Factors associated with respectful maternity care during hospital deliveries: A cross-sectional study in Bangladesh

Fahmida Islam Chowdhury; Moshammat Zebunnessa; Mortuza Begum; Fahmida Shirin; Musarrat Naz; Samira Amir Chowdhury; Hasnatul Jannat; Selina Parvin; Md. Abdur Rafi; Mohammad Jahid Hasan

doi:10.1371/journal.pone.0334418

Peer Review History

Original SubmissionApril 28, 2025
12 Aug 2025 Decision Letter - Paridhi Jha, Editor PONE-D-25-20339Respectful maternity care during hospital deliveries in Bangladesh: a comparative study between public and private hospitalPLOS ONE Dear Dr. Hasan, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. ============================== Before resubmitting a revised version, kindly ensure:1. The manuscript has been reviewed by an English Language expert for improving the grammar quality.============================== Please submit your revised manuscript by Sep 26 2025 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols . Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols . We look forward to receiving your revised manuscript. Kind regards, Paridhi Jha, PhD Academic Editor PLOS ONE Journal requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. In the online submission form, you indicated that [Patient-level data will be available on request from the corresponding author.]. All PLOS journals now require all data underlying the findings described in their manuscript to be freely available to other researchers, either 1. In a public repository, 2. Within the manuscript itself, or 3. Uploaded as supplementary information. This policy applies to all data except where public deposition would breach compliance with the protocol approved by your research ethics board. If your data cannot be made publicly available for ethical or legal reasons (e.g., public availability would compromise patient privacy), please explain your reasons on resubmission and your exemption request will be escalated for approval. 3. Please include a separate caption for each figure in your manuscript. 4. We note that Figure 1 in your submission contain [map/satellite] images which may be copyrighted. All PLOS content is published under the Creative Commons Attribution License (CC BY 4.0), which means that the manuscript, images, and Supporting Information files will be freely available online, and any third party is permitted to access, download, copy, distribute, and use these materials in any way, even commercially, with proper attribution. For these reasons, we cannot publish previously copyrighted maps or satellite images created using proprietary data, such as Google software (Google Maps, Street View, and Earth). For more information, see our copyright guidelines: http://journals.plos.org/plosone/s/licenses-and-copyright. We require you to either (1) present written permission from the copyright holder to publish these figures specifically under the CC BY 4.0 license, or (2) remove the figures from your submission: 1. You may seek permission from the original copyright holder of Figure 1 to publish the content specifically under the CC BY 4.0 license. We recommend that you contact the original copyright holder with the Content Permission Form (http://journals.plos.org/plosone/s/file?id=7c09/content-permission-form.pdf) and the following text: “I request permission for the open-access journal PLOS ONE to publish XXX under the Creative Commons Attribution License (CCAL) CC BY 4.0 (http://creativecommons.org/licenses/by/4.0/). Please be aware that this license allows unrestricted use and distribution, even commercially, by third parties. Please reply and provide explicit written permission to publish XXX under a CC BY license and complete the attached form.” Please upload the completed Content Permission Form or other proof of granted permissions as an "Other" file with your submission. In the figure caption of the copyrighted figure, please include the following text: “Reprinted from [ref] under a CC BY license, with permission from [name of publisher], original copyright [original copyright year].” 2. If you are unable to obtain permission from the original copyright holder to publish these figures under the CC BY 4.0 license or if the copyright holder’s requirements are incompatible with the CC BY 4.0 license, please either i) remove the figure or ii) supply a replacement figure that complies with the CC BY 4.0 license. Please check copyright information on all replacement figures and update the figure caption with source information. If applicable, please specify in the figure caption text when a figure is similar but not identical to the original image and is therefore for illustrative purposes only. The following resources for replacing copyrighted map figures may be helpful USGS National Map Viewer (public domain): http://viewer.nationalmap.gov/viewer/ The Gateway to Astronaut Photography of Earth (public domain): http://eol.jsc.nasa.gov/sseop/clickmap/ Maps at the CIA (public domain): https://www.cia.gov/library/publications/the-world-factbook/index.html and https://www.cia.gov/library/publications/cia-maps-publications/index.html NASA Earth Observatory (public domain): http://earthobservatory.nasa.gov/ Landsat: http://landsat.visibleearth.nasa.gov/ USGS EROS (Earth Resources Observatory and Science (EROS) Center) (public domain): http://eros.usgs.gov/# Natural Earth (public domain): http://www.naturalearthdata.com/ 5. If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise. Additional Editor Comments (if provided): [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Partly Reviewer #2: Partly Reviewer #3: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: I Don't Know Reviewer #3: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: No Reviewer #3: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: The Title relate to a Comparative study - whilst the Manuscript refer to a Cross- Sectional study (In essence, a comparative study is more about drawing distinctions between groups, while a cross-sectional study is more about describing a situation across a population at a moment in time. That said, a cross-sectional study can also be comparative if it’s comparing subgroups within the population) The reader hopes to find in the conclusion the goal that the Cross-sectional hoped to uncover such as in this research undertaking (The Objective of the study is to investigate the status of respectful maternity care and its associated factors in public and private hospitals in Bangladesh) Notably, the Conclusion in the Abstract only refer to: A study finding showing a significant difference in respectful maternity care between public and private hospitals, with private facilities showing markedly higher care standards across domains. (This is generally a known fact). In the Manuscript the Discussion 0n Page 10 Line 229 - 232 assert: Discussion: 230 Our study found that approximately half of the women delivering in either public or private 231 hospitals in Chattagram, Bangladesh, received respectful maternity care, while the remainder 232 experienced at least one form of disrespect or abuse - (this is not consistent with the Conclusion - Suggest revisiting the Conclusion as the two groups compares a particular variable or outcome...RMC. Importantly, the structured questionnaire ... Focuses on Status of respectful maternity care (RMC) - (hence the comparison between the two groups on these aspects) Figure 2: Status of respectful maternity care among participants (n = 598) depicts the status of RMC and its associated factors - hence, suggesting the Conclusion should congruently address such aspects. Reviewer #2: The word “postpartum” is misspelled in multiple places (as “postpurtam” and similar spellings). Fix spelling throughout. (It is also acceptable to use “postnatal,” if preferred.) I recognize that the city of Chittagong is colloquially known as Chottogram in Bangladesh, so the use of this name in the paper makes sense. However, most people in the world do not know that this city has two names, so at some point early in the paper, please explain that the two names refer to one city. You also have Chottogram spelled in a variety of ways (Chottogram, Chattagram, Chattogram, etc.). I recognize these differences are basically moot when using Bangla script, but to avoid confusion among English-speakers, using a single spelling is essential (or replacing this everywhere with Chittagong). I have no opinion on which is best, but make sure one spelling is consistently applied throughout the document. (One exception: in all institutional/hospital/university names that include either Chittagong or Chottogram, please use the exact formal name, with whichever name and spelling the institution uses.) The educational qualifications in Tables 1 and 2 do not align with the educational item on the survey. Please report these numbers using the same categories you used to collect the data. In lines 180-182, you say “We classified women as having received respectful maternity care if all items were coded as ‘Yes’. If any item was coded as ‘No’, the woman was considered to have not received respectful maternity care.” However, 6 items on the survey would be answered “yes” if DISRESPECTFUL maternity care occurred: • Some healthcare providers slapped me during delivery for different reasons • Some health workers shouted at me because I haven’t done what I was told to do • I was kept waiting for a long time before receiving services • Service provision was delayed due to the health facilities’ internal problem • Some of the health workers do not treat me well because of some personal attribute • Some health workers insulted me and my companions due to my personal attributes Scoring for those items would have to count “no” as the presence of respectful maternity care. This is in contrast to all the other items in the survey, where answering “yes” would indicate respectful care. Scoring and statistics must account for the six reverse-scored items, or the results of your calculations would be incorrect. It’s not clear how extensive this problem is. It's possible that you simply need to state more clearly how you did the scoring of responses before statistics were calculated. It’s also possible that essentially every finding on respectful maternity care in this paper is incorrect because of this scoring error. In either case, it is likely fixable. Please clarify the issue, check all underlying raw data and every statistic throughout the paper to ensure that all are correct, and fix any miscalculations. Reviewer #3: Thank you for submitting your manuscript. The following are some minor comments to help you improve the paper. General & Title Title: I suggest a revised title to better reflect the study's design and focus: "Factors associated with respectful maternity care during hospital deliveries: a cross-sectional study in Bangladesh." Results Section Clarity of Acronyms: For the first time they appear in both the abstract and the results section, please spell out aOR (Adjusted Odds Ratio) and 95% CI (95% Confidence Interval) before using the acronyms. Figure 1: I recommend removing Figure 1 as it does not appear to be essential for the main findings of the paper. Table 2: I suggest reorganizing your presentation of the data. Please remove the first two columns (Respectful maternity care) from Table 2. Instead, create a new table that presents all the predictor variables against the two outcome categories (respected vs. not respected), including p-values. This new table should be placed just before your logistic regression analysis. Discussion Section Limitations: Please include this point as one of key limitations of the study: the potential information loss that occurred when converting the original 5-point Likert scale into a binary (Yes/No) categorical variable. Policy Implications: I recommend adding a section that discusses the practical policy implications of your findings, outlining how this research can inform future interventions or policies in Bangladesh. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean? ). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy . Reviewer #1: No Reviewer #2: No Reviewer #3: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/ . PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org . Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0334418.r001
