BACKGROUND:
Disrespect in childbirth undermines women's rights, with implications for maternal outcomes and system trust. While Cyprus has the highest caesarean section (C/S) rate in the EU, raising questions about informed choices, a recent C/S reduction National Strategy does not address deeper systemic and cultural drivers of care.

OBJECTIVES:
This academia-led project co-developed a National Strategy for Respectful Maternity Care (RMC) through a participatory process with a diverse set of stakeholders.

METHODS:
Using a participatory action research approach, the RESPECT project engaged 35 stakeholders, including professional associations, government departments, regulatory bodies, and civil society. Stakeholders mapped the determinants of RMC using socio-ecological and COM-B behavioural models, identifying barriers and opportunities across multiple levels. Actionable recommendations and resources were co-created in a series of structured workshops.

RESULTS:
The mapping revealed systemic gaps and complex interdependencies. Key issues emerging were: the absence of national guidelines, quality assurance systems, in-service training, and the pervasive impact of fear of litigation on defensive medical practices. Recommendations were grouped under four pillars: clinical practice, professional development, public awareness, and research and data monitoring. Actions implemented include: a checklist for clinics adapted from the WHO quality standards, shared decision-making training curriculum for providers, empowerment workshops and e-course on RMC rights, an RMC lexicon linking concepts to recommendations, and the research-informed video "When standard practice is not Practicing Standards", among others.

CONCLUSIONS:
The participatory and inclusive approach built trust with stakeholders, fostering a shared understanding and ownership of quality improvement efforts in maternity care in Cyprus. While certain terminology (e.g. "obstetric violence") triggered backlash, the process was successful in developing context-specific strategies and tangible resources for the promotion of Respectful Maternity Care.

KEY MESSAGE:
This project demonstrates the value of inclusive policy co-creation that integrates women’s lived experiences and system constraints, offering a replicable model for aligning maternity care with human rights and quality standards. Policy - professionalism