Abstract
BackgroundEfforts to improve maternal health are increasingly focused on improving the quality of care provided to women at health facilities, including the promotion of respectful care and eliminating mistreatment of women during childbirth. A WHO-led multi-country research project aims to develop and validate two tools (labor observation and community survey) to measure how women are treated during facility-based childbirth. This paper describes the development process for these measurement tools, and how they were implemented in a multi-country study (Ghana, Guinea, Myanmar and Nigeria).MethodsAn iterative mixed-methods approach was used to develop two measurement tools. Methodological development was conducted in four steps: (1) initial tool development; (2) validity testing, item adjustment and piloting of paper-based tools; (3) conversion to digital, tablet-based tools; and (4) data collection and analysis. These steps included systematic reviews, primary qualitative research, mapping of existing tools, item consolidation, peer review by key stakeholders and piloting.ResultsThe development, structure, administration format, and implementation of the labor observation and community survey tools are described. For the labor observations, a total of 2016 women participated: 408 in Nigeria, 682 in Guinea, and 926 in Ghana. For the community survey, a total of 2672 women participated: 561 in Nigeria, 644 in Guinea, 836 in Ghana, and 631 in Myanmar. Of the 2016 women who participated in the labor observations, 1536 women (76.2%) also participated in the community survey and have linked data: 779 in Ghana, 425 in Guinea, and 332 in Nigeria.ConclusionsAn important step to improve the quality of maternity care is to understand the magnitude and burden of mistreatment across contexts. Researchers and healthcare providers in maternal health are encouraged to use and implement these tools, to inform the development of more women-centered, respectful maternity healthcare services. By measuring the prevalence of mistreatment of women during childbirth, we will be able to design and implement programs and policies to transform maternity services.
Highlights
Efforts to improve maternal health are increasingly focused on improving the quality of care provided to women at health facilities, including the promotion of respectful care and eliminating mistreatment of women during childbirth
An important step to improve the quality of maternity care is to understand the magnitude and burden of mistreatment across contexts
We identified relevant existing tools through a) measurement studies identified via the mixed-methods systematic review [5], and b) contacting key stakeholders working in maternal and perinatal health research and quality of maternity care to share any existing measurement tools
Summary
Efforts to improve maternal health are increasingly focused on improving the quality of care provided to women at health facilities, including the promotion of respectful care and eliminating mistreatment of women during childbirth. The new recommendations articulate the overarching importance of respectful maternity care, and the need for staff and health services to create enabling maternity care environments that encourage a woman’s sense of control and their involvement in decision-making [3]. It contains specific recommendations on respectful care policies, labor companionship and effective communication. These recommendations reflect a growing body of literature demonstrating that women may experience abusive, neglectful or disrespectful care during labor and childbirth in healthcare facilities [5]. These negative experiences may inhibit women from attending health facilities for childbirth, or using them in the future [6]
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