Contextualizing Women’s Birth Experiences at Hospitals in Conflict-Affected Settings in Northeast Nigeria and Eastern Democratic Republic of Congo: A Mixed Methods Comparative Case Study

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Abstract Introduction In conflict-affected settings, insecurity, poor health systems, and displacement hinder women’s access to timely, quality maternal and newborn care. In Northeastern Nigeria and Eastern DRC, access to quality intrapartum care remains limited, contributing to preventable deaths. This study compares the quality of intrapartum care in rural hospitals in Yobe State (Nigeria) and North and South Kivu (DRC), using, facility assessments, provider perspectives and women’s experiences to inform women-centered improvements in maternal health. Methods A comparative mixed-methods case study was conducted across three rural public hospitals selected from the most insecure districts in Yobe State and North and South Kivu. Data were collected through facility assessments, semi-structured interviews with providers, and focus group discussions with postpartum women and triangulated for an in-depth understanding of care quality in these settings. Results Women’s childbirth experiences across the three conflict-affected settings were shaped by a combination of under-resourced but functioning facilities, financial barriers, sociocultural norms, and interactions with health personnel. While structural limitations such as overcrowding, limited privacy and infrastructures, and cost barriers were reported in all settings, the degree of support from external actors and local health governance shaped key differences in experience. Autonomy in birth decisions was often limited, and perceptions of communication, respect, and emotional support varied. Nonetheless, across all contexts, compassionate provider behavior was consistently valued by women and contributed to more positive experiences, even in strained environments. Conclusions Improving maternal care in these settings requires systemic reforms that combine infrastructure and workforce investment with attention to sociocultural norms, women’s autonomy, and equity.

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