Revision 1
5 Sep 2025 Author Response PONE-D-25-20339 Respectful maternity care during hospital deliveries in Bangladesh: a comparative study between public and private hospital Reviewer #1: The Title relate to a Comparative study - whilst the Manuscript refer to a Cross- Sectional study (In essence, a comparative study is more about drawing distinctions between groups, while a cross-sectional study is more about describing a situation across a population at a moment in time. That said, a cross-sectional study can also be comparative if it’s comparing subgroups within the population) The reader hopes to find in the conclusion the goal that the Cross-sectional hoped to uncover such as in this research undertaking (The Objective of the study is to investigate the status of respectful maternity care and its associated factors in public and private hospitals in Bangladesh) Notably, the Conclusion in the Abstract only refer to: A study finding showing a significant difference in respectful maternity care between public and private hospitals, with private facilities showing markedly higher care standards across domains. (This is generally a known fact). In the Manuscript the Discussion 0n Page 10 Line 229 - 232 assert: Discussion: 230 Our study found that approximately half of the women delivering in either public or private 231 hospitals in Chattagram, Bangladesh, received respectful maternity care, while the remainder 232 experienced at least one form of disrespect or abuse - (this is not consistent with the Conclusion - Suggest revisiting the Conclusion as the two groups compares a particular variable or outcome...RMC. Importantly, the structured questionnaire ... Focuses on Status of respectful maternity care (RMC) - (hence the comparison between the two groups on these aspects) Figure 2: Status of respectful maternity care among participants (n = 598) depicts the status of RMC and its associated factors - hence, suggesting the Conclusion should congruently address such aspects. Authors’ response: We sincerely thank the reviewer for the thoughtful and constructive comments. We appreciate the careful reading and the emphasis on ensuring that the manuscript accurately reflects both the study design and its objectives. First, regarding the study title, we acknowledge the reviewer’s observation that the original title suggested a comparative study, whereas the manuscript is based on a cross-sectional design. To address this, we have revised the title to clearly indicate that this is a cross-sectional study. The present version of the title is “Factors associated with respectful maternity care during hospital deliveries: a cross-sectional study in Bangladesh” Second, we recognize the reviewer’s concern that the abstract conclusion previously highlighted only the differences in respectful maternity care (RMC) between public and private hospitals. While this comparison is important, it did not fully convey the study’s objective of assessing the overall status of RMC and its associated factors. In response, we have updated the abstract conclusion as: “Respectful maternity care was significantly more likely among women delivering in private hospitals, through facility-level referrals, and by cesarean section, indicating gaps in public hospital practices that require attention to ensure respectful care for all mothers.” Third, we addressed the inconsistency between the discussion and the abstract conclusion. The discussion had noted that “Our study found that approximately one-third of the women delivering in public hospitals and two-thirds of the women delivering in private hospitals in Chittagong, Bangladesh, received respectful maternity care, while the remainder experienced at least one form of disrespect or abuse.” Finally, we have ensured that the conclusion reflects the primary focus of our study, which is the status of RMC and its associated factors. These revisions also align the narrative with Figure 2 and the statistical analyses, providing a clear and accurate reflection of our study findings. We sincerely thank the reviewer again for these valuable comments, which have strengthened the clarity, consistency, and scientific rigor of our manuscript. Reviewer #2: The word “postpartum” is misspelled in multiple places (as “postpurtam” and similar spellings). Fix spelling throughout. (It is also acceptable to use “postnatal,” if preferred.) I recognize that the city of Chittagong is colloquially known as Chottogram in Bangladesh, so the use of this name in the paper makes sense. However, most people in the world do not know that this city has two names, so at some point early in the paper, please explain that the two names refer to one city. You also have Chottogram spelled in a variety of ways (Chottogram, Chattagram, Chattogram, etc.). I recognize these differences are basically moot when using Bangla script, but to avoid confusion among English-speakers, using a single spelling is essential (or replacing this everywhere with Chittagong). I have no opinion on which is best, but make sure one spelling is consistently applied throughout the document. (One exception: in all institutional/hospital/university names that include either Chittagong or Chottogram, please