{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T11:00:46Z","timestamp":1782298846706,"version":"3.54.5"},"reference-count":51,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2022,2,28]],"date-time":"2022-02-28T00:00:00Z","timestamp":1646006400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Health and Medical Research Council, Australia"},{"name":"June Canavan Foundation"},{"name":"Gras Foundation"},{"name":"Bank South Pacific PNG"},{"name":"Steamships PNG Community Grant"},{"name":"Alistair Lucas Prize for Medical Research"},{"name":"Naylor Steward Ancillary Fund"},{"DOI":"10.13039\/100002734","name":"Chrysalis Foundation","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100002734","id-type":"DOI","asserted-by":"crossref"}]},{"name":"National Health and Medical Research Council, Australia"},{"name":"National Health and Medical Research Council, Australia"}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>Companionship during labour and birth is a critical component of quality maternal and newborn care, resulting in improved care experiences and better birth outcomes. Little is known about the preferences and experiences of companionship in Papua New Guinea (PNG), and how it can be implemented in a culturally appropriate way. The aim of this study was to describe perspectives and experiences of women, their partners and health providers regarding labour and birth companionship, identify enablers and barriers and develop a framework for implementing this intervention in PNG health facilities. A mixed methods study was conducted with five facilities in East New Britain, PNG. Data included 5 facility audits, 30 labour observations and 29 in-depth interviews with women who had recently given birth, partners and maternity care providers. A conceptual framework was developed drawing on existing quality care implementation frameworks. Women and partners wanted companions to be present, whilst health providers had mixed views. Participants described benefits of companionship including encouragement and physical support for women, better communication and advocacy, improved labour outcomes and assistance with workforce issues. Adequate privacy and space constraints were highlighted as key barriers to address. Of the women observed, only 30% of women had a companion present during labour, and 10% had a companion at birth. A conceptual framework was used to highlight the interconnected inputs required at community, facility and provincial health system levels to improve the quality of care. Key elements to address included attitudes towards companionship, the need for education and training and restrictive hospital policies. Supporting women to have their companion of choice present during labour and birth is critical to improving women\u2019s experiences of care and improving the quality of maternal and newborn care. In order to provide companionship during labour and birth in PNG, a complex, intersecting, multi-faceted approach is required.<\/jats:p>","DOI":"10.1371\/journal.pgph.0000102","type":"journal-article","created":{"date-parts":[[2022,2,28]],"date-time":"2022-02-28T18:21:30Z","timestamp":1646072490000},"page":"e0000102","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":14,"title":["Partnership-defined quality approach to companionship during labour and birth in East New Britain, Papua New Guinea: A mixed-methods study"],"prefix":"10.1371","volume":"2","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9229-789X","authenticated-orcid":true,"given":"Alyce N.","family":"Wilson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3137-4502","authenticated-orcid":true,"given":"Pele","family":"Melepia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rose","family":"Suruka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8272-7614","authenticated-orcid":true,"given":"Priscah","family":"Hezeri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dukduk","family":"Kabiu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7796-1270","authenticated-orcid":true,"given":"Delly","family":"Babona","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pinip","family":"Wapi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4179-4682","authenticated-orcid":true,"given":"Meghan A.","family":"Bohren","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3214-7096","authenticated-orcid":true,"given":"Joshua P.","family":"Vogel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Kelly-Hanku","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5380-1619","authenticated-orcid":true,"given":"Alison","family":"Morgan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1018-7898","authenticated-orcid":true,"given":"James G.","family":"Beeson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0931-5474","authenticated-orcid":true,"given":"Christopher","family":"Morgan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1044-4604","authenticated-orcid":true,"given":"Naomi","family":"Spotswood","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1417-1524","authenticated-orcid":true,"given":"Michelle J. L.","family":"Scoullar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8247-7683","authenticated-orcid":true,"given":"Lisa