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Health facility-based childbirth services are essential for reducing maternal and neonatal mortality. Yet, these services remain underutilized in many low- and middle-income countries (LMICs), including Papua New Guinea (PNG), where birthing at home or in village settings continue to predominate. This study investigated the determinants of non-utilization of health facilities for childbirth among women in PNG. Data from a weighted sample of 6,432 women using the 2016-2018 PNG Demographic and Health Survey (DHS) were analyzed. Descriptive statistics and multivariate logistic regression analyses were conducted to determine the factors associated with the non-utilization of health facilities for childbirth. The adjusted odds ratios (AOR) with their corresponding 95% confidence intervals (CI) were computed using the Statistical Package for Social Sciences, version 30.0. Overall, 58.3% (95% CI: 57.0-59.5) of women did not give birth in a health facility. Women were more likely to give birth at home or in the village if they had no formal education (AOR: 1.48; 95% CI: 1.11-2.09), lived in rural areas (AOR: 1.31; 95% CI: 1.11-1.75), were from the Southern (AOR: 1.05; 95% CI: 1.01-1.54), or Momase (AOR: 1.06; 95% CI: 1.02-1.83) regions, made their own healthcare decisions (AOR: 1.21; 95% CI: 1.10-4.14), had these decisions made by their husbands (AOR: 1.69; 95% CI: 1.13-2.63), walked to a health facility (AOR: 1.01; 95% CI: 1.00-1.67), or traveled more than 24 hours to access care (AOR: 1.02; 95% CI: 1.39-2.70), and had no antenatal care visits during pregnancy (AOR: 1.08; 95% CI: 1.04-1.51). Over half of the women in this study did not utilize health facilities for childbirth. Demographic and health service-related factors influenced the non-utilization of facility-based childbirth, highlighting the need to scale up maternal health services. Increasing uptake of facility-based childbirth requires coordinated system-level efforts and incentive-based interventions that promote antenatal care and skilled birth attendance, especially for rural women. Male-inclusive strategies in maternal health decision-making are critical for improving women's access to and utilization of facility-based childbirth services.

Background Globally, disrespectful, and abusive childbirth practices negatively impact women’s health, create barriers to accessing health facilities, and contribute to poor birth experiences and adverse outcomes for both mothers and newborns. However, the degree to which disrespectful maternity care is associated with complications during childbirth is poorly understood, particularly in Ethiopia. Aim To determine the extent to which disrespectful maternity care is associated with maternal and neonatal-related complications in central Ethiopia. Methods A multicentre cross-sectional study was conducted in the West Shewa Zone of Oromia, Ethiopia. The sample size was determined using the single population proportion formula. Participants ( n  = 440) were selected with a simple random sampling technique using computer-generated random numbers. Data were collected through face-to-face interviews with a pretested questionnaire and were entered into Epidata and subsequently exported to STATA version 17 for the final analysis. Analyses included descriptive statistics and binary logistic regression, with a 95% confidence interval (CI) and an odds ratio (OR) of 0.05. Co-founders were controlled by adjusting for maternal sociodemographic characteristics. The primary exposure was disrespectful maternity care; the main outcomes were maternal and neonatal-related complications. Results Disrespectful maternity care was reported by 344 women (78.2%) [95% CI: 74–82]. Complications were recorded in one-third of mothers (33.4%) and neonates (30%). Disrespectful maternity care was significantly associated with maternal (AOR = 2.22, 95% CI: 1.29, 3.8) and neonatal-related complications (AOR = 2.78, 95% CI: 1.54, 5.04). Conclusion The World Health Organization advocates respectful maternal care during facility-based childbirth to improve the quality of care and outcomes. However, the findings of this study indicated high mistreatment and abuse during childbirth in central Ethiopia and a significant association between such mistreatment and the occurrence of both maternal and neonatal complications during childbirth. Therefore, healthcare professionals ought to prioritise respectful maternity care to achieve improved birth outcomes and alleviate mistreatment and abuse within the healthcare sector.

