Pregnant Women’s Perceptions of Maternity Care Provided by Midwives at Women and Newborn Hospital in Lusaka, Zambia

Maternal healthcare quality remains a cornerstone of positive pregnancy outcomes. In Sub-Saharan Africa, including Zambia, high maternal mortality rates persist due to systemic challenges such as understaffing, overcrowding, and social inequities. Midwives are pivotal in addressing these issues, yet little is known about how women perceive the care they receive. This study explored pregnant women’s perceptions of maternity care provided by midwives at the Women and Newborn Hospital in Lusaka, Zambia. A qualitative descriptive design was used to collect data through semi-structured interviews with 18 pregnant women of diverse backgrounds. Thematic analysis revealed six key themes: communication gaps, inconsistent care quality, structural and resource challenges, expectations of midwifery roles, socioeconomic inequities, and women’s coping mechanisms. While instances of compassionate care were noted, systemic shortcomings and discriminatory attitudes—particularly towards single and younger women—undermined trust. The study recommends enhancing trauma-informed communication, addressing institutional staffing gaps, and implementing equity-focused reforms. These findings contribute to the understanding of how intersecting identities shape maternal care experiences and highlight pathways toward more respectful, patient-centered maternity services in urban Zambia. Methods: A qualitative descriptive design was employed, with data collected via in-depth, semi-structured interviews conducted on 18 pregnant women at the Women and Newborn Hospital in Lusaka, Zambia. Eighteen participants were purposively selected to ensure diversity in age (20 - 42 years), marital status (married, single, engaged), gravidity (1 - 6 pregnancies), and socioeconomic backgrounds (e.g., employed, unemployed, self-employed). Interviews, lasting 30 - 45 minutes, were audio-recorded, transcribed verbatim, and anonymized to ensure confidentiality. Thematic analysis was conducted using a six-step iterative process: (1) data familiarization, (2) initial code generation, (3) theme identification, (4) theme review, (5) theme definition, and (6) report production. Coding was performed independently by two researchers, with discrepancies resolved through consensus discussions to enhance rigor. Results: Six key themes emerged: (1) communication gaps, particularly for first-time mothers; (2) inconsistent care quality, influenced by midwives’ attitudes (empathy vs. dismissiveness); (3) structural challenges, including staffing shortages and long wait times; (4) expectations of midwifery roles, with participants valuing holistic care but criticizing transactional service; (5) socioeconomic disparities, limiting access to alternatives for low-income women; and (6) resilience strategies, such as peer comparisons. Marital status and parity intersected with experiences, with single and younger women reporting heightened stigma and neglect. Conclusion: While compassionate midwives enhanced care satisfaction, systemic issues like understaffing and stigma undermined trust. Recommendations include: (1) training midwives in trauma-informed communication; (2) policy reforms to address staffing and facility conditions; and (3) research on economic-mediated care disparities. These steps are vital to achieving equitable, patient-centred maternity care in Zambia.