use the exact formal name, with whichever name and spelling the institution uses.) The educational qualifications in Tables 1 and 2 do not align with the educational item on the survey. Please report these numbers using the same categories you used to collect the data. In lines 180-182, you say “We classified women as having received respectful maternity care if all items were coded as ‘Yes’. If any item was coded as ‘No’, the woman was considered to have not received respectful maternity care.” However, 6 items on the survey would be answered “yes” if DISRESPECTFUL maternity care occurred: • Some healthcare providers slapped me during delivery for different reasons • Some health workers shouted at me because I haven’t done what I was told to do • I was kept waiting for a long time before receiving services • Service provision was delayed due to the health facilities’ internal problem • Some of the health workers do not treat me well because of some personal attribute • Some health workers insulted me and my companions due to my personal attributes Scoring for those items would have to count “no” as the presence of respectful maternity care. This is in contrast to all the other items in the survey, where answering “yes” would indicate respectful care. Scoring and statistics must account for the six reverse-scored items, or the results of your calculations would be incorrect. It’s not clear how extensive this problem is. It's possible that you simply need to state more clearly how you did the scoring of responses before statistics were calculated. It’s also possible that essentially every finding on respectful maternity care in this paper is incorrect because of this scoring error. In either case, it is likely fixable. Please clarify the issue, check all underlying raw data and every statistic throughout the paper to ensure that all are correct, and fix any miscalculations. Authors’ response: We sincerely thank the reviewer for their careful reading and constructive comments, which have greatly helped improve the clarity and accuracy of our manuscript. First, regarding the spelling of “postpartum/postnatal,” we have corrected all misspellings of “postpartum” (e.g., “postpurtam”) throughout the manuscript. Following the reviewer’s suggestion, we have consistently used “postnatal” to describe the period following delivery. Second, concerning the city name, we have standardized the spelling of the city throughout the manuscript as “Chittagong”. To avoid confusion for international readers, we have added a clarifying statement noting that “Chittagong (also locally known as Chottogram) refers to the same city in Bangladesh.” When it first appeared. Third, regarding educational qualifications, the reviewer suggested combining the “Higher secondary” and “University graduate” categories to be consistent with the questionnaire. We evaluated this suggestion but found that combining these groups would result in a disproportionate category, as nearly 70% of participants fall into these two groups. To preserve meaningful distinctions in educational attainment, we have retained the current categories in Tables 1 and 2 and throughout the manuscript. Fourth, we acknowledge the reviewer’s concern regarding the six negatively worded items in the respectful maternity care (RMC) questionnaire, where answering “yes” indicates disrespectful care. We have clarified in the Methods section that these six items were reverse coded prior to dichotomization. “For the six negatively worded items, responses were reverse coded prior to dichotomization so that “disagree” or “strongly disagree” indicated respectful care. This ensured that across all items, a response coded as “Yes” consistently represented respectful care, and “No” indicated disrespect or abuse. This categorization was applied for the overall scale as well as for each of the specific domains.” (Page 8, Line 181-188) The results presented in the revised manuscript now accurately reflect these corrections. Additionally, the Methods section has been updated to clearly describe the coding procedure, ensuring that readers understand how RMC was classified prior to analysis. We sincerely thank the reviewer again for these valuable comments, which have helped us ensure the accuracy, clarity, and scientific rigor of our manuscript. Reviewer #3: Thank you for submitting your manuscript. The following are some minor comments to help you improve the paper. General & Title Title: I suggest a revised title to better reflect the study's design and focus: "Factors associated with respectful maternity care during hospital deliveries: a cross-sectional study in Bangladesh." Results Section Clarity of Acronyms: For the first time they appear in both the abstract and the results section, please spell out aOR (Adjusted Odds Ratio) and 95% CI (95% Confidence Interval) before using the acronyms. Figure 1: I recommend removing Figure 1 as it does not appear to be essential for the main findings of the paper. Table 2: I suggest reorganizing your presentation of the data. Please remove the first two columns (Respectful maternity care) from Table 2. Instead, create a new table that presents all the predictor variables against the two outcome categories (respected vs. not respected), including p-values. This new table should be placed just before your logistic regression analysis. Discussion Section Limitations: Please include this point as one of key limitations of the study: the potential information loss that occurred when converting the original 5-point Likert scale into a binary (Yes/No) categorical variable. Policy Implications: I recommend adding a section that discusses the practical policy implications of your findings, outlining how this research can inform future interventions or policies in Bangladesh. Authors’ response: We sincerely thank the reviewer for the