Advancing Respectful Maternity Care: co-developing the RESPECT National Strategy in Cyprus

Abstract

Issue/problem: Disrespect in childbirth is increasing recognised as a public health and human rights issue across Europe, affecting care experiences, maternal-child outcomes and trust in health systems. In Cyprus, the National Strategy to reduce caesarean sections (highest in EU) has a narrow focus to address underlying systemic and behavioural drivers, limiting its effectiveness.

Description: Through a participatory action process, RESPECT co-developed a Strategy for Respectful Maternity Care (RMC) engaging 35 stakeholders from government, professional bodies, regulatory authorities and civil society. The process explored drivers of sub-optimal care practices and produced actionable recommendations and deliverables through structured workshops, while fostering shared understanding and ownership.

Results: Stakeholders mapped RMC determinants using the socio-ecological and COM-B models, identifying interconnected system-level drivers, including absence of national guidelines, weak quality assurance mechanisms, limited in-service training, and litigation-driven clinical decision-making. Actionable recommendations were organised across four pillars: clinical practice, professional development, women’s’ empowerment and research. Implemented outputs include: a quality checklist for maternity clinics based on the WHO standards, workshops and e-course on RMC rights, shared decision-making training for providers, and research-informed resources, such as the “When standard practice is not Practicing Standards” video and RMC Lexicon, among others.

Lessons: This academia-led project highlights the value of participatory policy development and the need to go beyond single-policy measures. Despite tensions around terminology (e.g. “obstetric violence”), the process enabled dialogue among stakeholder groups and produced context-specific, actionable tools. The project developed a model transferrable to other settings seeking to align with Respectful rights-based Maternity Care.

Key messages: • The RESPECT project produced tangible and sustainable tools and resources for advancing Respectful Maternity Care offering a replicable model linking research with policy, training and practice.

• Inclusive and participatory policy development approaches are essential for building trust, aligning stakeholders and fostering shared ownership of quality improvement efforts in maternity care.

Evaluation of a Respectful Maternity Care Train-the-Trainer Workshop
Nicole Pelligrino, Morgan Richardson Cayama, Estefania Rubio +3
The Journal of Perinatal Education1 Oct 2026Peer-reviewedLicence not statedFull textObstetrics, gynaecology & paediatricsPMC
Breastfeeding self-efficacy and maternity care practices: implications for the National Strategy
E Economou, O Kolokotroni, I Paphiti-Demetriou +5
The European Journal of Public Health1 Oct 2026Peer-reviewedCC BY-NC 4.0Full textEpidemiology & public healthPMCEurope PMC
Respectful maternity care among midwifery graduates trained under competency-based versus conventional curricula in Ethiopia: a comparative cross-sectional study.
Awoke Giletew Wondie, Matthias Siebeck, Tegbar Yigzaw Sendekie +2
BMC medical education24 Oct 2026Peer-reviewedCC BYFull textObstetrics, gynaecology & paediatricsEurope PMC
Respectful maternity care and its determinants in public health facilities of thar desert district, India: a mixed methods approach.
Bindiya C Gowda, Neeti Rustagi, Ankit Mittal +4
Reproductive health30 Jul 2026Peer-reviewedCC BY-NC-NDFull text1 citedObstetrics, gynaecology & paediatricsEurope PMCPMC
Co-developing Georgia’s National Digital Health Strategy through a multistakeholder convergence workshop: An implementation case study from the WHO European Region
Nato Gzirishili, Mehar Grover, Resham Sethi +6
PLOS Digital Health1 Oct 2026Peer-reviewedCC BYFull textEpidemiology & public healthPLOSEurope PMC

Cite

BibTeX RIS

BibTeX

@article{middleton2026advancing,
  title = {{Advancing Respectful Maternity Care: co-developing the RESPECT National Strategy in Cyprus}},
  author = {N Middleton and I Papairaklediou and M Kapsou and E Hadjigeorgiou and P Kinni and M Karanikola and C Nicolaou and I Orphanide-Eteokleous and O Kolokotroni and PT RESPECT},
  journal = {The European Journal of Public Health},
  year = {2026},
  month = oct,
  doi = {10.1093/eurpub/ckag169.298},
  url = {https://doi.org/10.1093/eurpub/ckag169.298},
  note = {CC BY-NC 4.0},
}

RIS

TY  - JOUR
TI  - Advancing Respectful Maternity Care: co-developing the RESPECT National Strategy in Cyprus
AU  - N Middleton
AU  - I Papairaklediou
AU  - M Kapsou
AU  - E Hadjigeorgiou
AU  - P Kinni
AU  - M Karanikola
AU  - C Nicolaou
AU  - I Orphanide-Eteokleous
AU  - O Kolokotroni
AU  - PT RESPECT
PY  - 2026
DA  - 2026/10/01
JO  - The European Journal of Public Health
DO  - 10.1093/eurpub/ckag169.298
UR  - https://doi.org/10.1093/eurpub/ckag169.298
AB  - Issue/problem: Disrespect in childbirth is increasing recognised as a public health and human rights issue across Europe, affecting care experiences, maternal-child outcomes and trust in health systems. In Cyprus, the National Strategy to reduce caesarean sections (highest in EU) has a narrow focus to address underlying systemic and behavioural drivers, limiting its effectiveness.  Description: Through a participatory action process, RESPECT co-developed a Strategy for Respectful Maternity Care (RMC) engaging 35 stakeholders from government, professional bodies, regulatory authorities and civil society. The process explored drivers of sub-optimal care practices and produced actionable recommendations and deliverables through structured workshops, while fostering shared understanding and ownership.  Results: Stakeholders mapped RMC determinants using the socio-ecological and COM-B models, identifying interconnected system-level drivers, including absence of national guidelines, weak quality assurance mechanisms, limited in-service training, and litigation-driven clinical decision-making. Actionable recommendations were organised across four pillars: clinical practice, professional development, women’s’ empowerment and research. Implemented outputs include: a quality checklist for maternity clinics based on the WHO standards, workshops and e-course on RMC rights, shared decision-making training for providers, and research-informed resources, such as the “When standard practice is not Practicing Standards” video and RMC Lexicon, among others.  Lessons: This academia-led project highlights the value of participatory policy development and the need to go beyond single-policy measures. Despite tensions around terminology (e.g. “obstetric violence”), the process enabled dialogue among stakeholder groups and produced context-specific, actionable tools. The project developed a model transferrable to other settings seeking to align with Respectful rights-based Maternity Care.  Key messages: • The RESPECT project produced tangible and sustainable tools and resources for advancing Respectful Maternity Care offering a replicable model linking research with policy, training and practice.  • Inclusive and participatory policy development approaches are essential for building trust, aligning stakeholders and fostering shared ownership of quality improvement efforts in maternity care.
SN  - 1101-1262
SN  - 1464-360X
ER  -

Abstract

Related

Cite