A recent study led by the SA Medical Research Council and UKZN and published in The Lancet Regional Health – Africa, found that improving teamwork, communication and organisational culture inside maternity wards can dramatically improve women’s childbirth experiences, reports TimesLIVE.
Many women still experience disrespect, neglect and abuse while giving birth in this country, dissuading women from seeking timely medical care and contributing to preventable deaths and complications.
However, this latest study suggested that these childbirth experiences could be improved, even in under-resourced public health facilities, after the teams evaluated the Strengthening Teamwork and Respect (STAR) intervention across nine districts in KwaZulu-Natal.
The researchers found that when maternity healthcare workers were encouraged to reflect on how women experience care and were empowered to introduce practical changes, patients reported better communication, greater respect, increased autonomy and more supportive treatment during childbirth.
The findings coincide with growing concern over the treatment of women in labour wards countrywide. A 2020 study published by the National Library of Medicine found that disrespect and abuse during childbirth were common in midwife-led obstetric units in Tshwane, raising alarm about the state of maternal care in public facilities.
In this new research, the study team found that the greatest improvements were seen by women from poorer households and those who had attended fewer antenatal visits, groups considered especially vulnerable to poor maternal outcomes.
The STAR intervention brought together maternity teams in facilitated learning sessions where nurses, midwives and doctors reflected on workplace culture, teamwork and patient interactions. These sessions allowed staff to identify challenges and implement solutions tailored to their own facilities.
Surveys conducted with postpartum women and maternity staff before and after the intervention showed measurable improvements not only in women’s experiences of care, but also in organisational learning culture within maternity units.
The intervention, wrote the researchers, strengthened teamwork, encouraged reflection and improved systems for continuous learning and accountability.
Dr Neil Moran, Head of Obstetrics and Gynaecology for the KwaZulu-Natal Department of Health, said respectful maternity care remains a priority for the province.
“For this to happen, health workers of different categories and seniority must also support each other and treat each other with respect, so that they work well as a team with a common goal to provide a positive experience for their patients.”
Moran described the STAR project as an innovative approach to improving maternal healthcare by encouraging front-line staff to look at how patients perceive their care and what immediate improvements could be made using available resources.
He added that the findings provide evidence that managerial support and stronger teamwork can positively influence women’s childbirth experiences and improve morale among staff.
Professor Tanya Doherty, Project Lead and Chief Specialist Scientist at the SAMRC, said the study offers important new insights into how health worker-led interventions can improve respectful maternity care.
“This is the first study to assess an intervention that addresses both organisational learning culture and women’s experience of care,” she said.
“No midwife, nurse or doctor goes to work intending to cause harm to women in labour. However, the systems they work in can make it difficult to provide respectful, supportive care.”
Dr Christiane Horwood, study co-investigator, said the findings highlighted the importance of strengthening the systems in which healthcare workers operate.
“Our findings highlight how creating space for collective reflection, learning, and locally led action can strengthen both teamwork and accountability, ultimately improving women’s experiences of care,” she said.
Study details
Impact of the Strengthening Teamwork and Respect (STAR) intervention on organisational learning culture and person-centred maternity care in rural South Africa: an uncontrolled before-and-after implementation study
Tanya Doherty, Veronique Filippi, Vaughn John, Lyn Haskins, Sandra Land, Cleo Phewa, Sphindile Mapumulo, Silondile Luthuli, Loveday Penn-Kekana, Samuel Manda, Neil Moran, Rose Sibiya, Hlengiwe Myeza, Christiane Horwood.
Published in The Lancet Regional Health – Africa on 25 May 2026
Summary
Background
Respectful maternity care is essential for quality maternal and newborn health services. Interventions to promote respectful care often focus on training, overlooking organisational culture underpinning disrespectful behaviour. This study aimed to evaluate the implementation and effects of the Strengthening Teamwork and Respect (STAR) intervention on organisational learning culture and person-centred maternity care (PCMC).
Methods
This implementation research used an uncontrolled before-and-after design with continuous process evaluation in nine district hospitals in KwaZulu-Natal, South Africa. Surveys with postpartum women (baseline n = 893; endline n = 918) and maternity staff (baseline n = 104; endline n = 102) assessed changes in PCMC using the validated PCMC scale and organisational learning culture using the Dimensions of Learning Organisations Questionnaire (DLOQ). Descriptive statistics and Wilcoxon-Rank Sum test explored changes in the DLOQ. PCMC scores were modelled using mixed-effects linear regression including interaction terms with time period (pre-vs post) to examine variation across key predictors.
Findings
Five of seven DLOQ dimensions improved, particularly among attendees of STAR learning sessions. Mean re-scaled PCMC scores increased from 61.5/100 to 65.7/100 post-intervention (p < 0.0001), with significant improvements in communication and autonomy (53.5/100–59.4/100; p < 0.0001) and supportive care (57.5/100–63.0/100; p < 0.0001). Mixed-effects analysis showed an overall increase of 4.56 percentage points. Women in the lowest socio-economic status group and those with fewer antenatal care visits experienced the largest gains.
Interpretation
Modest improvements in organisational learning culture and PCMC were observed following STAR implementation, with larger gains among disadvantaged women. While causal attribution is limited, the findings suggest that participatory approaches targeting organisational culture may support more equitable and respectful maternity care in resource constrained settings.
See more from MedicalBrief archives:
Obstetric violence rampant in KZN, Gauteng, survey finds
Mothers call for probe into obstetric violence at state hospitals
Pregnant women suffer ‘obstetric violence’ in health systems