measures. These operational adjustments can be tracked over time using the same indicators to monitor progress.

At the district or regional level, aggregated results can help allocate support to facilities where experience indicators lag, especially during peak service hours. Because the survey reports are based on women’s accounts of their own births, they provide a direct view into interpersonal care and environmental constraints that may not be fully captured by routine administrative data. This makes them a useful complement to coverage and outcome indicators in quality-of-care assessments.

The findings also help align measurement with established respectful care domains. By mapping results to dignity, privacy, consent, communication, non-discrimination, companionship, and environmental readiness, stakeholders can ensure that reported improvements address the complete spectrum of experience. Where certain domains are strong and others are weaker, the cross-sectional results offer a targeted entry point for immediate corrective action.

For frontline teams, the survey highlights how structured communication, consistent consent processes, and clear care explanations can make a measurable difference in women’s reported experience. Simple, repeatable steps at the bedside can reinforce respectful behaviors and reduce variability across shifts. Where companionship is permitted, clear guidance and ward routines can ensure that companions support rather than disrupt care, reinforcing both emotional support and efficient workflows.

Finally, the results encourage continued integration of experience measures into routine quality monitoring. Collecting, reviewing, and acting on respectful care indicators at the facility level strengthens the feedback loop between women, providers, and managers. As facilities track whether every woman has her own bed throughout labor and immediate postpartum recovery, privacy and dignity become operational goals rather than aspirational statements, and improvements in experience can be sustained alongside clinical quality and safety.