TABLE 1.

Components and Subcomponents of the S-RMC Intervention in Sindh, Pakistan

Component	Description
1. Building capacity
S-RMC training	Training (3 days) for all staff (clinical, nonclinical, and administrators) on: 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}
2. Improving governance and accountability mechanisms
Front-end operationalization of S-RMC: Activities and/or processes that directly engage pregnant women and/or their companions
Assessment of women's demographic and psychosocial vulnerabilities	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)
Benchmarking respectful care and psychosocial support	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)
Care coordination	For pregnant women: sharing of women's personalized preferences and needs with each team member For staff: addressing of psychosocial needs of staff
Assessment of quality of care	Periodic assessment of women's experiences of S-RMC through exit interviews and complaint management system
Back-end operationalization of S-RMC: Managerial, administrative, and information-system activities and/or processes linked to the maternity team
Enhanced management information system	Consolidation of S-RMC-related data (e.g., vulnerability assessment and women's feedback and complaints)
Performance review and accountability	Introduction of periodic (monthly) performance review meetings, including discussion on S-RMC performance and taking actions Identification of S-RMC carer-of-the-month
Continuous professional development	On-the-job training and refreshers to staff by mental health first aider, a clinical member of the maternity team at each health facility

Abbreviation: S-RMC, supportive and respectful maternity care.
↵a The research team devised a customized strategy to operationalize S-RMC in routine intrapartum care.