# ‘One woman, one bed’: prevalence and factors associated with women’s experiences of respectful birth in urban Dar es Salaam, Tanzania – across-sectional survey

## TL;DR

A survey in Dar es Salaam found that while most women were satisfied with maternity care, many experienced mistreatment and overcrowded conditions, highlighting the need for better rights-based care.

## Contribution

The study introduces a locally co-created RMC measurement tool and identifies factors like marital status and complications that influence respectful care experiences.

## Key findings

- 96.4% of women reported satisfaction, but 32.2% experienced mistreatment during childbirth.
- Single women and those with childbirth complications were significantly less likely to experience respectful care.
- Bed-sharing and lack of birth companions were common despite high satisfaction scores.

## Abstract

Respectful maternity care (RMC) is essential for quality care, safety, and a fundamental right of women during childbirth. However, mistreatment during childbirth hinders global efforts to reduce maternal and perinatal deaths and birth-related injuries. In rapidly urbanizing Dar es Salaam, disrespectful care in overcrowded maternity units is concerning.

To assess the prevalence and factors associated with women’s experiences of RMC in four urban health facilities in Dar es Salaam.

A 25-item locally co-created and validated measurement tool was administered to 838 postnatal women before discharge in a cross-sectional survey. Data were analyzed in Stata 14 to describe sociodemographic characteristics, birth outcomes, and birth experiences. Multivariable logistic regression identified factors associated with RMC.

Satisfaction was reported by 96.4% (793/823) of women. Additionally, 84.3% (689/817) reported effective communication. However, 60.8% (503/827) shared hospital beds, 32.2% (253/785) experienced mistreatment, and 10.7% (89/829) had a birth companion. RMC was significantly less frequent among single women (aOR 0.56; 95% CI: 0.36–0.87) and those with childbirth complications (aOR 0.52; 95% CI: 0.35–0.78). Complications were reported less frequently when women had their own bed (aOR 0.51; 95% CI: 0.34–0.77).

High satisfaction scores, despite mistreatment, bed-sharing, and lack of birth companionship highlight the need to raise awareness of rights-based care in communities. As urban growth strains healthcare systems, addressing structural constraints and overcrowding is crucial. Strengthening provider training in RMC and complications management, along with institutionalizing RMC measurements, can improve accountability, clinical outcomes, and women’s experiences of care.

● Main findings: A survey of 838 postnatal women in four urban maternity units in Dar es Salaam using a validated Respectful Maternity Care tool found high satisfaction (96.4%) and effective communication (84.3%); however, two-thirds shared hospital beds, one-third experienced mistreatment, and those with birth complications had higher odds of mistreatment and sharing beds.● Added knowledge: The gap between high satisfaction and widespread mistreatment, including bed-sharing indicates that satisfaction surveys overestimate care quality and highlight the importance of measuring satisfaction and specific mistreatment experiences.● Global health impact for policy and action: Advocacy for institutionalizing measurement of respectful care, and further exploration of the link between overcrowding, birth complications, and mistreatment is essential.