Patience Afulani

• Doctor of Philosophy
• Professor (Associate) at University of California, San Francisco

Background Racial disparities in perinatal outcomes are worsened by systemic racism in the United States. San Francisco's Pregnancy Village is a novel cross-sector care delivery model providing a one-stop shop for city government, clinical, and community-based wraparound services, delivered in an uplifting, celebratory, and dignified environment to...

The Pregnancy Village (PV) was created to deliver cross-sector services at a convenient time and location for Black pregnant and postpartum people. This study examines the accessibility and acceptability of PV among pregnant individuals and their families. We surveyed 116 participants (57 pregnant/postpartum individuals and 59 family members) and c...

Introduction In the United States, Black birthing people report poor‐quality health care and face adverse maternal and infant outcomes. Empowerment to advocate with health care providers could help improve outcomes for birthing people of color. The literature is, however, sparse on factors associated with empowerment in the perinatal period. We exa...

Background Person-centered maternity care (PCMC) refers to respectful, responsive, and compassionate childbirth care. The PCMC scale enables quantitative measurement of PCMC. Despite the widespread use of the PCMC scale, no global synthesis exists. We, therefore, conducted a global systematic review of studies using the PCMC scale to quantitatively...

Introduction The COVID-19 pandemic negatively impacted the working conditions and mental health of healthcare workers (HCWs) across the globe. Little is understood of the factors influencing the mental health of HCWs in low-and middle-income countries like Ghana, which faced significant challenges from the COVID-19 pandemic due to their overburdene...

Background High-quality postnatal care (PNC), including Person-centered postnatal care (PCPNC), is essential to achieving optimal maternal and neonatal outcomes. PCPNC refers to postnatal care that is respectful of and responsive to postpartum women’s preferences, needs, and values. While interest in person-centered care across the reproductive hea...

Background Person-centered antenatal care (PCANC)—antenatal care that is respectful and responsive to people’s needs, values, and preferences—is essential to achieving optimal pregnancy outcomes. Yet, no validated tools exist to comprehensively measure PCANC in low- and middle-income countries (LMICs). We aim to develop and validate a tool to compr...

Objectives This study aims to assess if an integrated simulation-based training on respectful maternity care (RMC) and management of obstetric and neonatal emergencies could improve the quality of antenatal care (ANC). Methods The data are from two cross-sectional surveys administered in the East Mamprusi District of Northern Ghana in 2017 to eval...

Importance Preterm birth (PTB) (gestational age <37 weeks) is a major cause of infant mortality and morbidity in the US and is marked by racial and ethnic and socioeconomic inequities. Further research is needed to elucidate the association of risk and protective factors with trends in PTB rates and with related inequities. Objective To describe t...

Background Poor person-centered maternal care (PCMC) contributes to high maternal mortality and morbidity, directly and indirectly, through lack of, delayed, inadequate, unnecessary, or harmful care. While evidence on poor PCMC prevalence, as well as inequities, expanded in the last decade, there is still a significant gap in evidence-based interve...

Adequate preparedness of health systems, particularly healthcare workers (HCWs), to respond to COVID-19 is critical for the effective control of the virus, especially in low- and middle-income countries where health systems are overburdened. We examined Ghanaian HCWs’ perceived preparedness to respond to the pandemic and the factors that shaped the...

Key drivers of poor person-centered maternal care (PCMC)—respectful and responsive care—include provider stress and bias. The Caring for Providers to Improve Patient Experience (CPIPE) intervention is a 5-component intervention including provider training, peer support, mentorship, embedded champions, and leadership engagement that addresses these...

Objectives To understand local mechanisms of racial inequities and generate recommendations from community members regarding how to promote racial equity in the Neonatal Intensive Care Unit (NICU). Methods In an urban tertiary care NICU, 4 semi-structured in-person focus groups with follow-up audio diaries were conducted with NICU parents and staf...

Introduction Centering affected individuals and forming equitable institutional–community partnerships are necessary to meaningfully transform care delivery systems. We describe our use of the PRECEDE‐PROCEED framework to design, plan, and implement a novel care delivery system to address perinatal inequities in San Francisco. Methods Community en...

Background Despite research that has shown that the presence of support persons during maternity care is associated with more respectful care, support persons are frequently excluded due to facility practices or negative attitudes of providers. Little quantitative research has examined how integrating support persons in maternity care has implicati...

