Barriers and Facilitators of Continuous Labor Companion Support in Ethiopia: Qualitative Formative Study on Facility Readiness and Respectful Maternity Care

In Ethiopia, women strongly desire continuous support during childbirth. Despite its benefits, this practice remains uncommon. The study aimed to evaluate health facility readiness and explore the preferences and experiences of women and providers to identify the factors affecting the implementation of continuous labor support in Ethiopia. This formative qualitative study utilized the COM-B model and Theoretical Domain Framework (TDF) to map barriers. Data were collected through 25 in-depth interviews and 12 facility observations, focusing on 'role-oriented support' to understand the physical and psychological needs of laboring women. Using purposive sampling, 25 in-depth interviews were conducted with 7 pregnant women, 5 postpartum women, 5 maternity heads, and 8 healthcare providers, along with assessments of the readiness of the 12 healthcare facilities. Data were analyzed through thematic analysis and narrative summaries, with findings mapped using behavioral models of Capability, Opportunity, and Motivation for behavior change, combined with a Theoretical Domain Framework to enhance understanding. Six primary themes were identified: (1) lack of emotional support skills among companions; (2) insufficient knowledge of support roles; (3) restrictive health facility policies; (4) cultural expectations impacting companionship; (5) undefined roles leading to inefficient support; and (6) limited responses by healthcare providers affecting labor companions. The key barriers to effective continuous support are systemic and institutional restrictions from health facilities and staff, aggravated by companions' limited knowledge and skills. Addressing multifaceted barriers to continuous labor support requires an inclusive approach. Such systemic changes are essential for creating a supportive birthing environment that ultimately improves maternal outcomes and overall birth experience.