Respectful Maternity Care Practices and Associated Factors among Healthcare Providers at Health Facilities in Nepal

Introduction: Respectful maternity care (RMC) is a core component of quality maternal health services and an essential element of rights-based and equitable childbirth care. Despite global commitments to improve the quality of facility-based maternity services, respectful care is not consistently practiced, particularly in low- and middle-income countries. Existing evidence has predominantly focused on women’s experiences of maternity care, with limited examination of healthcare providers’ practices and the health system factors influencing respectful care delivery. This study assessed respectful maternity care practices and associated factors among healthcare providers in Nepal. Methods: A cross-sectional analytical study was conducted between January to March 2025 in selected maternity units of healthcare facilities in Bagmati Province, Nepal. A total of 260 healthcare providers were selected using multistage cluster sampling followed by proportionate simple random sampling. Data were collected using a self-administered semi-structured questionnaire. Descriptive statistics and multivariable logistic regression analyses were performed using Statistical Package for the Social Sciences(SPSS) version 22 to identify factors associated with RMC practices. Results: Overall, 56.5% of healthcare providers demonstrated good respectful maternity care practices, while 43.5% exhibited poor practices. Provider-related factors, including lower educational qualification, longer work experience, and unmarried status, were significantly associated with better RMC practices. Institutional factors such as employment in federal-level hospitals and permanent employment status were also positively associated with good RMC practices. In addition, providers reported that service recipient characteristics including age, education level, occupation, parity, and mode of delivery influenced the provision of respectful maternity care. Conclusion: Respectful maternity care practices among healthcare providers in selected health facilities in Nepal remain suboptimal, indicating persistent gaps in the quality of maternity care delivery. The findings demonstrate that respectful care is shaped by interconnected provider, institutional and health system, and also care recipient related factors. Strengthening respectful maternity care requires a comprehensive health systems approach that addresses workforce capacity, employment conditions, institutional environments, and provider attitudes, while ensuring equity, dignity, and rights-based care for all women during childbirth.