Prevalence of respectful maternity care and associated factors among Somali refugee women following facility-based childbirth in Melkadida refugee camps, Ethiopia: a mixed-methods study

Abstract

Abstract Background Respectful maternity care (RMC) is a fundamental human right that ensures women’s dignity, privacy, and autonomy during childbirth. In humanitarian settings, however, RMC is often neglected. Despite Ethiopia hosting one of Africa's largest refugee populations, research on RMC in refugee camps, particularly in the Melkadida camps, remains limited. Aim This study aimed to estimate the prevalence of respectful maternity care and examine factors associated with receiving respectful maternity care among Somali refugee women following facility-based childbirth in Melkadida refugee camps, Ethiopia. Methods A convergent mixed-methods study was conducted from March 1 to March 30, 2025. Quantitative data were collected from 417 women using a structured questionnaire, while qualitative data were gathered through in-depth interviews with 16 participants. Data were analyzed using SPSS for quantitative analysis and open code software for thematic analysis of qualitative data. Results The study had a 98.6% response rate, with 18.7% of participants reporting respectful maternity care (95% CI: 15%–24.4%). Factors positively associated with RMC included being aged 25–29 years (AOR = 3.46), attending four or more antenatal care visits (AOR = 3.77), daytime delivery (AOR = 2.20), staying less than 12 h post-delivery (AOR = 3.82), and having male providers (AOR = 3.20). Conversely, poor facility maintenance (AOR = 0.09) and moderate maintenance (AOR = 0.40) were negatively associated with RMC. Key barriers to RMC included poor infrastructure, staff shortages, insufficient training, and a lack of accountability. Conclusion Respectful maternity care is critically low in Melkadida refugee camps. To improve RMC, it is essential to prioritize infrastructure upgrades, ensure resource availability, enhance staff training, and implement monitoring and accountability measures.