Cultural Competence and Respectful Care

Cultural competence is the capacity of midwives and maternity services to provide care that recognizes and responds to a woman's cultural background, language, beliefs, and preferences. Respectful care extends this to upholding every woman's dignity, privacy, autonomy, and freedom from discrimination or mistreatment throughout pregnancy and childbirth.

Definition

Cultural competence in midwifery is the practitioner's and system's ability to deliver care responsive to women's cultural and individual needs; respectful care is the provision of dignified, non-discriminatory maternity care that protects autonomy, privacy, and freedom from mistreatment.

Scope

This topic describes culturally competent and respectful maternity care, the rights underpinning it, the documented problem of disrespect and mistreatment, and the way cultural factors shape access to and experience of care. It is a reference description and does not provide individualized clinical or legal direction.

Core questions

• How do cultural background and language shape women's needs and experiences of maternity care?
• What does respectful, dignified, and non-discriminatory care require in practice?
• How do cultural and respect-related factors influence whether women access skilled care?

Key concepts

• Cultural competence and cultural humility
• Respectful maternity care
• Dignity and privacy
• Non-discrimination and equity
• Language and communication
• Woman-centred care
• Barriers to facility-based care

Mechanisms

Culturally competent, respectful care is delivered through communication that bridges language and cultural difference, accommodation of preferences where safe, and standards that protect dignity and prohibit mistreatment. Qualitative evidence shows that perceived disrespect, cultural mismatch, and poor communication act as barriers that can deter women from seeking facility-based birth (Bohren et al., 2014), while a typology of mistreatment identifies discrimination and loss of dignity as recurrent harms (Bohren et al., 2015).

Clinical relevance

Respect for culture and dignity affects whether women feel safe to seek and continue maternity care and shapes their experience and trust in services. Evidence links disrespect, discrimination, and cultural insensitivity to reduced use of skilled care, particularly in low- and middle-income settings (Bohren et al., 2014; Sacks & Kinney, 2015). This entry describes standards of respectful, culturally competent care and is not a source of individualized clinical advice.

Epidemiology

A qualitative evidence synthesis across many low- and middle-income countries identified disrespect, cultural and language barriers, and fear of mistreatment among the factors that discourage women from giving birth in health facilities (Bohren et al., 2014).

Evidence & guidelines

Respectful maternity care frameworks set out shared standards for dignity, non-discrimination, and freedom from mistreatment (Sacks & Kinney, 2015), supported by systematic and qualitative evidence on mistreatment and barriers to care (Bohren et al., 2015; Bohren et al., 2014).

Key figures

• Emma Sacks
• Meghan A. Bohren

Seminal works

• bohren-2015
• sacks-2015

Frequently asked questions

What is the difference between cultural competence and respectful care?

Cultural competence is the ability to recognize and respond to a woman's cultural background and preferences; respectful care is the broader commitment to dignity, privacy, autonomy, and freedom from discrimination and mistreatment for every woman.

Why does respectful, culturally competent care affect outcomes?

Evidence shows that disrespect, discrimination, and cultural or language barriers can deter women from seeking skilled facility-based care, so respectful care supports both access and a positive experience.