thoughtful comments and suggestions, which have helped improve the clarity and impact of our manuscript. We appreciate the reviewer’s suggestion regarding title. The manuscript title has been revised to “Factors associated with respectful maternity care during hospital deliveries: a cross-sectional study in Bangladesh” to better reflect the study design and focus. In response to the comment on acronyms, we have now spelled out Adjusted Odds Ratio (aOR) and 95% Confidence Interval (95% CI) the first time they appear in both the abstract and the Results section, before using the abbreviated forms subsequently. Regarding Figure 1, we have removed it, as it was not essential to the main findings of the paper. Following the reviewer’s recommendation, we have reorganized the presentation of the data. The first two columns (Respectful maternity care) have been removed, and a new table has been created that presents all predictor variables against the two outcome categories (respected vs. not respected), including p-values. This new table has been placed just before the logistic regression analysis to improve flow and clarity. We have added a limitation regarding the potential information loss that could occur when converting the original five-point Likert scale into a binary (Yes/No) variable, noting that this may have reduced the granularity of participants’ responses. Additionally, we have included a section on policy and practice implications, highlighting how the findings can inform future interventions and policies in Bangladesh. This section emphasizes the need for strengthening respectful maternity care in public hospitals, targeted training for healthcare providers, structured referral pathways, and embedding respectful care into national maternal health policies and quality assurance frameworks. We sincerely thank the reviewer again for these valuable comments, which have enhanced the clarity, rigor, and practical relevance of our manuscript. Attachments Attachment Submitted filename: Review Note.docx https://doi.org/10.1371/journal.pone.0334418.r002
16 Sep 2025 Decision Letter - Paridhi Jha, Editor PONE-D-25-20339R1Factors associated with respectful maternity care during hospital deliveries: a cross-sectional study in BangladeshPLOS ONE Dear Dr. Hasan, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Oct 31 2025 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols . Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols . We look forward to receiving your revised manuscript. Kind regards, Paridhi Jha, PhD Academic Editor PLOS ONE Journal Requirements: If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #2: All comments have been addressed Reviewer #3: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #2: Yes Reviewer #3: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #2: Yes Reviewer #3: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #2: Yes Reviewer #3: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #2: Yes Reviewer #3: Yes ******** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #2: You answered all reviewers' questions well. I have a few small items, and then this is ready for publication, in my view. Line 80 refers to Bangladesh as “a developing country of south-east Asian region.” Bangladesh is in South Asia, not Southeast Asia. The phrase “developing country” has been superseded by the specific income level of the country named. In the case of Bangladesh, it is a lower-middle-income country. Please change the phrase on line 80 to “a lower-middle-income country in South Asia.” Please review this World Bank list if needed: https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups. Thank you for the information about education levels. I’m noting that your study includes much higher percentages of women educated to upper secondary and university levels than Bangladesh generally. This likely tracks closely with socioeconomic status, and you mention in your limitations that you do not handle socioeconomic disparities in detail. That is reasonable (because most of the population you are capturing are those who can go to a private hospital) and so no change is needed there. However, you could also include a sentence or two in the discussion/limitation section noting that you captured a cohort that skews more highly educated than the female population of Bangladesh generally, and this limits how generalizable your findings are. In Table 3, you use the term “cOR.” I assume you mean “crude odds ratio.” Please spell out the full term somewhere in the document. Finally, Table 3 shows some dramatic shifts between your cOR and aOR values, including some changes in direction (eg, with respect to facilities referrals, from cOR of 0.56 (0.38, 0.83)* to aOR of 2.88 (1.59, 5.31), so changing from lower likelihood to higher likelihood of respectful care). Is this due to small sample sizes? Please review closely and ensure all values are correct, and please comment on these shifts in your discussion or limitation section. Reviewer #3: Thank you for your revisions. I have reviewed the updated manuscript and find the changes to be satisfactory. I have no additional comments. ******** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean? ). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy . Reviewer #2: No Reviewer #3: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/ . PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org . Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0334418.r003
Revision 2
