Educational Interventions to Improve Respectful Maternity Care Among Midwives in Low- and Middle-Income Countries: A Narrative Review

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@article{1723793,
      author = {Kadir, A. T. (Dr.), Ijaya, Z. B. (Dr.)},
      title = {Educational Interventions to Improve Respectful Maternity Care Among Midwives in Low- and Middle-Income Countries: A Narrative Review},
      journal = {Iconic Research And Engineering Journals},
      year = {2026},
      volume = {10},
      number = {4},
      pages = {1342-1360},
      issn = {2456-8880},
      url = {https://www.irejournals.com/formatedpaper/1723793.pdf},
      abstract = {Background: Disrespect, abuse, and obstetric violence experienced by laboring women in healthcare facilities represent severe violations of fundamental human rights, major barriers to maternal health service utilization, and critical indicators of sub-optimal care quality across low- and middle-income countries (LMICs). Practising midwives and skilled birth attendants operate at the frontlines of intrapartum care, yet frequently function within under-resourced, highly stressed healthcare systems characterized by institutionalized power hierarchies, chronic staffing shortages, and professional burnout. This narrative review synthesizes empirical evidence regarding in-service educational interventions designed to foster Respectful Maternity Care (RMC) among practising midwives in LMICs, specifically excluding pre-service student cohorts.
Objectives: Four primary objectives guided this review: (1) to categorize and describe the types, instructional content, and pedagogical delivery mechanisms of in-service RMC educational programs; (2) to appraise their empirical impacts on midwives’ knowledge, attitudes, observed clinical practices, and women-reported experiences of person-centered care and mistreatment; (3) to examine workplace governance, leadership, and environmental factors determining implementation success and long-term sustainability; and (4) to establish actionable evidence gaps and strategic priorities for health workforce policy, clinical practice, and future research.
Methods: Conducted in strict alignment with the Scale for the Quality Assessment of Narrative Review Articles (SANRA) guidelines, a comprehensive search strategy was deployed across PubMed/MEDLINE, CINAHL, Global Health, Scopus, and WHO institutional repositories targeting peer-reviewed studies published predominantly between 2020 and 2026, complemented by foundational landmark references.
Results: Synthesis of 16 core primary empirical studies demonstrates that multi-component, experiential, and participatory educational modalities yield superior transformative outcomes compared to passive, didactic lectures. Interventions combining low-dose high-frequency (LDHF) clinical simulation (e.g., PRONTO, MAMA training), Values Clarification and Attitude Transformation (VCAT), game-based experiential learning (e.g., Dignity game), reflective writing journals, and participatory theater (Forum Play) generated significant improvements in midwives’ RMC charter knowledge, professional empathy, self-efficacy, and communication skills. Importantly, these pedagogical gains translated into observed clinical practice changes—including increased adoption of non-supine birthing positions, routine informed consent, and labor companion integration. Facility-level evaluations demonstrated marked reductions in disrespect and abuse (D&A)—ranging from a 72% reduction in observed mistreatment in Tanzania to significant score increases on the Person-Centered Maternity Care (PCMC) scale in Kenya and Ghana (beta = 17.6, 95% CI: 15.6–19.6; p < 0.001). However, educational effects decayed rapidly in facilities lacking structured post-training mentorship, supportive supervision, charge midwife leadership, and institutional stress mitigation.
Conclusions: Educational interventions are essential but insufficient in isolation. Sustaining respectful childbirth practices requires integrating RMC training into national continuing professional development (CPD) re-licensing mandates, institutionalizing charge midwife leadership, establishing supportive clinical supervision, and addressing systemic health workforce constraints. In-service RMC education must be recognized as a core health workforce governance imperative to realize equitable, dignified maternal healthcare across LMICs.},
      keywords = {in-service training; low- and middle-income countries; midwifery education; person-centered care; respectful maternity care},
      month = {October},
  }