Experiences and perceptions of respectful maternity care among childbearing women in Busia district, Uganda: a phenomenological inquiry into maternal perspectives and healthcare dynamics

Introduction: Respectful Maternity Care (RMC) promotes dignified treatment of expectant mothers during healthcare encounters. Despite its critical role in improving access to quality maternal healthcare, mistreatment during childbirth remains common in rural public health facilities (PHFs). This study documented the experiences and perceptions of RMC among childbearing women in Busia District, Uganda, including how cultural, spiritual, and gender factors influence maternal care to inform policy development and program implementation in low-resource settings. Methods: A qualitative phenomenological design was employed, purposively sampling childbearing women and healthcare workers from PHFs. In-depth interviews and focus group discussions were conducted, with data transcribed and analyzed using Atlas.ti V9 through thematic content analysis. Quality control included pre-testing tools, training bilingual research assistants, and daily supervision. Themes explored included healthcare provider attitudes, facility constraints, cultural norms, spiritual beliefs, and gender dynamics. Ethical considerations—REC approval, informed consent, confidentiality, and participant autonomy—were ensured. Limitations included non-generalizability and potential social desirability bias. Findings: Some women reported positive experiences characterized by respectful treatment, but the majority encountered disrespect and abuse. Key contributors included limited awareness of maternal rights, gendered expectations affecting access and prioritization, spiritual beliefs guiding care choices, and systemic issues such as overcrowding, understaffing, insufficient supplies, and negative provider attitudes. Cultural and spiritual norms influenced care-seeking behaviors, including reliance on traditional birth attendants and ritual practices, sometimes conflicting with biomedical recommendations. Conclusion: Disrespect and abuse persist in PHFs in Busia District, compounded by systemic, cultural, spiritual, and gender-related factors. The absence of structured complaint mechanisms limits accountability. The study recommends establishing a platform for reporting and resolving maternal complaints, integrating culturally sensitive, gender-aware, and spiritually informed approaches to enhance maternal and child health outcomes and inform national, maternal healthcare policies.