‘Doing the best we can’: Skilled birth attendants’ perspectives on delivering respectful maternity care within constrained public health systems in India

Background and objectives Respectful maternity care (RMC) is essential for improving childbirth experiences and facility-based service utilisation. Despite emphasis on institutional delivery, disrespect and poor communication persist in public facilities, particularly in resource-constrained settings. This study explored the experiences of skilled birth attendants’ providing RMC in public health facilities in Central India. Methods A qualitative study used in-depth interviews with providers in public maternity facilities. A facility was selected randomly, and participants were recruited purposively. Interviews were conducted, audio-recorded with consent, and transcribed. Data were analysed using thematic analysis, following consolidated criteria for reporting qualitative research (COREQ) guidelines for rigour. Results Four themes emerged: structural constraints to RMC, workload-driven compromises in care, operational pressures, and adaptive strategies. Providers reported moral discomfort when unable to uphold respectful care, noting that compromises stemmed from systemic factors. Interpretation and conclusions Constraints in public health systems affect respectful maternity care. Strengthening facility readiness, workforce, and administrative support is essential for RMC policy implementation.