Background: While infrastructure impacts are well documented, the consequences of armed conflict on working conditions of healthcare providers and experiences of women giving birth at health facilities remain under-explored.

Methodology: In 2023, we conducted a cross-sectional study in 28 health facilities in North and South Kivu provinces of Eastern Democratic Republic of Congo. To assess women’s experiences on the day of birth, we interviewed a representative sample of 231 postpartum women using an structured tool adapted from the Demographic and Health Survey (DHS) Service Provision Assessment (SPA) including a 13-item person-centered maternity care (PCMC) score. We also interviewed a representative sample of 220 maternity care providers on duty at the time of the assessment using a structured interview tool adapted from the DHS-SPA. Analysis was conducted using the Chi-square and T tests.

Results: PCMC scores averaged 24.5 out of 39, representing moderate patient-centered care. Scores were lowered by sub-optimal autonomy, privacy, and communication. In each province, half of the providers reported being satisfied with their workplace. More reported experiencing verbal abuse by other staff (41% v.28%, p=0.049) and by patients or family members (34% v 9%, p > 0.001) in North Kivu compared to South Kivu. Approximately half of providers surveyed felt safe and protected from crime when in or traveling to/from their facility. In contrast, 92% of postpartum reported feeling safe at the facility.

Conclusion: Contextualized assessment tools and targeted investments are needed to protect, support, and motivate health workers to provide PCMC in Eastern Democratic Republic of Congo. Focus areas should include safer work environments, training on patient rights and respectful care, and feedback mechanisms to align services with women’s needs.

Access the full paper in the International Journal of Women’s Health here.