Women with Disabilities’ Experiences with Respectful Maternity Care in Nepal: a Qualitative Study

Abstract Background: Ensuring respectful maternity care (RMC) is a key aspect of women's healthcare, particularly critical for women with disabilities who often encounter unique challenges in this regard. Despite existing research on respectful maternity care, there is a notable gap in literature specifically addressing the experiences of women with disabilities in Nepal. This study aims to fill this gap by exploring their unique challenges and perspectives on the principles of RMC, thereby contributing to a more inclusive understanding of maternity care in Nepal. Methodology: This study employed a qualitative design and was conducted in the outskirts of Kathmandu in 2023. It included 12 in-depth, semi-structured interviews with women with disabilities and 7 with healthcare providers, aiming to understand the women’s experiences in healthcare settings in relation to respectful care. Additionally, 2 focus group discussions were held with female community health volunteers (FCHVs) to explore community-based maternal healthcare experiences. All interviews were audio-recorded, transcribed, and translated into English. The data was then thematically analyzed, guided by the principles of the White Ribbon Alliance's RMC Charter. Results: The study revealed varied experiences of women during their pregnancies in relation to RMC. Many encountered negative interactions in government hospitals, characterized by disrespect and neglect, while others reported positive experiences with supportive providers. Communication issues were significant, as numerous women felt uninformed due to inadequate information sharing by healthcare workers. Privacy and confidentiality were compromised in overcrowded facilities and through insensitive handling of sensitive information. Economic constraints heavily influenced healthcare access, with clear disparities between public and private care. Despite healthcare providers often perceiving limited autonomy among these women, the majority were making autonomous decisions regarding their pregnancies. Timely access to healthcare was challenged by transportation and service inconsistencies. Conclusion: In the context of RMC principles, women’s experiences reveal varied experiences of women with healthcare providers, encompassing communication barriers and infrastructural inadequacies. These factors often compromised care quality and patient privacy. The study highlights a perception of limited autonomy among women. Recommended actions include RMC-focused training for providers and healthcare system reforms to enhance patient respect and privacy.