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Table 1 Types of disrespectful and abusive care as categorized by Bohren and colleagues in their systematic review [5]. Each is paired with the systems-level drivers of this care (Propagating Factors) and specific supports that care navigators can provide in order to address them (Care Navigator Roles)

From: Obstetric care navigation: a new approach to promote respectful maternity care and overcome barriers to safe motherhood

Type Propagating Factors Care Navigator Roles
1) Physical, sexual, or verbal abuse Normalization of patient abuse
Role modeling of behaviors by superiors
Mitigate through emotional support
Deter through mediation
2) Discrimination Social inequalities and segregation
Lack of consequences and oversight for discriminatory treatment
Advocate for incorporation of traditional birthing practices
Use cultural capital to identify both with patients and providers
3) Failure to provide professional standard of care (including patient’s autonomy) Medical paternalism
High patient volume
Hierarchy of hospital staff
Lack of mechanisms to measure and improve quality of care
Advocate for appropriate and timely care
Assist providers in obtaining patient consent
Take steps to protect patients’ dignity (ex: shielding while changing into gown in public exam room)
Educate patients and hospital staff on mothers’ rights
4) Poor communication Language barriers
Lack of training on effective communication
Translate between patients and providers
Report back to family and traditional midwife
5) Poor rapport Social stratification
Burnout-motivated behaviors
Act as cultural broker
Provide emotional and labor support
7) Health system constraints Provider frustration due to lack of resources Lack of basic resources to provide care
Uncomfortable working conditions
Provide economic support for medical needs
Contextualize limitations faced by medical providers for patients and family
8) Health system conditions Excessive bureaucracy Inadequate support staff Navigate complex work flows Coordinate care across settings (ex: between rural health post and hospital) Cultivate relationships with frontline health workers