Women’s Autonomy and Respectful Maternity Care in Zambia: A Cross-Sectional Study Using Validated Patient-Reported Measures

Objective: Although women’s autonomy is key to patient care, the extent to which patients exercise autonomy during clinical consultations in resource-limited contexts such as Zambia remains unknown. This study aimed to examine women’s experiences of autonomy in decision-making and respectful treatment in Zambian maternal healthcare. Methods: The study was conducted in Lusaka and used a cross-sectional survey design. The sample consisted of 305 women who were conveniently recruited. Data was collected using a questionnaire consisting of sociodemographic data and two validated instruments: the 7-item Mothers Autonomy and Decision-Making Scale (MADM), and the 14-item Measure of Respect (MOR) index. Results: Higher levels of decision-making autonomy, according to MADM, are significantly associated with higher levels of perceived respect in maternal healthcare settings, according to MOR (p <.001). Furthermore, higher education was found to correlate significantly with higher autonomy and respect (p <.001). Both instruments showed an excellent (MADM) and good (MOR) internal consistency among this sample (Cronbach’s alpha = 0.959 and 0.851, respectively). Overall, while there’s significant variation in responses, there is a slight tendency towards positive experiences in both autonomy and respect in maternal healthcare settings. Conclusions for Practice: Health authorities should promote the implementation of autonomous and respectful care for all women, regardless of socioeconomic or educational background, and provide a supportive environment that fosters user participation in decision-making.