How women are treated during facility-based childbirth: development and validation of measurement tools in four countries – phase 1 formative research study protocol

Abstract

BackgroundEvery woman has the right to dignified, respectful care during childbirth. Recent evidence has demonstrated that globally many women experience mistreatment during labour and childbirth in health facilities, which can pose a significant barrier to women attending facilities for delivery and can contribute to poor birth experiences and adverse outcomes for women and newborns. However there is no clear consensus on how mistreatment of women during childbirth in facilities is defined and measured. We propose using a two-phased, mixed-methods study design in four countries to address these research gaps. This protocol describes the Phase 1 qualitative research activities.Methods/DesignWe will employ qualitative research methodologies among women, healthcare providers and administrators in the facility catchment areas of two health facilities in each country: Ghana, Guinea, Myanmar and Nigeria. In-depth interviews (IDIs) and focus group discussions (FGDs) will be conducted among women of reproductive age (15–49 years) to explore their perceptions and experiences of facility-based childbirth care, focused on how they were treated by healthcare workers and perceived factors affecting how they were treated. IDIs will also be conducted with healthcare providers of different cadres (e.g.: nurses, midwives, medical officers, specialist obstetricians) and facility administrators working in the selected facilities to explore healthcare providers’ perceptions and experiences of facility-based childbirth care and how staff are treated, colleagues and supervisors. Audio recordings will be transcribed and translated to English. Textual data will be analysed using a thematic framework approach and will consist of two levels of analysis: (1) conduct of local analysis workshops with the research assistants in each country; and (2) line-by-line coding to develop a thematic framework and coding scheme.DiscussionThis study serves several roles. It will provide an in-depth understanding of how women are treated during childbirth in four countries and perceived factors associated with this mistreatment. It will also provide data on where and how an intervention could be developed to reduce mistreatment and promote respectful care. The findings from this study will contribute to the development of tools to measure the prevalence of mistreatment of women during facility-based childbirth.

Perceptions and experiences of the mistreatment of women during childbirth in health facilities in Guinea: a qualitative study with women and service providers

“…During the workshop, the study protocol and discussion guides were discussed in detail. All IDI and FGD discussion guides were pre-tested in order to evaluate, improve and adapt the discussion guides for the Guinea context (from the multi-country study protocol [12]). During data collection, IDIs and FGDs with women were conducted in private, quiet areas in the community, and data collectors were women.…”

“…This study is part of a multi-country study on mistreatment of women during childbirth in four countries: Guinea, Ghana, Nigeria and Myanmar [12]. The first phase of the study is qualitative, aiming to better understand factors contributing to mistreatment during childbirth and identify areas where interventions could be developed.…”

Mistreatment of women during childbirth in Abuja, Nigeria: a qualitative study on perceptions and experiences of women and healthcare providers

“…Using the categories proposed by Bowser and Hill, four recent studies in sub-Saharan Africa have measured disrespect and abuse through direct labor observations, facility exit interviews and community-based follow-up surveys [36–38, 42]. However, differential operational definitions, lack of consensus on what constitutes poor treatment and varying study designs have resulted in wide differences in prevalence, and it is unclear if differences in prevalence relate to differences in methodology or true variation [43]. These studies have highlighted that many women are mistreated during childbirth, but limitations exist to define and measure mistreatment during childbirth in a systematic and standardized way.…”

A qualitative study of women’s and health providers’ attitudes and acceptability of mistreatment during childbirth in health facilities in Guinea

“…This study was conducted to explore and understand how women are treated during childbirth in health facilities, and is part of a multi-country study in Guinea, Ghana, Nigeria and Myanmar [13]. In short, the study is comprised of a qualitative formative phase and a quantitative measurement phase, and aims to better understand how mistreatment during childbirth is occurring, contributing factors, and how to measure its occurrence.…”