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Selection of studies for systematic review
(((((mistreatment[All Fields] AND (“women”[MeSH Terms] OR “women”[All Fields]) AND (“parturition”[MeSH Terms] OR “parturition”[All Fields] OR “childbirth”[All Fields])) OR “disrespect and abuse”[All Fields]) OR (dehumanized[All Fields] AND care[All Fields])) OR (humanized[All Fields] AND care[All Fields])) OR “obstetric violence”[All Fields]) OR “respectful maternity care”[All Fields] AND (((“pregnancy”[MeSH Terms] OR “pregnancy”[All Fields]) OR (“parturition”[MeSH Terms] OR “parturition”[All Fields] OR “childbirth”[All Fields])) OR maternity[All Fields]).
Abuya_2015_Exploring Prevalence of Disrespect and Abuse during Childbirth in Kenya
Asefa_2015_Status of respectful and non-abusive care during facility-based childbirth in a hospital and health centers in Addis Ababa, Ethiopia
Kruk_2014_Disrespectful and abusive treatment during facility delivery in Tanzania- a facility and community survey
Okafor_2014_Disrespect and abuse in childbirth in Nigeria
Sando_2014_The Prevalence of disrespect and abuse during facility-based childbirth in urban Tanzania.
Thirteen facilities in both rural and urban Kenya
Four facilities (1 specialized hospital and 3 health centers) in Ethiopia
Eight facilities (2 district hospitals, 5 health centers and 1 dispensary) in rural, Tanzania
One referral hospital in southeastern Nigeria
One referral facility in urban, Tanzania
Number of participants
Prevalence estimates (%)
Exit Interview n = 641
Exit Interview n = 173
Exit Interview n = 1779
Follow-up survey n = 546
Written survey at 4–6 weeks postpartum n = 446
Exit Interview n = 1914
Follow-up survey n = 64
Non dignified care
Non consented care
Non confidential care
Inappropriate demand for payment
Lack of privacy
Analytical framework for comparative analysis
Common types of systematic error in prevalence studies
Type of Systematic Error
Systematic Error in the Selection of Study Population
This is the degree to which the survey estimate differs from the true value of the phenomenon due to the fact that study was conducted in a non-representative sample of the target population.
Response rate bias
This type of occurs when a substantial number of sampled study subjects refuse/decline to participate in the study or do not respond to a part of the study that is relevant to the outcome variable.
Measurement Errors (can be random or systematic)
Imperfect test error
Values in the study data set do not reflect the true values of the variable of interest due to inaccurate measurement caused by poor data collection instrument
It reflects validity (the degree to which the instrument measures accurately what it purports to measure).
This is distortion of the responses given by subjects caused by behaviors of the interviewer, such as leading or cueing the subject, which influence subjects’ responses.
This error occurs when respondents do not report accurately on any event of interest because they don’t want to offend the person seeking their opinion.
The degree to which the study value differs from the true value because of inaccurate recall of information about the variable of interest.
Independent external review of study methods
Study areas and study site characteristics
Prevalence findings from each study
Comparison of methods: overview
Selection of study facilities
Selection of study participants
Categories of D&A chosen for study
Operational definitions of categories of D&A
Bowser & Hill categories
1. Physical abuse
Slapping, pinched, pushed, beaten or being poked during childbirth. Rape/sexual harassment.
The woman is not protected from physical harm or ill treatment: The provider used physical force/slapped me/hit me; I was: physically restrained; separated from my baby without medical indication; s denied food or fluid in labor unless medically necessitated; I did not receive comfort/pain-relief as necessary; The providers did not demonstrate caring in a culturally appropriate way
Physical abuse: Hitting, slapping, pushing, pinching or otherwise beating the patient; sexual harassment; rape
Physical abuse: Restrained or tied down during labor; Episiotomy given or sutured without anesthesia; Beaten, slapped, or pinched; Sexually abused by health worker
Physical abuse: Kicked, pinched, slapped, episiotomy without anesthesia, pushed, raped, other
2. Non-consented care
Non-consented care: Treatment given without permission. No permission obtained before examination for medical procedures such as tubal ligation, hysterectomy.
