Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Nov 15;18(1):132.
doi: 10.1186/s12874-018-0603-x.

Methodological development of tools to measure how women are treated during facility-based childbirth in four countries: labor observation and community survey

Meghan A Bohren  1   2 , Joshua P Vogel  3 , Bukola Fawole  4 , Ernest T Maya  5 , Thae Maung Maung  6 , Mamadou Diouldé Baldé  7   8 , Agnes A Oyeniran  9 , Modupe Ogunlade  9 , Kwame Adu-Bonsaffoh  10 , Nwe Oo Mon  6 , Boubacar Alpha Diallo  7   8 , Abou Bangoura  7   11 , Richard Adanu  5 , Sihem Landoulsi  3 , A Metin Gülmezoglu  3 , Özge Tunçalp  3
Affiliations

Methodological development of tools to measure how women are treated during facility-based childbirth in four countries: labor observation and community survey

Meghan A Bohren et al. BMC Med Res Methodol. .

Abstract

Background: 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. 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).

Methods: An 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.

Results: The 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.

Conclusions: An 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.

Keywords: Childbirth; Disrespect and abuse; Ghana; Guinea; Maternal health; Mistreatment; Myanmar; Nigeria; Obstetric delivery; Quality of care.

PubMed Disclaimer

Conflict of interest statement

Authors’ information

Not applicable.

Ethics approval and consent to participate

This study was approved by the World Health Organization Ethical Review Committee (protocol: A65880) and the World Health Organization Human Reproduction Programme (HRP) Review Panel on Research Projects (RP2). This study was also approved by in-country ethical committees in: Guinea [le comité national d’éthique pour la recherche en santé, protocol ID: 024/CNERS/15]; Nigeria [Federal Capital Territory Health Research Ethics Committee (protocol ID, FHREC/2014/01/72/28–11-14); Research Ethical Review Committee, Oyo State (protocol ID AD13/479); and State Health Research Ethics Committee of Ondo State (protocol ID AD 3693/299)]; Ghana [Ethical Review Committee of the Ghana Health Service (GHS) (Protocol ID GHS-ERC-13/01/15)]; and Myanmar [Ethics Review Committee, Department of Medical Research (protocol ID (Ethics/DMR/2017/096)]. All participants provided written informed consent prior to participation.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Visual depiction of the tool development process
Fig. 2
Fig. 2
Study procedure and workflow for the labor observations. All images developed by the research team
Fig. 3
Fig. 3
Visual depiction of the structure of the labor observation tool
Fig. 4
Fig. 4
Study procedure and workflow for the community survey. All images developed by the research team
Fig. 5
Fig. 5
Visual depiction of the structure of the community survey tool
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. World Health Organization. Trends in Maternal Mortality: 1990 to 2015: Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2015.
    1. Tuncalp O, Were WM, Maclennan C, Oladapo OT, Gulmezoglu AM, Bahl R, et al. Quality of care for pregnant women and newborns - the WHO vision. BJOG: An International Journal of Obstetrics and Gynaecology. 2015;122(8):1045–1049. doi: 10.1111/1471-0528.13451. - DOI - PMC - PubMed
    1. World Health Organization . WHO recommendations: intrapartum care for a positive childbirth experience. Geneva: World Health Organization; 2018. - PubMed
    1. Oladapo OT, Tuncalp O, Bonet M, Lawrie TA, Portela A, Downe S, et al. WHO model of intrapartum care for a positive childbirth experience: transforming care of women and babies for improved health and well-being. BJOG. 2018;125(8):918–922. doi: 10.1111/1471-0528.15237. - DOI - PMC - PubMed
    1. Bohren MA, Vogel JP, Hunter EC, Lutsiv O, Makh SK, Souza JP, et al. The Mistreatment of Women during Childbirth in Health Facilities Globally: A Mixed-Methods Systematic Review. PLOS Medicine. 2015;12(6):e1001847. doi: 10.1371/journal.pmed.1001847. - DOI - PMC - PubMed

Publication types

MeSH terms