Woman-centred care in conflict-affected and fragile states: a scoping review of policy integration and implementation gaps in the greater horn of Africa

Woman-centred care (WCC) is a respectful approach and a key component of quality care that prioritises a woman's dignity, autonomy, and preferences during pregnancy, birth, and postpartum. Health policies and guidance documents underpinned by such principles are essential to shaping high-quality healthcare that prevents adverse outcomes, saves lives, and makes pregnancy and childbirth positive experiences, regardless of humanitarian settings. We sought to identify how WCC is incorporated into national intrapartum care policies, plans, and service guidelines in conflict-affected and fragile states in the Greater Horn of Africa. We systematically searched for policy, plans and guidance documents focusing on maternal health and intrapartum care in Sudan, South Sudan, Ethiopia, Somalia and Eritrea published between 2000 and 2025. A directed qualitative content analysis approach was used to analyse 42 documents, organised into six core WCC principles. Of the 42 documents reviewed, 17 national policies, 7 plans, and 18 technical guidelines, most were issued by government health ministries. Explicit reference to “woman-centred care” was rare, with related terms like patient-centred and respectful maternity care appearing more frequently after 2016. Three main patterns of WCC integration emerged: systematic, fragmented, and profession-specific. Ethiopia has incorporated a respectful maternity care framework into policy and training since 2016, with ongoing audits but limited accountability. Sudanese documents (2008–2027) support patient-centred care but lack clear guidance on implementation and monitoring. South Sudanese documents reference client-centred values in policy, though implementation guidance is inconsistent. In Somalia, WCC is addressed mainly in midwifery strategies, while broader plans seldom mention it, and monitoring frameworks are unclear. National health policies and guidance documents in the Greater Horn of Africa increasingly acknowledge WCC principles, though explicit use of the term “woman-centred care” is rare. Accountability mechanisms, resource allocation, and monitoring frameworks for WCC are notably lacking, except partially in Ethiopia. Addressing implementation challenges such as accountability, resource allocation, and monitoring is critical for advancing WCC and improving maternal health outcomes in crisis contexts. Integrating WCC principles across the reproductive health continuum, including adolescent health and postnatal care, is necessary for comprehensive quality improvement.