The determinants of Maternal Satisfaction; A Systematic Review

Abstract

Maternal satisfaction is widely recognized as a key indicator of the quality of maternity care and an important determinant of women’s future use of health services. It reflects women’s perceptions of interpersonal care, clinical practices, and health system responsiveness across antenatal, intrapartum, and postnatal services. Despite growing attention to respectful and woman-centered care, evidence on the prevalence, determinants, and outcomes of maternal satisfaction remains fragmented across regions and service types. This systematic review synthesized existing evidence on the prevalence of maternal satisfaction with maternity care and identified its key behavioral, organizational, and contextual determinants, as well as its outcomes for women and health systems. A systematic literature search was conducted across multiple academic databases in accordance with PRISMA 2020 guidelines. Peer-reviewed empirical studies and systematic reviews addressing maternal satisfaction with antenatal, intrapartum, postnatal, or vaccination services were included. Studies were screened using predefined eligibility criteria, and data were extracted on study design, setting, sample characteristics, measurement tools, prevalence estimates, determinants, and reported outcomes. Due to heterogeneity in study designs and measurement instruments, a narrative synthesis approach was applied. The review revealed substantial variation in reported levels of maternal satisfaction across countries and care settings, with generally higher satisfaction in well-resourced facilities and lower satisfaction in settings characterized by long waiting times, inadequate privacy, and limited respectful care. Key determinants of satisfaction included quality of communication, respectful treatment, shared decision-making, waiting time, facility cleanliness, availability of supplies, mode of delivery, labor duration, and women’s prior expectations and experiences. Maternal satisfaction was consistently associated with greater confidence in the maternal role, improved health-seeking behavior, and a higher likelihood of recommending services to others. Overall, maternal satisfaction is a multidimensional construct shaped by both interpersonal interactions and health system factors. Enhancing respectful maternity care, improving communication, and strengthening facility resources are critical strategies for improving women’s experiences and promoting positive maternal and child health outcomes. Future research should adopt standardized measurement tools and comparative designs to enable stronger cross-country evidence synthesis.