The woman’s right to information, informed consent, and choice/preferences is not protected:
The provider did not: introduce himself/herself to me and my companion; encourage me to ask questions; respond to my questions with promptness, politeness, and truthfulness; explain to me what is being done and what to expect throughout labor and birth; give me periodic updates on status and progress of my labor; allow me to move about during labor; allow to assume position of choice during birth; obtain my consent or permission prior to any procedure
Non-consented care: Non-consent for tubal ligation; non-consent for hysterectomy; non-consent for Caesarean section
Non-consented care: Episiotomy; Augmentation of labor; Shaving of pubic hair; Sterilization; Cesarean delivery; Blood transfusion
Non-consented care: Tubal ligation, hysterectomy, abdominal palpation, vaginal examination, episiotomy, other
3. Non-confidential care
Non-confidential care: Treated in a way that violated privacy; Treated in a way that violated confidentiality. HIV status shown to others; health information discussed with non-health staff; uncovered during delivery or
examination; no screens blocking
view during delivery or examination; discussed her issues when other clients were listening.
The woman’s confidentiality and privacy is not protected: The provider did not use curtains or other visual barriers to protect me
Body seen by others
Non-confidential care: Age disclosure without consent; Provision of care without privacy; Medical history disclosure without consent; Disclosure of HIV status without consent
Non-confidential care: HIV status shown to others, other health information shown to others, HIV status shown to non-health staff, health information discussed with non-health staff, personal issues discussed in earshot of others, other
Lack of privacy: Uncovered during delivery or examination, no screens blocking view during delivery or examination
4. Non-dignified care
Non-dignified care: Provider talked or used a facial expression that made you feel uncomfortable. Use of non-dignifiedlanguage such as shouting and scolding; Threats of
withholding services/threatened with going to theatre, called insulting names, laughed or scorned at.
The woman is not treated with dignity and respect: The provider did not speak to me politely; The provider made insults, intimidation, threats, or coerced me
Non-dignified care: Shouting/scolding; threatening to withhold treatment; threatening comments or negative or discouraging comments
Non-dignified care: Blamed or intimidated during childbirth; Threatened with cesarean delivery to discourage patient from shouting; Received slanderous remarks (aspersions) from birth attendant; Scolded, shouted at, or called stupid
Non-dignified care: Shouted at, scolded, threatened to withhold services, laughed at or scorned, other
The woman did not receive equitable care, free of discrimination: The provider spoke to me in a language and at a language-level that I cannot understand; The provider showed disrespect to me based on any specific attribute
Discrimination on the basis of specific patient attributes:
Denial of needed attention on the basis of ethnic origin; Denial of needed attention because of low social class; Denial of needed attention because of teen age (≤19 years); Denial of needed attention because of HIV-seropositive status
6. Abandonment of care
Neglect/abandonment: Left unattended by health workers when you needed help; Ignored when sought help for pain relief or left unattended by heath workers when they needed help.
The woman is left without care/attention: The provider did not: encourage me to call if needed; come quickly when I called him/her; The provider left me alone or unattended
Neglect: Ignoring or abandoning patient when in need; delivered alone
Abandonment/neglect of care:
Denied companionship by the husband or close relatives; Being left unattended in second stage of labor; Birth attendant failed to intervene in a life-threatening situation; Not granted requested attention because staff was exhausted
While in labor, while delivering, while experiencing a complication, after delivery, other
7. Detention in facilities
Inappropriate demand for payment:
Detention in facility for failure to pay; Request for a bribe for services
The woman is detained or confined against her will:
I was detained in health facility against my will
Inappropriate demand for payments:
Detention due to failure to pay; Request for bribe
Detention in the health facility:
Discharge postponed until her hospital bills are paid; Detained in the hospital until infant’s bills are paid