Knowledge and Practice of Respectful Maternity Care among Labour Ward Staff: A Closed-Loop Clinical Audit at a District-Level Hospital in Sri Lanka

Abstract

Aims: To assess baseline knowledge, attitudes, and self-reported practices related to Respectful Maternity Care (RMC) among maternity ward staff at Base Hospital, Eravur, Sri Lanka, and to evaluate improvement following targeted quality improvement interventions, thereby completing a closed-loop clinical audit cycle. Study Design: Closed-loop clinical audit comprising a baseline audit and a re-audit using identical instruments. Place and Duration of Study: Maternity ward and labour room, Base Hospital, Eravur, Sri Lanka. Baseline audit conducted in June 2025; re-audit conducted in September 2025. Methodology: A structured, self-administered, anonymous questionnaire was administered to all doctors, nurses, and midwives working in the maternity unit (n = 20 per cycle). The questionnaire assessed demographic details, knowledge of RMC principles, and attitudes and self-reported practices. Responses were scored quantitatively (maximum 30 marks per participant). Performance was categorised as adequate (≥80%), partially adequate (60–79%), or inadequate (<60%). Audit standards were benchmarked at ≥90% compliance, aligned with the WHO Respectful Maternity Care framework. Results: At baseline, individual scores ranged from 43.3% to 70%; no participant achieved the adequate category (≥80%), 65% were partially adequate, and 35% scored below 60%, indicating significant gaps. Following targeted interventions including structured teaching sessions, display of RMC posters, supportive supervision, and introduction of physical privacy measures, re-audit data demonstrated marked improvement: mean score increased to 75.4%, 50% of participants achieved the adequate category (≥80%), 35% were partially adequate, and only 15% remained in the inadequate category. Increased compliance was demonstrated across all RMC domains. Conclusion: Targeted quality improvement measures resulted in measurable improvement in knowledge, attitudes, and self-reported practices related to Respectful Maternity Care, demonstrating successful completion of a closed-loop clinical audit cycle. Continued reinforcement and periodic re-assessment are recommended to sustain and further consolidate these gains.