Comparing observed occurrence of mistreatment during childbirth with women’s self-report

A validation study in Ghana, Guinea and Nigeria

Bibliographic Data

ID21881546
AuthorsHedieh Mehrtash (0000-0003-4991-616X, University of Washington, corresponding author), Meghan A Bohren (0000-0002-4179-4682, The University of Melbourne), Kwame Adu-Bonsaffoh (0000-0002-3741-6646, University of Ghana), Theresa Azonima Irinyenikan (0000-0002-5594-037X, University of Medical Sciences, Ondo), Blair O Berger (0000-0002-7962-0522, Johns Hopkins University), Ernest Maya (0000-0001-6050-6837, University of Ghana), Mamadou Diouldé Baldé (0000-0003-0998-5793, Institut de Recherche Agronomique de Guinée), Thae Maung Maung (0000-0002-1265-3813, Ministry of Health and Sports), Adeniyi Kolade Aderoba (0000-0002-4333-9093, University of Oxford), Özge Tunçalp (0000-0002-5370-682X, World Health Organization), Hannah H Leslie (0000-0002-7464-3645, University of California, San Francisco)
Year2023
Volume5
IssueSuppl 2
Pagese012122
Publication date2023-07-01
Open AccessYes
TypeARTICLE
VenueBMJ Global Health (JOURNAL)
Journal identifiersISSN: 2059-7908 • E-ISSN: 2059-7908
PublisherBMJ (PUBLISHER • GB)
DOI10.1136/bmjgh-2023-012122
PMID37479486
OpenAlexW4385064678
LanguageEN
Citations received2
References cited31

BACKGROUND: There has been substantial progress in developing approaches to measure mistreatment of women during childbirth. However, less is known about the differences in measurement approaches. In this study, we compare measures of mistreatment obtained from the same women using labour observations and community-based surveys in Ghana, Guinea and Nigeria. METHODS: Experiences of mistreatment during childbirth are person-centred quality measures. As such, we assessed individual-level and population-level accuracy of labour observation relative to women's self-report for different types of mistreatment. We calculated sensitivity, specificity, percent agreement and population-level inflation factor (IF), assessing prevalence of mistreatment in labour observation divided by 'true' prevalence in women's self-report. We report the IF degree of bias as: low (0.75<IF<1.5), moderate (0.50<IF<0.75 or 1.5<IF<2.0) or high (IF≤0.50 or IF≥2.0). RESULTS: 1536 women across Ghana (n=779), Guinea (n=425) and Nigeria (n=332) were included. Most mistreatment items demonstrated better specificity than sensitivity: observation of any physical abuse (44% sensitive, 89% specific), any verbal abuse (61% sensitive, 73% specific) and presence of a labour companion (19% sensitive, 93% specific). Items for stigma (IF 0.16), pain relief requested (IF 0.38), companion present (IF 0.32) and lack of easy access to fluids (IF 0.46) showed high risk of bias, meaning labour observations would substantially underestimate true prevalence. Other items showed low or moderate bias. CONCLUSION: Using self-report as the reference standard, labour observations demonstrated moderate-to-high specificity (accurately identifying lack of mistreatment) but low-to-moderate sensitivity (accurately identifying presence of mistreatment) among women. For overall prevalence, either women's self-report or observations can be used with low-moderate bias for most mistreatment items. However, given the dynamicity, complexity, and limitations in 'objectivity', some experiences of mistreatment (stigma, pain relief, labour companionship, easy access to fluids) require measurement via women's self-report. More work is needed to understand how subjectivity influences how well a measure represents individual's experiences

Childbirth · Environmental health · Injury prevention · Poison control · Population · Pregnancy · Psychiatry · Verbal abuse · Child Abuse and Trauma · Clinical Psychology · Demography · Intimate Partner and Family Violence · Maternal and Perinatal Health Interventions · Medicine · Psychology

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