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

From: Methods used in prevalence studies of disrespect and abuse during facility based childbirth: lessons learned

  Abuya Asefa Kruk Okafor Sando
Bowser & Hill categories
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
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