Understanding women’s care experiences in public health facilities in a conflict-affected area of Nigeria

Person-centered maternity care (PCMC) is an essential aspect of quality maternal healthcare. However, limited research has been conducted on PCMC in Northeast Nigeria, where the Boko Haram insurgency has impacted healthcare delivery. We sought to assess the status of PCMC as well as women and providers' perceptions of security drawing on cross-sectional data collected through 167 postpartum patient exit surveys and 32 surveys with maternity care providers in public health facilities in Yobe State, Nigeria. Results were analyzed using descriptive statistics to describe the environment of care, and PCMC was calculated, using a validated 13-item scale. We calculated an overall PCMC score as well as scores for each of the three PCMC sub-domains. We additionally assessed bivariable associations between PCMC and factors like facility type, women's characteristics, and provider training in respectful care. The average PCMC score was 27 out of 39 (or 70% of the maximum score), indicating important gaps in the quality of person-centered maternity care. While respectful care and dignity (78%) and supportive care (78%) were rated relatively high, effective communication and autonomy scored notably lower (57%). Women reported challenges, including limited ability to ask questions (33%), lack of autonomy in choosing birthing positions (12%), and inadequate explanations of prescribed medications (12%). Women reporting household internal displacement, those with less education and those who delivered in higher level facilities tended to report worse PCMC scores. However, both providers and women generally reported feeling safe within healthcare facilities. Poor communication between provider and patient and lack of support for women's autonomy were important contributors to suboptimal PCMC. Our findings highlight the vulnerability of internally displaced women and those with less education to poor care, underscoring key areas for targeted improvement and intervention.