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Table 1 GVtM items that align with WHO [63] typology of mistreatment

From: The Giving Voice to Mothers study: inequity and mistreatment during pregnancy and childbirth in the United States

Bohren et al. – Third-Order Themes Bohren et al. – Second -Order Themes GVtM – US items and scales
Physical abuse Use of force “You experienced physical abuse (including aggressive physical contact, inappropriate sexual conduct, a refusal to provide anesthesia for an episiotomy, etc.)”
Physical restraint
Sexual abuse Sexual abuse
Verbal abuse Harsh language “Health care providers (doctors, midwives, or nurses) shouted at or scolded you”
Threats and blaming “Health care providers threatened to withhold treatment or to force you to accept treatment you did not want”
  “Health care providers threatened you in any other way”
Stigma and discrimination Discrimination based on socio-demographic characteristics Mothers on Respect (MOR) Index (14 items)a
• Adapted 17-item Perceptions of Racism Scale
• Four items that assess perceived discrimination from care providers or other disrespectful care provider behaviours, e.g. During my pregnancy I held back from asking questions or discussing my concerns because I felt discriminated against; During my pregnancy I held back from asking questions or discussing my concerns because my care provider used language I could not understand.
• One item asking women how often they have felt treated unfairly because of their race, heritage or ethnic group
Failure to meet professional standards of care Lack of informed consent and confidentiality “Your private or personal information was shared without your consent”
“Your physical privacy was violated (i.e., being uncovered or having people in the delivery room without your consent)”
Physical examinations and procedures “My doctor or midwife explained different options for care during my labour and birth.”
“My doctor or midwife asked me what I wanted to do before the following procedures were done: (episiotomy, continuous fetal monitoring, screening tests etc).”
Neglect and abandonment
“Health care providers ignored you, refused your requests for help, or failed to respond to requests for help in a reasonable amount of time.”
Poor rapport between women and providers Ineffective communication Mother Autonomy in Decision Making scale (MADM) (7 items)b
• Three items that ask women to rate the level of respect, dignity and privacy that their care provider showed during labour and/or birth
Lack of supportive care
• Five items about care that women declined, what they declined, why, how their care provider reacted and if anyone helped the woman maintain her wishes.
Loss of autonomy
Health system conditions and constraints Lack of policies Adapted Perceptions of Racism Scale included items assessing treatment in medical offices and hospital wards
Facility culture
  1. aVedam S, Stoll K, Rubashkin N, et al. The Mothers on Respect (MOR) index: measuring quality, safety, and human rights in childbirth. Social Science and Medicine: Population Health. https://doi.org/10.1016/j.ssmph.2017.01.005
  2. bVedam S, Stoll K, Martin K, et al. The Mother’s Autonomy in Decision Making (MADM) scale: Patient-led development and psychometric testing of a new instrument to evaluate experience of maternity care. PLOS ONE https://doi.org/10.1371/journal.pone.0171804