Objective Medication abortions now make up the majority of abortions in the US, with new service delivery models such as telehealth; however, it is unclear how this may impact patient experiences. The objective of the study is to adapt and validate a person-centered abortion care (PCAC) scale for medication abortions that was developed in a global...

Background Poor person-centered maternal care (PCMC) contributes to high maternal mortality and morbidity, directly and indirectly, through lack of, delayed, inadequate, unnecessary, or harmful care. While evidence on poor PCMC prevalence, as well as inequities, expanded in the last decade, there is still a significant gap in evidence-based interve...

Introduction Person-centred care (PCC) is provision of care that is respectful of and responsive to individual patient preferences, needs and values, and ensures that patient values guide all clinical decisions. While there is a large body of evidence on the benefits of PCC in high-income countries, little research exists on PCC in Ghana and Sub-Sa...

Objective To assess the impact of the Caring for Providers to Improve Patient Experience (CPIPE) intervention, which sought to improve person‐centered maternal care (PCMC) by addressing two key drivers: provider stress and bias. Methods CPIPE was successfully piloted over 6 months in two health facilities in Migori County, Kenya, in 2022. The eval...

Objectives To assess psychometric properties of two scales developed to measure the quality of person-centered care during pregnancy and childbirth in the United States—the Person-Centered Prenatal Care (PCPC-US) and Person-Centered Maternity Care (PCMC-US) scales—in a low-income predominantly Latinx population in California. Methods Data were col...

Background Globally, approximately 800 women and 6400 newborns die around the time of childbirth each day. Many of these deaths could be prevented with high-quality emergency obstetric and newborn care (EmONC). The Monitoring Emergency Obstetric Care: A handbook guides strengthening EmONC services. However, the handbook contains limited quality of...

Objective: To assess the impact of the Caring for Providers to Improve Patient Experience (CPIPE) intervention, which sought to improve person-centered maternal care (PCMC) by addressing two key drivers: provider stress and bias. Methods: CPIPE was successfully piloted over 6-months in two health facilities in Migori County, Kenya in 2022. The eval...

Background Integrating support persons into maternity care, such as making them feel welcome or providing them with information, is positioned to increase support for women and improve birth outcomes. Little quantitative research has examined what support women need and how the healthcare system currently facilitates support for women. We introduce...

Background Increasing evidence show that women across the world face unacceptable mistreatment during childbirth. Person-centered maternity care is fundamental and essential to quality of healthcare services. The aim of this study was to translate and determine the psychometric properties of the Person-Centered Maternity Care (PCMC) Scale among Chi...

Objectives To assess psychometric properties of two scales developed to measure the quality of person-centered care during pregnancy and childbirth in the United States—the Person-Centered Prenatal Care (PCPC-US) and Person-Centered Maternity Care (PCMC-US) scales—in a low-income predominantly Latinx population in California. Methods Data were col...

Background Women’s childbirth experience of interpersonal care is a significant aspect of quality of care. Due to the lack of a reliable Cambodian version of a measurement tool to assess person-centered maternity care, the present study aimed to adapt the “Person-Centered Maternity Care (PCMC) scale” to the Cambodian context and further determine i...

Person‐centred sexual and reproductive health (PCSRH) care refers to care that is respectful of and responsive to people's preferences, needs, and values, and which empowers them to take charge of their own sexual and reproductive health (SRH). It is an important indicator of SRH rights and quality of care. Despite the recognition of the importance...

Key drivers of poor Person-Centered Maternal Care (PCMC)—respectful and responsive care—include provider stress and unconscious bias. The Caring for Providers to Improve Patient Experience (CPIPE) intervention, a 5-component intervention including provider training, peer support, mentorship, embedded champions, and leadership engagement, was succes...

Abstract Background Person-centered maternity care (PCMC) has become a priority in the global health discourse on quality of care due to the high prevalence of disrespectful and lack of responsive care during facility-based childbirth. Although PCMC is generally sub-optimal, there are significant disparities. On average, women of low socioeconomic...

The dynamic and complex nature of care provision predisposes healthcare workers to stress, including physical, emotional, or psychological fatigue due to individual, interpersonal, or organizational factors. We conducted a convergent mixed-methods study with maternity providers to understand their sources of stress and coping mechanisms they adopt....

Background Robust evidence supports the effectiveness of simulation training in nursing and midwifery education. Simulation allows trainees to apply newly-learned skills in a supportive environment. Method This study was conducted using the Consolidated Framework for Implementation Research (CFIR). We conducted in-depth individual interviews with...

