Findings from the IMAgiNE EURO Study: Women’s Experiences of Respectful Maternity Care in Healthcare Facilities Across 22 Countries Over 3.5 Years

Introduction: Respectful Maternity Care (RMC) is widely recognized as essential by scientific societies and international agencies, yet multicountry studies capturing women's experiences remain limited. This study presents findings from the IMAgiNE EURO study, which assessed women’s perceptions of RMC across 22 countries using a standardised, validated questionnaire. Methods: Women aged 18+ who gave birth in healthcare facilities between March 2020 and September 2023 participated via a validated questionnaire in 27 languages, capturing 15 key RMC measures. Univariate and multivariate analyses were conducted, an RMC index was calculated, and correlations with COVID-19 trends were explored. Findings: 74026 women accessed the questionnaire, 67064 (90.6%) provided consent to participate, and 50641 (81.3%) were included in the analysis. Only a small fraction of women (3089, 6.1%) experienced during their childbirth all the 15 RMC measures reflecting positive practices (from 0.2% in Serbia to 20.2% in Luxembourg). Overall, 7749 (15.3%) reported feeling abused, with the most frequent being emotional abuse. Lack of dignity (26.9%, from 11.6% in Belgium to 62.1% in Serbia) and privacy (23.5%, from 10.4% in Switzerland to 70.5% in Serbia) were frequent. High rates of poor communication (33.1%) and exclusion from decision-making (40.4%) were observed across all countries. The RMC index showed significant variation between countries but did not correlate with COVID-19 trends. Results: These findings highlight widespread inequities in RMC across Europe, emphasising the need for urgent action to uphold human rights in maternity care. Adequate resources and capacitybuilding for health professionals are essential to improve RMC practices.