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

1. Building capacity
S-RMC trainingTraining (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 strategya

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.