M.","family":"Vallely","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline S. E.","family":"Homer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,2,28]]},"reference":[{"issue":"7","key":"pgph.0000102.ref001","article-title":"Continuous support for women during childbirth","author":"MA Bohren","year":"2017","journal-title":"Cochrane Database of Systematic Reviews"},{"issue":"3","key":"pgph.0000102.ref002","article-title":"Perceptions and experiences of labour companionship: a qualitative evidence synthesis","author":"MA Bohren","year":"2019","journal-title":"Cochrane Database of Systematic Reviews"},{"key":"pgph.0000102.ref003","unstructured":"World Health Organization. Standards for improving quality of maternal and newborn care in health facilities 2016 https:\/\/www.who.int\/maternal_child_adolescent\/documents\/improving-maternal-newborn-care-quality\/en\/."},{"key":"pgph.0000102.ref004","unstructured":"World Health Organization. WHO recommendations on intrapartum care for a positive childbirth experience: World Health Organization 2018."},{"issue":"8","key":"pgph.0000102.ref005","doi-asserted-by":"crossref","first-page":"918","DOI":"10.1111\/1471-0528.15237","article-title":"WHO model of intrapartum care for a positive childbirth experience: transforming care of women and babies for improved health and wellbeing","volume":"125","author":"O Oladapo","year":"2018","journal-title":"BJOG: An International Journal of Obstetrics & Gynaecology"},{"issue":"Suppl 2","key":"pgph.0000102.ref006","doi-asserted-by":"crossref","first-page":"e003564","DOI":"10.1136\/bmjgh-2020-003564","article-title":"Labour companionship and women\u2019s experiences of mistreatment during childbirth: results from a multi-country community-based survey","volume":"5","author":"MD Balde","year":"2020","journal-title":"BMJ global health"},{"issue":"1","key":"pgph.0000102.ref007","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12884-018-1806-1","article-title":"Companionship during facility-based childbirth: results from a mixed-methods study with recently delivered women and providers in Kenya","volume":"18","author":"P Afulani","year":"2018","journal-title":"BMC pregnancy and childbirth"},{"issue":"3","key":"pgph.0000102.ref008","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/j.ijgo.2014.12.005","article-title":"Perceptions about labor companionship at public teaching hospitals in three Arab countries","volume":"129","author":"T Kabakian-Khasholian","year":"2015","journal-title":"International Journal of Gynecology & Obstetrics"},{"issue":"5","key":"pgph.0000102.ref009","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1017\/S0021932013000412","article-title":"Social support during delivery in rural central Ghana: a mixed methods study of women\u2019s preferences for and against inclusion of a lay companion in the delivery room","volume":"46","author":"A Alexander","year":"2014","journal-title":"Journal of Biosocial Science"},{"issue":"1","key":"pgph.0000102.ref010","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12884-017-1447-9","article-title":"Companion of choice at birth: factors affecting implementation","volume":"17","author":"T Kabakian-Khasholian","year":"2017","journal-title":"BMC pregnancy and childbirth"},{"key":"pgph.0000102.ref011","unstructured":"SIL-PNG. Language of East New Britian, Papua New Guinea: SIL-PNG; 2019 https:\/\/pnglanguages.sil.org\/resources\/provinces\/province\/East%20New%20Britain."},{"key":"pgph.0000102.ref012","unstructured":"World Bank. Birth rate, crude (per 1,000 people): World Bank; 2019 https:\/\/data.worldbank.org\/indicator\/SP.DYN.CBRT.IN."},{"issue":"1","key":"pgph.0000102.ref013","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1080\/26410397.2019.1686199","article-title":"Maternal and newborn health indicators in Papua New Guinea\u20132008\u20132018","volume":"27","author":"G Robbers","year":"2019","journal-title":"Sexual and reproductive health matters"},{"key":"pgph.0000102.ref014","doi-asserted-by":"crossref","first-page":"100028","DOI":"10.1016\/j.lanwpc.2020.100028","article-title":"Improving the quality of maternal and newborn care in the Pacific region: A scoping review","volume":"3","author":"A Wilson","year":"2020","journal-title":"The Lancet Regional Health-Western Pacific"},{"key":"pgph.0000102.ref015","unstructured":"United Nations Population Fund (UNFPA) Pacific Sub-Regional Office (PSRO). The state of the Pacific\u2019s Reproductive, Maternal, Newborn, Child and Adolescent Health Workforce. Fiji: United Nations Population Fund (UNFPA) Pacific Sub-Regional Office (PSRO), 2019."},{"key":"pgph.0000102.ref016","unstructured":"World Health Organization. Global strategy on human resources for health: workforce 2030. 2016."},{"key":"pgph.0000102.ref017","unstructured":"UNFPA. The State of the Pacific\u2019s RMNCAH Workforce 2019 Report: UNFPA, 2019."},{"key":"pgph.0000102.ref018","unstructured":"Mola G. Manual of Standard Management in Obstetrics and Gynaecology for Doctors, HEOs and Nurses in Papua New Guinea Port Morebsy: Port Moresby General Hospital 2018."