Key Messages With increased evidence of the importance of promoting respectful maternity care (RMC), and more interventions being developed, implementers and intervention developers could learn from existing frameworks to guide the design of more effective interventions. We argue that a behavior change framework, such as the capability, opportunity...

Background: Although several indicators have been proposed to measure women's experience of care in health facilities during the intrapartum period, it is unknown if these indicators perform differently in the context of obstetric emergencies. We examined the relationship between experience of care indicators from the Person-Centered Maternity Car...

Background In Cambodia, the importance of valuing women’s childbirth experiences in improving quality of care has been understudied. This is largely because of absence of reliable Khmer tools for measuring women’s intrapartum care experiences. Generally, cross-cultural development of those tools often involves translation from a source language int...

Synopsis A summary of the findings in the Supplement, highlighting the heterogeneity in reported quality of maternity care and inequalities within and between countries in the European region.

Background Maternity providers, including nurses, midwives, physicians, are at significant risk for stress and burnout due to the nature of care provision in maternal and child health settings. Yet, the empirical evidence on stress and burnout among maternity providers in sub-Saharan Africa is scarce. Therefore, the purpose of our study was to (1)...

Background Simulation has been shown to improve clinical and behavioral skills of birth attendants in low-resource settings at a low scale. Populous, low-resource settings such as Bihar, India, require large cadres of simulation educators to improve maternal and newborn health. It’s unknown if simulation facilitation skills can be adopted through a...

A growing body of research has documented disrespectful, abusive, and neglectful treatment of women in facilities during childbirth, as well as the drivers of such mistreatment. Yet, little research exists on effective interventions to improve Person-Centred Maternal Care (PCMC)—care that is respectful and responsive to individual women's preferenc...

Background Person-centered maternity care (PCMC) has become a priority in the global health discourse on the quality of care due to the high prevalence of disrespectful and lack of responsive care during facility-based childbirth. Although PCMC is generally sub-optimal, there are significant disparities. On average, women of low socioeconomic statu...

Background Giving birth in health facilities with skilled birth attendants (SBAs) is one of the key efforts promoted to reduce preventable maternal deaths in sub-Saharan Africa. However, research has revealed large socioeconomic status (SES) disparities in facility-based childbirth. We seek to extend the literature on the factors underlying these S...

Purpose This study (1) assessed the psychometric properties of a pregnancy-related COVID worry scale, (2) explored variations in pregnancy-related COVID worry over the course of the pandemic, and (3) examined associations between pregnancy-related COVID worry and depressive symptom severity, and evaluated sleep disturbance as a mediator. Methods D...

The dynamic and complex nature of care provision predisposes healthcare workers to stress, including physical, emotional, or psychological fatigue due to individual, interpersonal, or organizational factors. We conducted a convergent mixed-methods study with maternity providers to understand their sources of stress and coping mechanisms they adopt....

Introduction In the United States, adverse birth outcomes are most prevalent among Black women and birthing people, who are known to experience increased mistreatment and disrespect in care. The purpose of this paper is to describe findings from a study that used two validated scales to examine factors associated with experiences of person‐centered...

Introduction: Mistreatment by health care providers disproportionately affects Black, Indigenous, and other people of color in the United States. The goal of this study is to adapt the global Person-Centered Maternity Care (PCMC) scale for use in the United States, with particular attention to the experiences of Black women and birthing people. M...

Stigma and discrimination are fundamental causes of health inequities, and reflect privilege, power, and disadvantage within society. Experiences and impacts of stigma and discrimination are well-documented, but a critical gap remains on effective strategies to reduce stigma and discrimination in sexual and reproductive healthcare settings. We aime...

The biomarker cortisol assesses the impact of biopsychosocial stressors that activate the stress response system. Hair has emerged as a valid and non-invasive means of gauging cumulative cortisol deposited over month-long periods of time. Established protocols for the extraction of hair cortisol are being validated and refined in humans, yet method...

Background In Cambodia, the importance of valuing women’s childbirth experiences in improving quality of care has been understudied. This is largely because of absence of reliable Khmer tools for measuring women’s intrapartum care experiences. Generally, cross-cultural development of those tools often involves translation from a source language int...

Background Simulation has been shown to improve clinical and behavioral skills of birth attendants in low-resource settings at a low scale. Populous, low-resource settings such as Bihar, India, require large cadres of simulation educators to improve maternal and newborn health. It’s unknown if simulation facilitation skills can be adopted through a...