17 Sep 2025 Author Response Reviewer #2: You answered all reviewers' questions well. I have a few small items, and then this is ready for publication, in my view. Line 80 refers to Bangladesh as “a developing country of south-east Asian region.” Bangladesh is in South Asia, not Southeast Asia. The phrase “developing country” has been superseded by the specific income level of the country named. In the case of Bangladesh, it is a lower-middle-income country. Please change the phrase on line 80 to “a lower-middle-income country in South Asia.” Please review this World Bank list if needed: https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups. Thank you for the information about education levels. I’m noting that your study includes much higher percentages of women educated to upper secondary and university levels than Bangladesh generally. This likely tracks closely with socioeconomic status, and you mention in your limitations that you do not handle socioeconomic disparities in detail. That is reasonable (because most of the population you are capturing are those who can go to a private hospital) and so no change is needed there. However, you could also include a sentence or two in the discussion/limitation section noting that you captured a cohort that skews more highly educated than the female population of Bangladesh generally, and this limits how generalizable your findings are. In Table 3, you use the term “cOR.” I assume you mean “crude odds ratio.” Please spell out the full term somewhere in the document. Finally, Table 3 shows some dramatic shifts between your cOR and aOR values, including some changes in direction (eg, with respect to facilities referrals, from cOR of 0.56 (0.38, 0.83)* to aOR of 2.88 (1.59, 5.31), so changing from lower likelihood to higher likelihood of respectful care). Is this due to small sample sizes? Please review closely and ensure all values are correct, and please comment on these shifts in your discussion or limitation section. Authors’ Response: We sincerely thank the reviewer for the careful review of our manuscript and for the insightful and constructive comments. First, we have updated line 80 to “a lower-middle-income country in South Asia” per your suggestion. Second, we acknowledged that our cohort includes a higher proportion of women with upper secondary and university education than the general female population, which may limit generalizability; this has been added to the limitations section of the manuscript. Third, the term “cOR” means “crude odds ratio (cOR)” which is now mentioned in the footnote of Table 3. According to your suggestion, we reviewed the analysis and we agree that shifts between cOR and aOR, including reversals (e.g., facility referrals), likely reflect confounding and the relatively small sample size. This has been noted in the limitations section of the manuscript. Finally, we greatly appreciate the reviewer’s thoughtful guidance in strengthening the manuscript. Reviewer #3: Thank you for your revisions. I have reviewed the updated manuscript and find the changes to be satisfactory. I have no additional comments. Authors’ Response: We sincerely thank the reviewer for taking the time to review our revised manuscript and for the positive feedback. We greatly appreciate your acknowledgment and support. Attachments Attachment Submitted filename: 1330-Reviewer correction.docx https://doi.org/10.1371/journal.pone.0334418.r004
28 Sep 2025 Decision Letter - Tanya Doherty, Editor Factors associated with respectful maternity care during hospital deliveries: a cross-sectional study in Bangladesh PONE-D-25-20339R2 Dear Dr. Hasan, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. For questions related to billing, please contact billing support . If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Tanya Doherty, PhD Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #2: All comments have been addressed Reviewer #3: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #2: Yes Reviewer #3: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #2: Yes Reviewer #3: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #2: Yes Reviewer #3: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #2: Yes Reviewer #3: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #2: No further recommendations. Thank you for your diligence, and congratulations on the publication of your research. Reviewer #3: Factors associated with respectful maternity care during hospital deliveries: a cross-sectional study in Bangladesh. All comments have been addressed. I have no comments ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean? ). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy . Reviewer #2: No Reviewer #3: No ******** https://doi.org/10.1371/journal.pone.0334418.r005
Formally Accepted
Acceptance Letter - Tanya Doherty, Editor PONE-D-25-20339R2 PLOS ONE Dear Dr. Hasan, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset You will receive further instructions from the production team, including instructions on how to review your proof when it is ready. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few days to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. You will receive an invoice from PLOS for your publication fee after your manuscript has reached the completed accept phase. If you receive an email requesting payment before acceptance or for any other service, this may be a phishing scheme. Learn how to identify phishing emails and protect your accounts at https://explore.plos.org/phishing. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Professor Tanya Doherty Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0334418.r006

Open letter on the publication of peer review reports

PLOS recognizes the benefits of transparency in the peer review process. Therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. Reviewers remain anonymous, unless they choose to reveal their names.

We encourage other journals to join us in this initiative. We hope that our action inspires the community, including researchers, research funders, and research institutions, to recognize the benefits of published peer review reports for all parts of the research system.

Learn more at ASAPbio .