Understanding the Mechanisms of Change in the Supportive and Respectful Maternity Care Intervention in Sindh, Pakistan: Provider Perspectives

Leadership and team-based maternity care

Supportive and dignified maternity care

Clarification of professional values to practice S-RMC

Ethical, rights-based, and woman-centered care

Psychosocial support and its implementation

Operationalization of S-RMC strategy^a

S-RMC activities and processes embedded within health facilities

Orientation of women and companions about their rights and responsibilities and available support

Register introduced for screening for psychosocial vulnerabilities (e.g., anxiety, depression, disability) and other sociodemographic vulnerabilities (e.g., poverty, lack of education or companionship, minority religion/caste)

Respectful care: avoiding violence, inclusive care, sharing information for informed decision-making, confidentiality, good rapport with pregnant woman, use of job aids

Supportive care (i.e., psychosocial support): environmental support (cleanliness, privacy) and individual support (psychoeducation regarding needs and stressors, reduced stress, strengthened social support via companion engagement, and promoted daily scheduling and lifestyle changes)

For pregnant women: sharing of women's personalized preferences and needs with each team member

For staff: addressing of psychosocial needs of staff

Periodic assessment of women's experiences of S-RMC through exit interviews and complaint management system

Consolidation of S-RMC-related data (e.g., vulnerability assessment and women's feedback and complaints)

Introduction of periodic (monthly) performance review meetings, including discussion on S-RMC performance and taking actions

Identification of S-RMC carer-of-the-month

On-the-job training and refreshers to staff by mental health first aider, a clinical member of the maternity team at each health facility