Voices from the neonatal unit: Mothers’ and healthcare workers’ perspectives on respectful and collaborative care for small and sick newborns
1
¹ School of Public Health, University of the Western Cape, Cape Town, South Africa
2
² Centre for Research in Health Systems, University of KwaZulu-Natal, Durban, South Africa
3
³ Global Surgery Division, Department of Surgery, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa
4
⁴ School of Education, University of KwaZulu-Natal, Pietermaritzburg, South Africa
5
⁵ London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom
6
⁶ Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
7
⁷ Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):A2326
ABSTRACT
INTRODUCTION:
Neonatal care increasingly emphasizes improving the care experience by engaging mothers as active partners alongside healthcare workers (HCWs) who provide clinical care for newborns. Guided by the World Health Organization’s Standards for improving the quality of care for small and sick newborns, this study focuses on Standard 4, which promotes care that is respectful, responsive, and supportive of families’ needs and preferences.
METHODS:
We conducted a concurrent triangulation mixed-methods study in two rural districts of KwaZulu-Natal, South Africa, between October 2022 and March 2023. Data included a cross-sectional survey of 116 mothers of small and sick newborns admitted to neonatal units, focus group discussions with 24 additional mothers, and in-depth interviews with 14 HCW.
RESULTS:
Effective communication emerged as a foundational factor shaping mothers’ experiences of care. While most mothers reported receiving clear guidance on unit orientation (80%) and newborn care practices (82%), their involvement was largely limited to routine tasks such as feeding newborns and changing nappies. Almost half of mothers (46%) reported not being allowed to attend doctor rounds, and 38% stated they never had the opportunity to speak with a doctor. Access was often constrained by structured visiting hours, overcrowded units, and limited privacy. Both mothers and HCWs identified significant barriers to effective communication. Mothers described unwelcoming attitudes, inconsistent or dismissive interactions, and exclusion from clinical decision-making, leading to fear of asking questions, frustration, limited collaboration, and a lack of informed consent. HCWs similarly reported challenges to providing respectful, family-centred care, citing overcrowding, staff shortages, fatigue, and insufficient space to support maternal participation.
CONCLUSIONS:
Findings reveal persistent gaps in the implementation of Standard 4 within rural neonatal units. Strengthening communication and integrating family-centred principles into routine neonatal care could enhance collaboration, rebuild trust, and improve the overall care experience for mothers and their newborns.
Neonatal care increasingly emphasizes improving the care experience by engaging mothers as active partners alongside healthcare workers (HCWs) who provide clinical care for newborns. Guided by the World Health Organization’s Standards for improving the quality of care for small and sick newborns, this study focuses on Standard 4, which promotes care that is respectful, responsive, and supportive of families’ needs and preferences.
METHODS:
We conducted a concurrent triangulation mixed-methods study in two rural districts of KwaZulu-Natal, South Africa, between October 2022 and March 2023. Data included a cross-sectional survey of 116 mothers of small and sick newborns admitted to neonatal units, focus group discussions with 24 additional mothers, and in-depth interviews with 14 HCW.
RESULTS:
Effective communication emerged as a foundational factor shaping mothers’ experiences of care. While most mothers reported receiving clear guidance on unit orientation (80%) and newborn care practices (82%), their involvement was largely limited to routine tasks such as feeding newborns and changing nappies. Almost half of mothers (46%) reported not being allowed to attend doctor rounds, and 38% stated they never had the opportunity to speak with a doctor. Access was often constrained by structured visiting hours, overcrowded units, and limited privacy. Both mothers and HCWs identified significant barriers to effective communication. Mothers described unwelcoming attitudes, inconsistent or dismissive interactions, and exclusion from clinical decision-making, leading to fear of asking questions, frustration, limited collaboration, and a lack of informed consent. HCWs similarly reported challenges to providing respectful, family-centred care, citing overcrowding, staff shortages, fatigue, and insufficient space to support maternal participation.
CONCLUSIONS:
Findings reveal persistent gaps in the implementation of Standard 4 within rural neonatal units. Strengthening communication and integrating family-centred principles into routine neonatal care could enhance collaboration, rebuild trust, and improve the overall care experience for mothers and their newborns.
| eISSN: | 2654-1459 |
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