Objective Explore parents’ experiences of care before and after stillbirth to identify potential areas for improvement. Design Internet-based survey of parents distributed via International Stillbirth Alliance networks. Setting Global. Population or Sample 2488 parents with a stillborn baby in the previous 5 years Methods Framework analysis of free-text responses, using an a priori framework developed from global respectful maternity care rights and guidelines. Main Outcome Measures Self-reported experience of care Results Four major themes arose: compassionate communication and shared decision making; respect for individuality, autonomy and legal rights; competent staff, facilities, and care systems; and holistic support. Many parents reported individualised, compassionate, and high-quality care, with synergistic community support. Negative experiences involved paternalistic or disrespectful care. Commonly parents felt that not enough information about stillbirth prevention had been provided. Conclusions Bereaved parents want supportive healthcare providers who listen to them, provide information and treat them with kindness and respect. Parents do not want, or expect, all care to come from healthcare providers. Intersection of healthcare with community, charities and spiritual support is important. The option of legal registration and naming of the stillborn baby is important to many parents. Funding The Centre of Research Excellence in Stillbirth (Stillbirth CRE) at the Mater Research Institute, The University of Queensland, Australia funded the survey. The National Health and Medical Research Council (NHMRC) provides core funding to the Stillbirth CRE. Keywords Stillbirth, stillborn, perinatal loss, intra-uterine death, perinatal bereavement, online survey, qualitative, respectful care

Objective To quantify parents’ experiences of respectful care around stillbirth globally. Design Multi-country, online, cross-sectional survey. Setting and Population Self-identified bereaved parents (n=3769) of stillborn babies from 44 high- and middle-income countries. Methods Parents’ perspectives of 7 aspects of care quality, factors associated with respectful care, and 7 bereavement care practices were compared across geographical regions using descriptive statistics. Respectful care was compared between country income groups using multivariable logistic regression. Main Outcome Measures Self-reported experience of care around the time of stillbirth Results A quarter (25.4%) of 3769 respondents reported disrespectful care after stillbirth and 23.5% reported disrespectful care of their baby. Gestation <30 weeks, and primiparity were associated with disrespect. Reported respectful care was lower in middle-income countries (MICs) than in high-income countries (HICs) (aOR=0.35, 95%CI (0.29-0.42), p <0.01). In many countries, aspects of care quality need improvement, such as ensuring families have enough time with providers. Participating respondents from Latin America and Southern Europe reported lower satisfaction across all aspects of care quality compared to Northern Europe. Unmet need for memory-making activities in MICs is high. Conclusions Despite improvements, many parents still experience disrespectful care around stillbirth. The gap between parents’ access to memory-making activities in MICs and HICs needs urgent attention. Tweetable abstract A quarter of parents of stillborn babies experience disrespectful care. There is global unmet need for memory-making activities