Background The core principles and key indicators of Respectful Maternity Care (RMC), particularly in low-income settings, are under-researched. Validated core principles and indicators are crucial for measuring RMC, especially in contexts where workforce shortages, infrastructure gaps, and sociocultural factors impact the care. Thus, this study aimed to identify and validate the core principles and indicators of RMC in resource-limited settings. Methods A three-round Delphi study was conducted. Maternity care professionals (midwives, educators, researchers, and obstetricians) based in Ethiopia ( n  = 33) were recruited via email through professional networks. Original peer-reviewed research published in English-language journals between 2010 and 2024 was reviewed and used to generate 75 initial indicators, which were securely uploaded to Qualtrics ® for digital distribution. The indicators were evaluated on a four-point Likert scale for importance, relevance, and clarity. Responses were analysed and reported back to the participants for round two. After analysing the second-round results, the final version was shared with the participants for the third round. The third round did not generate any new information or ideas. Participants were also invited to provide feedback and suggest additional core principles and indicators that they considered missing. Results In the first round, 75 indicators were assessed. The Item-level Content Validity Indexes ranged from 0.66 to 1.00 for importance and relevance, and 0.90 to 1.00 for clarity. The Scale-level Content Validity Index was 0.94 for importance and relevance and 0.98 for clarity. Three indicators were eliminated in round one; 12 were merged, and three remained unchanged. Two new indicators were added to the items. Thirteen core principles of RMC were proposed, and ten were accepted. Sixty indicators aligned with the ten core principles of RMC were finalised for round two. After round two, 11 indicators were removed, leading to a final list of 49 indicators. The third round generated no further revisions to the questionnaire. Conclusion The ten core principles and forty-nine indicators validated in this study provide a robust blueprint for the consistent implementation and monitoring of RMC. This validated framework also provides a timely, evidence-based response to the WHO’s call for the most valid and responsive RMC indicators in clinical settings. Future research should assess the core principles and indicators’ validity and reliability across diverse contexts.

Disproportional morbidity and mortality experienced by ethnic minorities in the UK have been highlighted by the COVID-19 pandemic. The ‘Black Lives Matter’ movement has exposed structural racism’s contribution to these health inequities. ‘Cultural Safety’, an antiracist, decolonising and educational innovation originating in New Zealand, has been adopted in Australia. Cultural Safety aims to dismantle barriers faced by colonised Indigenous peoples in mainstream healthcare by addressing systemic racism.This paper explores what it means to be ‘culturally safe’. The ways in which New Zealand and Australia are incorporating Cultural Safety into educating healthcare professionals and in day-to-day practice in medicine are highlighted. We consider the ‘nuts and bolts’ of translating Cultural Safety into the UK to reduce racism within healthcare. Listening to the voices of black, Asian and minority ethnic National Health Service (NHS) consumers, education in reflexivity, both personal and organisational within the NHS are key. By listening to Indigenous colonised peoples, the ex-Empire may find solutions to health inequity. A decolonising feedback loop is required; however, we should take care not to culturally appropriate this valuable reverse innovation.

Female Aedes aegypti mosquitoes infect hundreds of millions of people each year with dangerous viral pathogens including dengue, yellow fever, Zika, and chikungunya. Progress in understanding the biology of this insect, and developing tools to fight it, has been slowed by the lack of a high-quality genome assembly. Here we combine diverse genome technologies to produce AaegL5, a dramatically improved and annotated assembly, and demonstrate how it accelerates mosquito science and control. We anchored the physical and cytogenetic maps, resolved the size and composition of the elusive sex-determining M locus, significantly increased the known members of the glutathione-S-transferase genes important for insecticide resistance, and doubled the number of chemosensory ionotropic receptors that guide mosquitoes to human hosts and egg-laying sites. Using high-resolution QTL and population genomic analyses, we mapped new candidates for dengue vector competence and insecticide resistance. We predict that AaegL5 will catalyse new biological insights and intervention strategies to fight this deadly arboviral vector.