<p>PRISMA 2020 checklist.</p>

Twenty three studies involving 15,325 women were included. The pooled mean PCMC score in East Africa was 63.08% (95% CI: 59.19, 66.97). Domain-specific scores were highest for dignity and respect (78.05%; 95% CI: 74.43–81.67), followed by supportive care (62.59%; 95% CI: 59.44–65.73), and lowest for communication and autonomy (55.29%; 95% CI: 48.66–61.92), demonstrating significant gaps in provider–patient communication and shared decision-making.

Lower PCMC scores were associated with nighttime delivery (β = −2.23; 95% CI: −3.35, −1.11), third-trimester antenatal care initiation (β = −4.06; 95% CI: −7.74, −0.38), and rural residence (β = −1.61; 95% CI: −2.60, −0.61), while higher maternal education was positively associated with PCMC. PCMC in East Africa remains suboptimal, predominantly in the communication, autonomy, and supportive care domains. Reinforcing provider communication and shared decision-making skills, improving night-shift staffing and supervision, integrating PCMC indicators into quality monitoring systems, and expanding community-level interventions through task-shifting and community engagement strategies are recommended.

Future research should prioritize implementation and intervention studies targeting identified gaps. The protocol has been registered in PROSPERO (CRD42024576229).</p></div>