Exploring women’s experiences of maternity care: A mixed-methods study in Cyprus and Croatia

Abstract Background Since the publication of Respectful Maternity Care (RMC) frameworks, studies on maternity care experiences have increased in Europe, shifting the discourse from overt abuse to subtle deviations from quality standards. This carries significant public health implications, as respectful care is essential for maternal outcomes and trust in healthcare systems. Methods The RESPECT mixed-methods study explored how women's experiences in Cyprus (CY) and Croatia (HR) align with RMC standards. Using online and community-based recruitment, women who gave birth in the past 5 years shared their experiences in writing or focus groups and responded to validated tools tapping on RMC rights: Person-Centred Maternity Care (PCMC), Autonomy in Decision Making (MADM), Mothers on Respect Index (MoRi), Mistreatment Index (MIST), and lack of informed consent. Results With a median on the PCMC scale (0-100%) of 81 (IQR 61-92) among 516 women in CY (49% Caesarean section) and 53 (IQR 35-75) among 855 in HR (30% C/S), experiences ranged from positive to negative. In CY, 29.8% rated their care above 90% compared to 9.0% in HR. Communication & Autonomy was the domain with the lowest scores in both (70% in CY, 48% in HR). Around 29% in CY and 63% in HR reported low autonomy, with associations observed with younger age, first-time birth, mode and place of birth, highlighting social inequities. Qualitative data triangulated the gaps in user-provider communication and decision-making. Conclusions The study revealed a range of problematic areas with different frequency but similar ranking in two European countries with different healthcare models. Despite possible selection bias, findings may under-represent the challenges faced by vulnerable groups, given the higher socio-economic profile of the sample. Standard RMC tools allowed comparative insights from two European countries and underscore both the need to replicate in other countries and an urgent need for systemic reform. Key messages • Autonomy, informed consent, and ineffective communication emerged as problematic in both countries, highlighting the need for systemic quality improvement in maternity care. • Using validated RMC tools enabled cross-country comparison and could be adopted in future European studies to systematically monitor and improve maternity care quality.