Respectful Maternity Care: What Research Says About Dignity, Autonomy, and Birth Experiences

By Birth & Baby University · Last updated: October 2026 · 7 min read

Few ideas in maternity care are as widely endorsed, and as hard to measure, as respectful care. Almost everyone agrees that people giving birth should be treated with dignity and should have a say in what happens to their bodies. The research asks harder questions: what exactly counts as respectful or disrespectful care, how often does mistreatment happen, and does improving it change health outcomes? This article reviews what the research says about dignity, autonomy and birth experiences, and what that means for the way doulas support families.

Key takeaways

Quick answer: studies across many countries describe a consistent set of components of respectful maternity care, including freedom from harm, privacy, dignity, information and consent, communication and equitable care. Surveys in the United States find that a meaningful share of people report mistreatment, with higher reports among women of color. However, a 2024 systematic review found almost no trial evidence on whether programs that improve respectful care change health outcomes.

• A global review identified seven domains of mistreatment during childbirth in health facilities, from physical and verbal abuse to stigma, discrimination and poor rapport.
• A synthesis of 67 qualitative studies identified twelve domains of respectful care and found that women’s views of what respectful care means are quite consistent across countries.
• In a U.S. survey, 17.3 percent of respondents reported at least one type of mistreatment, with higher rates among women of color and in hospital births.
• The evidence on whether respectful care programs improve outcomes is very limited, and the tools to measure it lack a gold standard.

What counts as respectful care

Shakibazadeh and colleagues (2018) synthesized 67 qualitative studies from 32 countries. Their twelve domains of respectful maternity care include being free from harm and mistreatment, privacy and confidentiality, preserving dignity, information and informed consent, continuous access to family and community support, equitable care, effective communication, respecting women’s choices that strengthen their capability to give birth, and continuity of care. The authors conclude that the concept is broader than reducing mistreatment, and that women’s perspectives on it are quite consistent worldwide.

The World Health Organization’s 2018 intrapartum care recommendations describe a package of care that emphasizes woman-centered care to optimize the experience of labor and childbirth through a holistic, human rights-based approach. This article relies on the publication page and does not summarize the individual recommendations.

Bohren and colleagues (2015) reviewed 65 studies from 34 countries and organized mistreatment into seven domains: physical abuse, sexual abuse, verbal abuse, stigma and discrimination, failure to meet professional standards of care, poor rapport between women and providers, and health system conditions and constraints. They note that mistreatment can occur in the interaction between a woman and a provider, and also through failures at the facility and system level. Because the quantitative data were too varied to combine, the review could not give a pooled rate.

What research says about experiences in the United States

In the Giving Voice to Mothers study (Vedam and colleagues, 2019), 17.3 percent of 2,138 respondents reported one or more types of mistreatment, such as loss of autonomy, being shouted at, scolded or threatened, or being ignored or refused help. Rates were higher for women of color, and for births in hospital (28.1 percent) than at home (5.1 percent). Mistreatment was more common after unexpected obstetric interventions and when patient and provider disagreed. This was a self-selected online survey, so it shows patterns, not national prevalence.

A 2025 scoping review of 66 U.S. studies (Cayama and colleagues, 2025) found the most common forms of mistreatment were poor rapport between women and providers (88 percent of studies), stigma and discrimination (79 percent) and failure to meet professional standards of care (73 percent). The authors note that few studies came from the South, only one represented rural participants specifically, and none represented sexual and gender minorities or Indigenous people. Most were qualitative.

Does respectful care change outcomes?

This is where the evidence is thinnest. Cantor and colleagues (2024) conducted a systematic review of respectful maternity care. They included 37 studies. Of those, one provided insufficient evidence on the effectiveness of respectful care for improving maternal outcomes, and none studied it as a way to improve infant outcomes. They identified 12 frameworks and 12 measurement tools, but found no single tool that stands out as the best, and no gold standard against which to judge them. Their conclusion is that frameworks are well described but vary, and that evidence on the effectiveness of implementing respectful care is lacking.

That is not a finding that respectful care has no effect. It is a finding that the question has barely been tested. Respectful care may matter in its own right, as a matter of rights and dignity, even before there is trial evidence on clinical outcomes.

What this means for doulas

• Treat dignity and autonomy as part of the service. The research frames consent, privacy, information and communication as core components, and these fall within the doula’s informational and emotional role.
• Support informed decisions without making them. A doula can help a client prepare questions, understand options in plain language and feel heard, but does not give medical advice or decide for the client. See our article on supporting informed decision-making without medical advice.
• Know where advocacy ends. Speaking for a client in place of the client, or challenging a clinician’s judgment, may strain relationships and crowd out the client’s own voice. Our article on advocacy versus clinical decision-making in doula care explores the boundary.
• Take reports of mistreatment seriously. Listen, write down what the client says in their words, and, if they wish, help them find the facility’s patient relations process or other ways to share their experience.
• Watch your own practice. Poor rapport and stigma are the forms of mistreatment most often described, so check how you communicate with clients and care teams.

Putting it into practice

1. Include a prenatal conversation about what respectful care would look like for this client, in their words.
2. Help clients prepare a short list of questions about consent and options, such as “What are the options?” and “What happens if we wait?”
3. In the room, use calm, neutral language. If a client seems unsure, offer them time to ask their own question.
4. After birth, invite the client to tell you about how they were treated, without leading them, and offer referral to a counselor if the experience was distressing.
5. Reflect on your own practice with a peer or supervisor, using the domains above as a checklist.

Limits and uncertainty

The studies cited use different definitions and measures, and many rely on self-report. The U.S. survey was not a random sample. The global reviews include many low- and middle-income countries, whose systems differ from the United States. The systematic review of effectiveness found little trial evidence, so claims that respectful care improves specific outcomes should be hedged. The WHO publication page was read at summary level only.

The bottom line

Research agrees on what respectful maternity care looks like and shows that mistreatment is reported in the United States, more often by women of color and in hospital births. What it cannot yet show is whether programs that improve respectful care change health outcomes. Doulas can honor dignity and autonomy by supporting information, communication and choice, while leaving medical decisions to the client and the care team.

Birth & Baby University’s For Doulas page outlines its online, self-paced birth and postpartum doula training, recertification and mentorship, for those building client-centered skills.

This article is for professional education. It is not medical, legal, financial or tax advice. Check the standards of your certifying organization and the rules where you work.

Sources and further reading

• Shakibazadeh E, Namadian M, Bohren MA, et al. Respectful care during childbirth in health facilities globally: a qualitative evidence synthesis. BJOG (2018). Read the source
• Bohren MA, Vogel JP, Hunter EC, et al. The mistreatment of women during childbirth in health facilities globally: a mixed-methods systematic review. PLOS Medicine (2015). Read the source
• Vedam S, Stoll K, Taiwo TK, et al. The Giving Voice to Mothers study: inequity and mistreatment during pregnancy and childbirth in the United States. Reproductive Health (2019). Read the source
• Cayama MR, Vamos CA, Harris NL, et al. Respectful maternity care in the United States: a scoping review of the research and birthing people’s experiences. Journal of Midwifery & Women’s Health (2025). Read the source
• Cantor AG, Jungbauer RM, Skelly AC, et al. Respectful maternity care: a systematic review. Annals of Internal Medicine (2024). Read the source
• World Health Organization. WHO recommendations: intrapartum care for a positive childbirth experience (2018). Read the source

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