Determinants of Respectful Maternity Care at a Tertiary Hospital in Nigeria: A Cross-Sectional Study

Background: Respectful maternity care (RMC) is a fundamental human right and a core quality indicator for maternal health services. Despite global emphasis on improving the quality of obstetric care, disrespect and abuse during facility-based childbirth remain pervasive in sub-Saharan Africa, including Nigeria. Understanding the determinants of RMC is essential for designing context-sensitive interventions.

Objective: This study aimed to assess the prevalence of RMC and identify its sociodemographic, institutional, and provider-level determinants among women who delivered at the University of Calabar Teaching Hospital (UCTH), Calabar, South-South Nigeria.

Methods: A cross-sectional descriptive study was conducted among 384 postpartum women between January and June 2024. A pre-tested, structured interviewer-administered questionnaire adapted from the WHO/White Ribbon Alliance RMC framework was used for data collection. RMC was assessed across eight domains. Data were analysed using SPSS version 26.0. Descriptive statistics, chi-square tests, and binary logistic regression were performed at a significance level of p < 0.05.

Results: The overall prevalence of adequate RMC was 54.9%. Disrespect and abuse were most common in the domains of autonomy in decision-making (61.2% reported inadequate care) and informed consent (56.5%). Multivariate logistic regression analysis indicated that higher education, antenatal care attendance, continuity of care, and delivery in a private ward were significant predictors of respectful maternity care. After adjustment, women with higher education had 2.74 times the odds, 95% CI: 1.64–4.70. Those who attended antenatal care had 2.14 times the odds, 95% CI: 1.28–3.57. Continuity of caregiver increased the odds 1.93-fold, 95% CI: 1.17–3.18, while private ward delivery increased odds 2.05 times, 95% CI: 1.22–3.44.Grand multiparity and night-time delivery were linked to disrespect and abuse. Grand multiparous women had lower odds, adjusted OR: 0.52, 95% CI: 0.31–0.88. Nocturnal births also showed reduced odds, adjusted OR: 0.61, 95% CI: 0.38–0.97.

Conclusion: The practice of RMC at the tertiary facility is suboptimal, with significant deficits in the domains of autonomy and informed consent. Education, antenatal care attendance, and institutional factors are key determinants. Targeted interventions including provider training, policy enforcement, and structural improvements are urgently required to ensure dignified, rights-based maternity care in Nigerian tertiary hospitals.

Keywords: dignified maternity care, mistreatment and abusive practices, facility-based deliveries, Nigeria, determinants, tertiary hospital, maternal health.