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Physical abuse
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Use of force
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“You experienced physical abuse (including aggressive physical contact, inappropriate sexual conduct, a refusal to provide anesthesia for an episiotomy, etc.)”
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Physical restraint
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Sexual abuse
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Sexual abuse
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Verbal abuse
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Harsh language
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“Health care providers (doctors, midwives, or nurses) shouted at or scolded you”
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Threats and blaming
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“Health care providers threatened to withhold treatment or to force you to accept treatment you did not want”
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“Health care providers threatened you in any other way”
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Stigma and discrimination
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Discrimination based on socio-demographic characteristics
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Mothers on Respect (MOR) Index (14 items)a
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• Adapted 17-item Perceptions of Racism Scale
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• 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.
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• One item asking women how often they have felt treated unfairly because of their race, heritage or ethnic group
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Failure to meet professional standards of care
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Lack of informed consent and confidentiality
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“Your private or personal information was shared without your consent”
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“Your physical privacy was violated (i.e., being uncovered or having people in the delivery room without your consent)”
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Physical examinations and procedures
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“My doctor or midwife explained different options for care during my labour and birth.”
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“My doctor or midwife asked me what I wanted to do before the following procedures were done: (episiotomy, continuous fetal monitoring, screening tests etc).”
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Neglect and abandonment
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“Health care providers ignored you, refused your requests for help, or failed to respond to requests for help in a reasonable amount of time.”
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Poor rapport between women and providers
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Ineffective communication
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Mother Autonomy in Decision Making scale (MADM) (7 items)b
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• Three items that ask women to rate the level of respect, dignity and privacy that their care provider showed during labour and/or birth
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Lack of supportive care
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• 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.
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Loss of autonomy
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Health system conditions and constraints
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Lack of policies
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Adapted Perceptions of Racism Scale included items assessing treatment in medical offices and hospital wards
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Facility culture
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