Respectful maternity care among midwifery graduates trained under competency-based versus conventional curricula in Ethiopia: a comparative cross-sectional study

Abstract Background In Ethiopia, midwifery education emphasizes theory over practice, limiting clinical competence, including professional behaviors. Debre Tabor University (DTU) adopted a competency-based curriculum in 2013 to address this. This study examined whether graduates trained under competency-based and conventional curricula differed in their observed provision of respectful maternity care (RMC). Methods A comparative cross-sectional study assessed observed mistreatment during care provided by 68 BSc midwifery graduates (32 trained under a competency-based curriculum and 36 under a conventional curriculum) from third-generation Ethiopian universities. Care was assessed through direct observation using a validated tool. Mean mistreatment scores were compared using t-tests, and the between-group difference was visualised using a Gardner–Altman plot. Results Overall, the mean mistreatment score was 34.6%. Conventional curriculum graduates had a higher mean score than competency-based curriculum graduates (38.1% versus 30.8%). The difference was statistically significant, t(66) = − 3.75, p < .001, with an absolute mean difference of 7.3% points and Cohen’s d = − 0.91 for competency-based versus conventional graduates. Descriptively, poor-rapport scores (36.7% versus 46.5%) and non-response to medical requests (15.6% versus 30.5%) were lower in the competency-based group. Both groups had recorded deficiencies in consent, supportive care, and privacy, as well as instances of verbal abuse. Conclusion Competency-based curriculum background was associated with lower observed mean mistreatment scores during labour and childbirth. This association does not establish a causal curriculum effect, and lower mistreatment scores do not demonstrate comprehensive RMC. Deficiencies observed in both groups warrant further attention. Longitudinal and multilevel research is needed to examine the contributions of preservice education and workplace conditions.