A new tool aimed to improve the quality of maternity care has been developed and tested in Dar es Salaam, Tanzania. Known as the Respectful Maternity Care Tool (RMC-T), this innovation is a significant step toward ensuring that women receive dignified and respectful care during childbirth, particularly in overcrowded maternity units.

The tool was co-created for use in Tanzanian government health facilities through a collaborative effort involving postnatal women, healthcare providers, local health leaders, and global researchers. Contributing to the study is Charles Festo, a Data Analyst from the Ifakara Health Institute. 

In a paper published in the Global Health Action journal, the creators highlight the tool’s primary goal, to establish a routine method for evaluating women’s experiences of respectful maternity care in urban health facilities across Dar es Salaam.

“This study aimed to develop an RMC measurement tool (RMC-T) for routine use in enhancing quality improvement in government health facilities, addressing a gap in current practices. We detail the co-creation, validation, content, and stakeholder acceptability of the RMC-T,” they noted.

Assessment of women's experiences
According to findings, women valued discussing their birth experiences during their hospital stay, and researchers noted that the tool’s high acceptability underscores the effectiveness of this participatory approach. 

“The major strength of this study lies in its participatory co-creation approach, which integrates human experiences and local contexts. It shifts from traditional top-down knowledge translation to a more collaborative model. It draws on extensive local and international expertise and builds upon prior RMC studies,” the researchers noted.

Addressing challenges in maternity care
Despite efforts to increase facility-based births, many countries, including Tanzania, still struggle to reduce maternal and newborn mortality. A major challenge is the lack of Respectful Maternity Care (RMC), which ensures that women are treated with dignity and respect during childbirth. The project addresses that gap by providing a mechanism to measure women’s experiences during childbirth.

The RMC-T structure
The RMC-T consists of 25 questions designed to assess key aspects of maternity care and reflects women's real-world priorities and experiences, such as supportive care, effective communication, and the absence of mistreatment. It is designed for quick administration and includes simple "yes/no/explain" responses to accommodate low-resource settings.

The tool's multi-phase co-creation process resulted in a refined evaluation framework that assesses not only satisfaction and communication but also mistreatment, such as physical, verbal, and sexual abuse, neglect, discrimination, and non-consensual care. It also evaluates supportive care elements such as pain management, nutrition, and newborn care.

“RMC is a complex issue for women in urban, low-resource settings during facility-based childbirth. The 25-item RMC-T is a user-friendly tool that effectively identifies areas for improving RMC and is well-received by both postnatal women and health facility leadership. Regular use of the tool, combined with targeted actions to address gaps, will advance RMC fostering rights-based respectful care,” wrote the authors.

The RMC-T has already been implemented as part of a study in five high-volume health facilities in Dar es Salaam to identify actionable improvements in maternity care. Its design allows frontline health managers to use it easily, focusing on real-time enhancements in the quality of care.

Addressing mistreatment during childbirth
In Tanzania, mistreatment during childbirth remains a critical issue, particularly in urban areas like Dar es Salaam. Studies have shown that maternal and perinatal mortality rates remain high in these regions, with mistreatment often contributing to poor outcomes. The RMC-T was developed to tackle these challenges, providing a practical method for healthcare managers to identify and address specific instances of mistreatment and advance rights-based respectful care.

RMC-T adaptation and validation
The study demonstrates that the RMC-T is contextualized, validated, and suitable for measuring women’s experiences of RMC. While the tool’s co-creation process is a notable strength, the authors underscore the need for further adaptation and validation to ensure its effectiveness in diverse healthcare settings. 

“Further innovations in community administration and validation studies across diverse settings are needed, along with efforts to raise awareness about women’s rights during childbirth. As global advocacy for facility births grows, this tool may also benefit rural areas facing similar RMC challenges,” the researchers concluded.

Ifakara scientists contribute to the study
Charles Festo, a Data Analyst at the Ifakara Health Institute, contributed to the study, led by Brenda Sequeira D'Mello from Comprehensive Community Based Rehabilitation in Tanzania (CCBRT) and Natasha Housseine from Aga Khan University in Tanzania. Additional contributors included the University of Copenhagen, VU University, Temeke Regional Referral Hospital, and Management and Development for Health (MDH).

Read the publication here.