‘They should listen to what we want’: striving for woman-centred intrapartum care in Sudan’s fragile healthcare system, a qualitative interpretive study

Woman-centred care is recognised globally as crucial for improving maternal health outcomes. However, its implementation in fragile healthcare systems presents unique challenges. This study explored how Sudanese women view and experience quality intrapartum care within the context of a fragile healthcare system. We undertook a qualitative interpretative study in Khartoum state, Sudan. We conducted semi-structured interviews with 18 women who had given birth in healthcare facilities within the previous year. We recruited participants from both urban and semi-rural settings. We analysed the data using the framework method. Poor quality intrapartum care resulted from systemic issues and embedded culture rather than individual behaviours. Key challenges included disrespectful care, inadequate pain management, and limited emotional support. Significant disparities existed between public and private healthcare facilities, with public hospitals characterised by poor infrastructure, limited resources, and disrespectful care. Power imbalances between women and healthcare providers undermined the provision of woman-centred care, particularly in public hospitals. The normalisation of informal payments created additional barriers to accessing quality care. However, women identified opportunities for improvement through enhanced engagement in care decisions and strengthened feedback mechanisms. Despite Sudan’s fragile healthcare context, opportunities exist to enhance woman-centred intrapartum care through systemic changes. Priority areas include addressing public-private care disparities, rebalancing power dynamics, improving physical environments, and actively engaging women in their care. Improving care requires a comprehensive approach incorporating community engagement, provider training, and health system strengthening within resource constraints.