Background: Person-centered care (PCC) is provision of care that is respectful of and responsive to in­dividual patient preferences, needs, and values, and ensures that patient values guide all clinical decisions. While there is a large body of evidence on the benefits of PCC in high-income countries, little research exists on PCC in Ghana and Sub-...

Objective This study assessed whether having continuous support during labor is associated with better person-centered maternity care (PCMC) among women in rural Kenya. Methods Data are from a cross-sectional survey with women aged 15–49 years who delivered in the 9 weeks preceding survey completion (N = 865). PCMC was operationalized using a vali...

Introduction Person-centred maternity care (PCMC), which refers to care that is respectful and responsive to women’s preferences needs, and values, is core to high-quality maternal and child health. Provider-reported PCMC provision is a potentially valid means of assessing the extent of PCMC and contributing factors. Our objectives are to assess th...

The COVID-19 pandemic has affected job satisfaction among healthcare workers; yet this has not been empirically examined in sub-Saharan Africa (SSA). We addressed this gap by examining job satisfaction and associated factors among healthcare workers in Ghana and Kenya during the COVID-19 pandemic. We conducted a cross-sectional study with healthcar...

Introduction Peri-urban settings have high maternal mortality and the quality of care received in different types of health facilities is varied. Yet few studies have explored the construct of person-centered maternity care (PCMC) within peri-urban settings. Understanding women’s experience of maternity care in peri-urban settings will allow health...

Background: Community perceptions of quality of maternal healthcare services—including Person-centered maternity care (PCMC)—influences the health-seeking behavior of women. Yet few studies have examined this quantitatively. This study aims to examine community perceptions of PCMC and its associated factors. Materials and Methods: We used data from...

Supportive care is a key component of person-centered maternity care (PCMC), and includes aspects such as timely and attentive care, pain control, and the health facility environment. Yet, few researchers have explored the degree of supportive care delivered or providers’ perceptions on supportive care practices during childbirth. The researchers’...

Introduction: Mistreatment by healthcare providers disproportionately affects people of color in the United States (US). The goal of this study is to adapt the global Person-Centered Maternity Care (PCMC) scale to the experiences of people of color in the US using a community-engaged approach. Methods: We conducted expert reviews to improve content...

Background Kenya continues to have a high maternal mortality rate that is showing slow progress in improving. Peri-urban settings in Kenya have been reported to exhibit higher rates of maternal death during labor and childbirth as compared to the general Kenyan population. Although research indicates that women in Kenya have increased access to fac...

Introduction The COVID-19 pandemic has compounded the global crisis of stress and burnout among healthcare workers. But few studies have empirically examined the factors driving these outcomes in Africa. Our study examined associations between perceived preparedness to respond to the COVID-19 pandemic and healthcare worker stress and burnout and id...

Background: Given stark disparities in maternal mortality and adverse birth outcomes among Black, Indigenous, and other people of color, there is a need to better understand and measure how individuals from these communities experience their care during pregnancy. Objectives: To develop and validate a tool that can be used to measure person-cent...

Background Research suggests that women’s experience of antenatal care is an important component of high-quality antenatal care. Person-centered antenatal care (PCANC) reflects care that is both respectful of, and responsive to, the preferences, needs, and values of pregnant women. Little is known in Rwanda about either the extent to which PCANC is...

Background Stress and burnout among healthcare workers has been recognized as a global crisis needing urgent attention. Yet few studies have examined stress and burnout among healthcare providers in sub-Saharan Africa, and even fewer among maternity providers who work under very stressful conditions. To address these gaps, we examined self-reported...

Objective This study explored providers’ perspectives and behavior regarding respectful maternity care, including knowledge, attitudes, and practices. Design Mixed-methods cross-sectional study combining quantitative survey data, qualitative interviews, and observations of labor and delivery across four health facilities Setting Government health...

Background Limited evidence exists on how women's experiences of care, specifically person-centered maternity care (PCMC) during childbirth, influences maternal and newborn health outcomes. Objectives This study aims to examine the associations between PCMC and maternal and newborn health outcomes. Study Design Longitudinal data were collected wi...

Studies in low-resource settings have highlighted disparities in person-centred maternity care (PCMC)—respectful and responsive care during childbirth—based on women’s socioeconomic status (SES) and other characteristics. Yet few studies have explored factors that may underlie these disparities. In this study, we examined implicit and explicit SES...

