Person-centered care across the maternal health continuum: evidence from a cross-sectional analysis of baseline data from the CPIPE trial in Kenya and Ghana

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Background Person-centered maternal health care (PCMHC), responsive and respectful care across the pregnancy, childbirth, and postpartum continuum, is essential for improving maternal and neonatal outcomes. We examined the extent of PCMHC and associated factors in Kenya and Ghana. Methods We used data from cross-sectional surveys conducted between March and October 2024 with 1999 postpartum women in Ghana (n = 1000) and Kenya (n = 999) within 12 weeks of birth. PCMHC was measured using summative scores from validated person-centered antenatal care (PCANC), maternity care (PCMC), and postnatal care (PCPNC) scales. Scores were standardized to range from 0 to 100, with higher scores indicating better care experience. Mixed-model multivariable linear regression analyses were used to identify factors associated with PCMHC across phases of care. Findings Average standardized scores were 71.5 (SD = 16.4) for PCANC; 71.7 (SD = 15.2) for PCMC; and 71.4 (SD = 15.7) for PCPNC. Communication and autonomy subdomain scores were the lowest at each phase of care. Less than 20% of women received optimal PCMHC (scores ≥ 90) across any phase of care: 13.1% (n = 260), 12.7% (n = 254), and 13.6% (n = 189) for PCANC, PCMC, and PCPNC, respectively. Women of higher socioeconomic status, those who received care in health centers or faith-based facilities (compared to public hospitals), and those who reported greater care continuity had higher PCMHC scores. Interpretation PCMHC is suboptimal across maternal care phases, with vulnerable women experiencing the poorest care. Targeted interventions such as provider training, fostering enabling facility environments, accountability mechanisms, and care continuity are needed to improve PCMHC and address disparities throughout the maternal care continuum. Funding Eunice Kennedy Shriver National Institute of Child Health and Human Development R01 grant to PA [R01 HD110370-02].