BACKGROUND:
The Respectful Maternity Care (RMC) framework has shifted attention from overt mistreatment to more subtle but widespread violations of rights-based, person-centered maternity care.

OBJECTIVES:
To compare how women’s childbirth experiences in Cyprus and Croatia align with RMC principles, using standardized measures of person-centred care.

METHODS:
As part of the EU/CERV-funded RESPECT project, an online survey was conducted with women who had given birth in the last five years in Cyprus and Croatia. The battery of tools included the 35-item Person-Centered Maternity Care (PCMC) questionnaire, which assesses deviation from quality standards on a 0–100% scale. Written responses to an open-ended survey question were also deductively content-analysed using the RMC framework.

RESULTS:
The median PCMC score was 81 (IQR 61–92) in Cyprus (n=516, 49% C-section) and 53 (IQR 35–75) in Croatia (n=855, 30% C-section). PCMC scores >90% were recorded by 29.8% of respondents in Cyprus, while 17.1% scored below 50%. Suboptimal care was more widespread in Croatia, with only 9.0% scoring above 90%. Average subscale scores followed a similar pattern in both countries: Dignity & Respect scored higher (82% Cyprus; 68% Croatia), followed by Responsive & Supportive Care (73% Vs 51%), and lowest in Communication & Autonomy (70% Vs 48%). Despite country-specific differences, item-level analysis revealed shared and common deficiencies including lack of emotional support, poor communication, and inconsistent consent processes before procedures. Mistreatment and discrimination were less frequently reported but remain concerning. Qualitative data reinforced the quantitative trends, providing a nuanced understanding of problematic areas.

CONCLUSIONS:
Despite different prevalence levels, both countries showed similarly ranked shortcomings, particularly in autonomy and communication. Standardized PCMC tools enabled cross-country comparison and underscored the urgent need for systemic reform.

KEY MESSAGE:
Persistent gaps in person-centered care, especially around communication and autonomy, call for structural change and regular monitoring using validated RMC tools. Respectful maternity care 1