Maternity Care Service Quality, Women’s Satisfaction, and Associated Factors in Public Hospitals in Sana'a City, Yemen
This facility-based cross-sectional study in Sana'a, Yemen, reveals that while overall maternity care quality is moderate, women's satisfaction is significantly higher among those who received antenatal education, had a birth plan, underwent Caesarean delivery, or experienced a live normal newborn outcome, highlighting the need to strengthen education and provider responsiveness to improve maternal care.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
In the quiet hours after a child is born, a mother's experience is often defined by more than just the medical success of the delivery. It is shaped by how she was treated, how well her needs were understood, and whether she felt safe and respected. For health systems around the world, a mother's satisfaction with her care is a vital sign. It is not merely a matter of feelings; it is a practical indicator of how well a hospital is functioning. When women feel heard and cared for, they are more likely to return for future checkups and follow medical advice, which leads to healthier families. However, in places where resources are scarce and conflict has strained daily life, measuring this satisfaction becomes a complex challenge. Researchers must look beyond simple checklists to understand what truly matters to a woman in the moments after she becomes a mother.
In Sana'a City, Yemen, a team of researchers set out to understand exactly this dynamic within the public hospital system. They focused on 232 women who had recently given birth in three major public hospitals: Al-Thowrah, Al-Jomhury, and Al-Kuwait. The study took place over three months in early 2025, a time when the country continues to face significant health system challenges. The researchers did not just ask if the women were happy; they used a structured approach to evaluate the quality of care across five specific areas. They looked at the physical condition of the hospital and its equipment, the reliability of the staff, how quickly they responded to needs, the trust women felt in their doctors and nurses, and the empathy shown by the caregivers. This method allowed them to separate the tangible aspects of care, like clean rooms and working tools, from the human elements, such as kindness and communication.
The results painted a picture of a system that is struggling with its physical resources but succeeding in its human connections. The overall quality of care was rated as moderate. The most striking finding was that the physical environment scored the lowest. The availability of supplies, the cleanliness of the facilities, and the condition of the equipment were the areas where women felt the greatest gap between what they received and what they hoped for. In contrast, the human side of care fared much better. The dimension of empathy—how well the staff listened, communicated, and offered emotional support—received the highest ratings. Women felt that the healthcare providers were willing to understand their individual needs and treat them with dignity. This suggests that while the buildings and tools may be lacking, the people working within them are making a significant effort to provide compassionate care.
When the researchers dug deeper to find out what specifically made a woman feel satisfied with her experience, the answers were tied closely to the outcome of the birth and the preparation she received beforehand. The most significant factor was the health of the newborn. Women who had a healthy, live baby were much more likely to report high satisfaction than those whose babies faced complications or did not survive. This is a powerful reminder that for a mother, the ultimate measure of a successful hospital visit is the well-being of her child. Beyond the outcome, the type of delivery played a major role. Women who had a Cesarean section reported higher levels of satisfaction than those who had a vaginal birth. This finding might seem surprising at first, but it likely reflects the relief of a planned or necessary intervention that ensured safety, rather than a preference for the procedure itself.
Preparation before the birth also proved to be a critical ingredient in a positive experience. Women who attended educational sessions during their pregnancy were far more satisfied with their care than those who did not. These sessions likely helped them understand what to expect, reducing fear and anxiety. Similarly, women who were given a birth plan—a document outlining their preferences and the steps for their delivery—felt more satisfied. This suggests that when women are informed and involved in the planning process, they feel more in control and respected, even in a difficult environment. Interestingly, factors like a woman's age, where she lived, or how much money her family earned did not independently predict her satisfaction once the researchers accounted for the quality of care she actually received. This indicates that a good experience is possible for any woman, regardless of her background, if the care she receives is responsive and well-prepared.
The study concludes that improving maternity care in Sana'a requires a dual approach. First, there is an urgent need to address the physical gaps: better equipment, cleaner facilities, and more reliable supplies. These are the foundations of trust. Second, the human strengths identified in the study must be reinforced. The empathy and responsiveness shown by the staff are powerful assets that should be protected and expanded. By strengthening antenatal education and ensuring that every woman has a clear birth plan, hospitals can build on the existing goodwill of their staff. The research does not claim to have solved the deep-seated issues of a conflict-affected health system, but it offers a clear roadmap: when the physical environment is improved and the human connection is nurtured, mothers feel seen, safe, and satisfied.
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