‘One woman, one bed’: prevalence and factors associated with women’s experiences of respectful birth in urban Dar es Salaam, Tanzania–across-sectional survey

Background: Respectful maternity care (RMC) is essential for quality care, safety, and a fundamental right of women during childbirth. However, mistreatment during childbirth hinders global efforts to reduce maternal and perinatal deaths and birth-related injuries. In rapidly urbanizing Dar es Salaam, disrespectful care in overcrowded maternity units is concerning. Objective: To assess the prevalence and factors associated with women’s experiences of RMC in four urban health facilities in Dar es Salaam. Method: A 25-item locally co-created and validated measurement tool was administered to 838 postnatal women before discharge in a cross-sectional survey. Data were analyzed in Stata 14 to describe sociodemographic characteristics, birth outcomes, and birth experiences. Multivariable logistic regression identified factors associated with RMC. Results: Satisfaction was reported by 96.4% (793/823) of women. Additionally, 84.3% (689/817) reported effective communication. However, 60.8% (503/827) shared hospital beds, 32.2% (253/785) experienced mistreatment, and 10.7% (89/829) had a birth companion. RMC was significantly less frequent among single women (aOR 0.56; 95% CI: 0.36–0.87) and those with childbirth complications (aOR 0.52; 95% CI: 0.35–0.78). Complications were reported less frequently when women had their own bed (aOR 0.51; 95% CI: 0.34–0.77). Conclusion: High satisfaction scores, despite mistreatment, bed-sharing, and lack of birth companionship highlight the need to raise awareness of rights-based care in communities. As urban growth strains healthcare systems, addressing structural constraints and overcrowding is crucial. Strengthening provider training in RMC and complications management, along with institutionalizing RMC measurements, can improve accountability, clinical outcomes, and women’s experiences of care.