Studies in low-resource settings have highlighted disparities in person-centered maternity care (PCMC)-respectful and responsive care during childbirth-based on women's socioeconomic status (SES) and other characteristics. Yet few studies have explored factors that may underlie these disparities. In this study, we examined implicit and explicit SES...

Background: Quality of care of family planning provision has many dimensions, including those related to a woman’s experience, or person-centered care, and measuring and understanding these different components is challenging. Understanding which components are most important for women’s experiences and method continuation is essential for improvin...

Background: Stress and burnout among healthcare workers has been recognized as a global crisis needing urgent attention. Yet few studies have examined stress and burnout among healthcare providers in sub-Saharan Africa, and even fewer among maternity providers who work under very stressful conditions. To address these gaps, we examined self-reporte...

Background: Research suggests that person centered antenatal care (PCANC) provides an effective tool for addressing maternal deaths in Sub-Saharan Africa through the delivery of health care which is both respectful of, and responsive to, the preferences, needs, and values of women. Yet little is known in Rwanda about either the extent to which PCAN...

The aim of the study was to investigate the relationship between counseling prior to starting antiretroviral treatment (ART) and adherence to treatment among women enrolled in Option B+ in Zambia. Using convenience sampling, 150 HIV+ women enrolled in an Option B+ treatment regimen in rural and urban districts were recruited. Four generalized Poiss...

Background: Healthcare workers' (HCWs) preparedness to respond to pandemics is critical to containing disease spread. Low-and middle-income countries, however, experience barriers to preparedness due to limited resources. In Ghana, a country with a constrained healthcare system, we examined HCWs' perceived preparedness to respond to coronavirus dis...

Background: There is a need for a standardized way to measure person-centered care for abortion. This study developed and validated a measure of person-centered abortion care. Methods: Items for person-centered abortion care were developed from literature reviews, expert review, and cognitive interviews, and administered with 371 women who recei...

Introduction: The COVID-19 pandemic has compounded the global crisis of stress and burnout among healthcare workers (HCWs). But few studies have empirically examined the factors driving these outcomes. We examined the association between perceived preparedness to respond to the pandemic and HCW stress and burnout and identified potential mediating...

Background: Quality of care of family planning provision has many dimensions, and measuring and understanding these different components is challenging. Furthermore, understanding which components are most important for women’s experiences and method continuation is essential for improving the quality of care provision. Methods: We use longitudinal...

Introduction: Healthcare workers' (HCWs) preparedness to respond to pandemics is critical to containing disease spread. Low-resource countries, however, experience barriers to preparedness due to limited resources. In Ghana, a country with a constrained healthcare system and high COVID-19 cases, we examined HCWs' perceived preparedness to respond t...

Background: Effective communication and respect for women's autonomy are critical components of person-centered care. Yet, there is limited evidence in low-resource settings on providers' perceptions of the importance and extent of communication and women's autonomy during childbirth. Similarly, few studies have assessed the potential barriers to...

Background: Effective communication and respect for women’s autonomy are critical components of person-centered care. Yet, there is limited evidence in low-resource settings on providers’ perceptions of the importance and extent of communication and women’s autonomy during childbirth. Similarly, few studies have assessed the potential barriers to e...

Background: Some opportunities to routinely capture and improve respectful maternity care (RMC) during facility-based childbirth include quality improvement (QI) initiatives, community-based monitoring efforts through community score cards (CSC), and performance-based financing (PBF) initiatives. But there is limited guidance on which types of RMC...

Disrespect and abuse during childbirth are violations of women's human rights and an indicator of poor-quality care. Disrespect and abuse during childbirth are widespread, yet data on providers' perspectives on the topic are limited. We examined providers' perspectives on the frequency and drivers of disrespect and abuse during facility-based child...

Introduction: Little is known about the effect of integrating respectful maternity care into clinical

Introduction: Little is known about the effect of integrating respectful maternity care into clinical training programs. We sought to examine the effectiveness of an integrated simulation training on emergency obstetric and neonatal care and respectful maternity care on providers' knowledge and self-efficacy, and to asess providers' perceptions of...

Objective Despite the recognized importance of person‐centered care, very little information exists on how person‐centered maternity care (PCMC) impacts newborn health. Methods Baseline and follow‐up data were collected from women who delivered in government health facilities in Nairobi and Kiambu counties in Kenya between August 2016 and February...