"We receive testimonials from mothers thanking us for our service”: Providers’ perceptions of Respectful Maternity in Rwanda
Authors: Muhayimana Alice , Kearns Irene , Thierry Uhawenimana C. , Olive Tengera , Darius Gishoma 
Published: November 2023

Abstract
Background: Research in Respectful Maternity Care (RMC) has primarily concentrated on midwives' mistreatment of women, with limited emphasis on exploring best practices. Furthermore, in Rwanda, investigations into RMC have predominantly centered on service users, leaving a significant knowledge gap regarding the perspectives of healthcare professionals providing maternity services to the mothers. The aim of this study is to explore and describe health care providers (midwives, nurses, doctors) perspectives on RMC, using the Appreciative Inquiry (AI) method.
Methods: We conducted 10 In depth Interviews(IDIs) and 5 Focus Group Discussions (FGD) on Health Care Providers (HCP) who were working in labour wards of 5 hospitals of Eastern Province of Rwanda. For interview, we purposely selected 5 unit managers, 5 physicians. For FGD, we recruited 55 midwives and nurses. Participants were from 3 district hospitals, 1 provincial hospital; and 1 referral hospital. Interview and Focus groups was guided by AI method. The participants were interviewed to gather their insights and experiences regarding the delivery of RMC to mothers, as well as their opinions on how to establish and maintain best practices for RMC. Nvivo 12 was used to organize codes and to create codebook. Thematic analysis was used to analyse data.
Results: Four themes were emerged from interviews and FGDs: 1) Perceived RMC provision, 2) Perceived RMC benefits, 3) RMC enablers, 4) Sustaining RMC.
Healthcare professionals perceive RMC as a commitment to championing women's rights. This encompasses ensuring privacy, confidentiality, and equality, fostering effective communication, and delivering superior care to guarantee an optimal childbirth experience for women. Recognized advantages of RMC consist of mutual satisfaction, increased utilization of maternity services, improved community reputation, enhancing of mutual trust and rapport, bolstering family well-being, and a favorable influence on maternal psychological health. Drivers of RMC incorporate professional obligations, education background, religious convictions, and positive feedback. Providers have emphasized the need for their peers to augment their sense of duty, uphold ethical professionalism, foster teamwork, and continuously evaluate care quality and client responses. They also advocated for more proactive hospital engagement, increased advocacy for mothers, staff motivation, continuous professional development opportunities, and the betterment of living conditions for healthcare providers. Notably, the gratitude from mothers epitomize the strides in RMC provision. Additionally, the accreditation endeavours and RMC training furnished by stakeholders signify noteworthy progress.
Conclusion and recommendation: We advise learning from successful RMC actions, maintaining current RMC best practices, and addressing the recommendations provided by healthcare providers. It is crucial for the entire healthcare system in Rwanda to collaborate and strive for RMC improvement.