Table 3 Variation in the operationalization of Bowser & Hill categories of D&A across five studies

1. Physical abuse

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

Non-confidential care:

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

5. Discrimination

N/A

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

N/A

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

N/A

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

Abandonment:

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

Detention:

Any