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Background: Person-centred maternity care (PCMC) is maternity care that is responsive to and respectful of women's needs and values. It is a key dimension of quality, capturing the experience of interpersonal dimensions of care. Poor PCMC contributes to high maternal mortality not only directly but also indirectly through decreased demand for services. Although there is growing recognition of the importance of PCMC to maternal and child health outcomes, there is a paucity of data on interventions that aim to integrate a person-centred approach to maternity care. In this study, we aimed to evaluate the effect of an integrated simulation training on provision of PCMC. Methods: The pilot PCMC training project was launched in a rural district in Northern Ghana in April, 2017. To improve quality of care, including PCMC, we integrated specific components of such care, emphasising dignity and respect, communication and autonomy, and supportive care, into a simulation training to improve identification and management of obstetric and neonatal emergencies. 43 providers in the district participated in two 2-day trainings led by PRONTO international trainers. Six providers were then trained as simulation facilitators, and they led refresher sessions every month for 4 months at the five highest-volume delivery facilities in the district. We conducted surveys at baseline and endline with women who had recently given birth to assess their experiences of care using a 24-item version of the 30-item PCMC scale. Findings: We included data from 215 baseline surveys, conducted in March and April, 2017, and 318 surveys at endline in November, 2017. Women at endline reported higher PCMC scores than did women at baseline. The average PCMC score increased from 35·9 (SD 6·3) at baseline to 51·5 (12·9) at endline, a change of 43% (p

Summary: Background: Several qualitative studies have described disrespectful, abusive, and neglectful treatment of women during facility-based childbirth, but few studies document the extent of person-centred maternity care (PCMC)—ie, responsive and respectful maternity care—in low-income and middle-income countries. In this Article, we present descriptive statistics on PCMC in four settings across three low-income and middle-income countries, and we examine key factors associated with PCMC in each setting. Methods: We examined data from four cross-sectional surveys with 3625 women aged 15–49 years who had recently given birth in Kenya, Ghana, and India (surveys were done from August, 2016, to October, 2017). The Kenya data were collected from a rural county (n=877) and from seven health facilities in two urban counties (n=530); the Ghana data were from five rural health facilities in the northern region (n=200); and the India data were from 40 health facilities in Uttar Pradesh (n=2018). The PCMC measure used was a previously validated scale with subscales for dignity and respect, communication and autonomy, and supportive care. We analysed the data using descriptive statistics and bivariate and multivariate regressions to examine predictors of PCMC. Findings: The highest mean PCMC score was found in urban Kenya (60·2 [SD 12·3] out of 90), and the lowest in rural Ghana (46·5 [6·9]). Across sites, the lowest scores were in communication and autonomy (from 8·3 [3.3] out of 27 in Ghana to 15·1 [5·9] in urban Kenya). 3280 (90%) of the total 3625 women across all countries reported that providers never introduced themselves, and 2076 (57%) women (1475 [73%] of 1980 in India) reported providers never asked permission before performing medical procedures. 120 (60%) of 200 women in Ghana and 1393 (69%) of 1980 women in India reported that providers did not explain the purpose of examinations or procedures, and 116 (58%) women in Ghana and 1162 (58%) in India reported they did not receive explanations on medications they were given; additionally, 104 (52%) women in Ghana did not feel able to ask questions. Overall, 576 (16%) women across all countries reported verbal abuse, and 108 (3%) reported physical abuse. PCMC varied by socioeconomic status and type of facility in three settings (ie, rural and urban Kenya, and India). Interpretation: Regardless of the setting, women are not getting adequate PCMC. Efforts are needed to improve the quality of facility-based maternity care. Funding: Bill & Melinda Gates Foundation, Marc and Lynne Benioff, and USAID Systems for Health.