},{"key":"pgph.0000102.ref019","unstructured":"Buasi N. The Implementation of Providing Support in Labour by a Person of the Birthing Woman\u2019s Choice at the Port Moresby General Hospital (PMGH) in Papua New Guinea (PNG). University of Technology, Sydney, 2011."},{"key":"pgph.0000102.ref020","unstructured":"National Department of Health. Monitoring and Research Branch. Sector Performance Annual Review. Port Moresby: National Department of Health, 2015."},{"key":"pgph.0000102.ref021","unstructured":"National Department of Health. Provincial Profile: East New Britain Province. Provincial and District Health Profiles: Data for decision makers Port Moresby. National Department of Health, 2018."},{"key":"pgph.0000102.ref022","unstructured":"National Department of Health. 2019 Sector Performance Annual Review Port Moresby, PNG National Department of Health, 2020."},{"issue":"1","key":"pgph.0000102.ref023","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1038\/s41598-020-79103-6","article-title":"Risk factors and knowledge associated with high unintended pregnancy rates and low family planning use among pregnant women in Papua New Guinea","volume":"11","author":"E Peach","year":"2021","journal-title":"Scientific Reports"},{"issue":"3","key":"pgph.0000102.ref024","doi-asserted-by":"crossref","first-page":"894","DOI":"10.3201\/eid2703.201783","article-title":"Mycoplasma genitalium and Other Reproductive Tract Infections in Pregnant Women, Papua New Guinea, 2015\u20132017","volume":"27","author":"MJ Scoullar","year":"2021","journal-title":"Emerging infectious diseases"},{"issue":"1","key":"pgph.0000102.ref025","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1186\/s12889-020-8172-4","article-title":"Strengthening routine immunization in Papua New Guinea: a cross-sectional provincial assessment of front-line services","volume":"20","author":"CJ Morgan","year":"2020","journal-title":"BMC public health"},{"key":"pgph.0000102.ref026","unstructured":"Save the Children. Partnership Defined Quality: a tool book for community and health provider collaboration for quality improvement. United States: Save the Children, 2003."},{"issue":"6","key":"pgph.0000102.ref027","doi-asserted-by":"crossref","DOI":"10.1177\/2042533313479197","article-title":"Using mixed methods in health research","volume":"4","author":"S Tariq","year":"2013","journal-title":"JRSM short reports"},{"issue":"10210","key":"pgph.0000102.ref028","doi-asserted-by":"crossref","first-page":"1750","DOI":"10.1016\/S0140-6736(19)31992-0","article-title":"How women are treated during facility-based childbirth in four countries: a cross-sectional study with labour observations and community-based surveys","volume":"394","author":"MA Bohren","year":"2019","journal-title":"The Lancet"},{"key":"pgph.0000102.ref029","unstructured":"StataCorp L. Stata data analysis and statistical Software. Special Edition Release:733."},{"issue":"9","key":"pgph.0000102.ref030","doi-asserted-by":"crossref","first-page":"1277","DOI":"10.1177\/1049732305276687","article-title":"Three approaches to qualitative content analysis","volume":"15","author":"H-F Hsieh","year":"2005","journal-title":"Qualitative health research"},{"issue":"1","key":"pgph.0000102.ref031","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1111\/j.1365-2648.2007.04569.x","article-title":"The qualitative content analysis process","volume":"62","author":"S Elo","year":"2008","journal-title":"Journal of advanced nursing"},{"key":"pgph.0000102.ref032","unstructured":"QSR Interntional Pty Ltd. NVivo (released in March 2020): QSR International Pty Ltd.; 2020 https:\/\/www.qsrinternational.com\/nvivo-qualitative-data-analysis-software\/home."},{"key":"pgph.0000102.ref033","volume-title":"Qualitative data analysis: A user friendly guide for social scientists","author":"I. Dey","year":"1993"},{"issue":"2","key":"pgph.0000102.ref034","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1742-4755-11-S2-S1","article-title":"Approaches to improve the quality of maternal and newborn health care: an overview of the evidence","volume":"11","author":"A Austin","year":"2014","journal-title":"Reproductive health"},{"issue":"3","key":"pgph.0000102.ref035","doi-asserted-by":"crossref","first-page":"166","DOI":"10.2307\/3348969","article-title":"Evaluating the quality of medical care","volume":"44","author":"A. Donabedian","year":"1966","journal-title":"The Milbank memorial fund quarterly"},{"issue":"1","key":"pgph.0000102.ref036","first-page":"1","article-title":"Social support during childbirth as a catalyst for early breastfeeding initiation for first-time Nigerian mothers","volume":"4","author":"IO Morhason-Bello","year":"2009","journal-title":"International breastfeeding journal"},{"issue":"10","key":"pgph.0000102.ref037","doi-asserted-by":"crossref","first-page":"1056","DOI":"10.1111\/j.1471-0528.1998.tb09936.x","article-title":"Effects of psychosocial support during labour and childbirth on breastfeeding, medical interventions, and mothers\u2019 wellbeing in a Mexican public hospital: a randomised clinical trial","volume":"105","author":"A Langer","year":"1998","journal-title":"BJOG: An International Journal of Obstetrics & Gynaecology"},{"key":"pgph.0000102.ref038","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1111\/apa.13147","article-title":"Optimal breastfeeding practices and infant and child mortality: a systematic review and meta\u2010analysis","volume":"104","author":"MJ Sankar","year":"2015","journal-title":"Acta paediatrica"},{"issue":"1","key":"pgph.0000102.ref039","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12884-021-03746-0","article-title":"Birth companionship in a government health system: a pilot study in Kigoma, Tanzania","volume":"21","author":"P Chaote","year":"2021","journal-title":"BMC pregnancy and childbirth"},{"issue":"1","key":"pgph.0000102.ref040","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1080\/26410397.2019.1610277","article-title":"Humanised childbirth: the status of emotional support of women in rural Bangladesh","volume":"27","author":"J Perkins","year":"2019","journal-title":"Sexual and reproductive health matters"},{"issue":"3","key":"pgph.0000102.ref041","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1111\/birt.12418","article-title":"Can an integrated obstetric emergency simulation training improve respectful maternity care? Results from a pilot study in Ghana","volume":"46","author":"PA Afulani","year":"2019","journal-title":"Birth"},{"issue":"1","key":"pgph.0000102.ref042","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12978-020-00953-4","article-title":"Lessons learned through respectful maternity care training and its implementation in Ethiopia: an interventional mixed methods study","volume":"17","author":"A Asefa","year":"2020","journal-title":"Reproductive health"},{"issue":"1","key":"pgph.0000102.ref043","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1186\/s12884-018-1759-4","article-title":"Expectant fathers\u2019 participation in antenatal care services in Papua New Guinea: a qualitative inquiry","volume":"18","author":"J Davis","year":"2018","journal-title":"BMC pregnancy and childbirth"},{"issue":"3","key":"pgph.0000102.ref044","doi-asserted-by":"crossref","first-page":"e0248488","DOI":"10.1371\/journal.pone.0248488","article-title":"Experiences of receiving and providing maternity care during the COVID-19 pandemic in Australia: A five-cohort cross-sectional comparison","volume":"16","author":"Z Bradfield","year":"2021","journal-title":"Plos one"},{"key":"pgph.0000102.ref045","article-title":"Australian women\u2019s experiences of receiving maternity care during the COVID\u201019 pandemic: A cross\u2010sectional national survey","author":"AN Wilson","year":"2021","journal-title":"Birth"},{"key":"pgph.0000102.ref046","doi-asserted-by":"crossref","first-page":"102996","DOI":"10.1016\/j.midw.2021.102996","article-title":"Becoming a mother in the \u2018new\u2019social world in Australia during the first wave of the COVID-19 pandemic","volume":"98","author":"L Sweet","year":"2021","journal-title":"Midwifery"},{"key":"pgph.0000102.ref047","unstructured":"World Health Organization. Every woman\u2019s right to a companion of choice during childbirth Geneva, Switzerland: World Health Organization 2020 https:\/\/www.who.int\/news\/item\/09-09-2020-every-woman-s-right-to-a-companion-of-choice-during-childbirth."},{"key":"pgph.0000102.ref048","unstructured":"National Department of Health Maternal Health Taskforce. Improving quality of care and incentivising family planning, ANC, facility-based delivery in PNG. Position Paper. Port Moresby, PNG: National Department of Health, 2019."},{"issue":"1","key":"pgph.0000102.ref049","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1111\/birt.12471","article-title":"Coverage, associated factors, and impact of companionship during labor: A large\u2010scale observational study in six hospitals in Nepal","volume":"47","author":"A Kc","year":"2020","journal-title":"Birth"},{"key":"pgph.0000102.ref050","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1016\/j.midw.2016.06.014","article-title":"The relationship between women\u2019s experiences of mistreatment at facilities during childbirth, types of support received and person providing the support in Lucknow, India","volume":"40","author":"N Diamond-Smith","year":"2016","journal-title":"Midwifery"},{"issue":"1","key":"pgph.0000102.ref051","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1186\/1742-4755-11-71","article-title":"Facilitators and barriers to facility-based delivery in low-and middle-income countries: a qualitative evidence synthesis","volume":"11","author":"MA Bohren","year":"2014","journal-title":"Reproductive health"}],"container-title":["PLOS Global Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0000102","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,2,28]],"date-time":"2022-02-28T18:22:29Z","timestamp":1646072549000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0000102"}},"subtitle":[],"editor":[{"given":"Vaibhav","family":"Saria","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,2,28]]},"references-count":51,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2022,2,28]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pgph.0000102","relation":{},"ISSN":["2767-3375"],"issn-type":[{"value":"2767-3375","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2,28]]}}}