title: How women are treated during facility-based childbirth: development and validation of measurement tools in four countries - phase 1 formative research study protocol.
abstract: BACKGROUND
  Every woman has the right to dignified, respectful care during childbirth. Recent evidence has demonstrated that globally many women experience mistreatment during labour and childbirth in health facilities, which can pose a significant barrier to women attending facilities for delivery and can contribute to poor birth experiences and adverse outcomes for women and newborns. However there is no clear consensus on how mistreatment of women during childbirth in facilities is defined and measured. We propose using a two-phased, mixed-methods study design in four countries to address these research gaps. This protocol describes the Phase 1 qualitative research activities.
  
  
  METHODS
  We will employ qualitative research methodologies among women, healthcare providers and administrators in the facility catchment areas of two health facilities in each country: Ghana, Guinea, Myanmar and Nigeria. In-depth interviews (IDIs) and focus group discussions (FGDs) will be conducted among women of reproductive age (15-49 years) to explore their perceptions and experiences of facility-based childbirth care, focused on how they were treated by healthcare workers and perceived factors affecting how they were treated. IDIs will also be conducted with healthcare providers of different cadres (e.g.: nurses, midwives, medical officers, specialist obstetricians) and facility administrators working in the selected facilities to explore healthcare providers' perceptions and experiences of facility-based childbirth care and how staff are treated, colleagues and supervisors. Audio recordings will be transcribed and translated to English. Textual data will be analysed using a thematic framework approach and will consist of two levels of analysis: (1) conduct of local analysis workshops with the research assistants in each country; and (2) line-by-line coding to develop a thematic framework and coding scheme.
  
  
  CONCLUSIONS
  This study serves several roles. It will provide an in-depth understanding of how women are treated during childbirth in four countries and perceived factors associated with this mistreatment. It will also provide data on where and how an intervention could be developed to reduce mistreatment and promote respectful care. The findings from this study will contribute to the development of tools to measure the prevalence of mistreatment of women during facility-based childbirth.
authors.affiliation: Department of Reproductive Health and Research, including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Avenue Appia 20, 1201, Geneva, Switzerland. vogeljo@who.int.
authors.forename: Joshua P
authors.initials: JP
authors.lastname: Vogel
authors.affiliation: Department of Reproductive Health and Research, including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Avenue Appia 20, 1201, Geneva, Switzerland. mbohren1@jhu.edu.|Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, USA. mbohren1@jhu.edu.
authors.forename: Meghan A
authors.initials: MA
authors.lastname: Bohren
authors.affiliation: Department of Reproductive Health and Research, including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Avenue Appia 20, 1201, Geneva, Switzerland. tuncalpo@who.int.
authors.forename: Özge
authors.initials: Ö
authors.lastname: Tunçalp
authors.affiliation: Department of Reproductive Health and Research, including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Avenue Appia 20, 1201, Geneva, Switzerland. oladapoo@who.int.
authors.forename: Olufemi T
authors.initials: OT
authors.lastname: Oladapo
authors.affiliation: School of Public Health, University of Ghana, Accra, Ghana. rmadanu@yahoo.com.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Adanu
authors.affiliation: Cellule de Recherche en Santé de la Reproduction en Guinée (CERREGUI), Enceinte Hôpital National Donka, Conakry, Guinea. mdbaldedka@yahoo.fr.
authors.forename: Mamadou Diouldé
authors.initials: MD
authors.lastname: Baldé
authors.affiliation: Department of Medical Research, Yangon, Myanmar. themgmg.dr@gmail.com.
authors.forename: Thae Maung
authors.initials: TM
authors.lastname: Maung
authors.affiliation: University of Ibadan, Ibadan, Nigeria. fawoleo@yahoo.co.uk.
authors.forename: Bukola
authors.initials: B
authors.lastname: Fawole
authors.affiliation: Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital, Korle Bu, Accra, Ghana. bonsaffoh@yahoo.com.
authors.forename: Kwame
authors.initials: K
authors.lastname: Adu-Bonsaffoh
authors.affiliation: School of Public Health, University of Ghana, Accra, Ghana. gyekenay@yahoo.com.
authors.forename: Phyllis
authors.initials: P
authors.lastname: Dako-Gyeke
authors.affiliation: School of Public Health, University of Ghana, Accra, Ghana. maya_ernest@yahoo.co.uk.
authors.forename: Ernest Tei
authors.initials: ET
authors.lastname: Maya
authors.affiliation: Departement de sociologie Université, Sonfonia, Conakry, Guinea. mdbaldedka@yahoo.fr.
authors.forename: Mohamed Campell
authors.initials: MC
authors.lastname: Camara
authors.affiliation: Service de Gynécologie-Obstétrique, Hôpital national universitaire de Conakry, Conakry, Guinea. mdbaldedka@yahoo.fr.
authors.forename: Alfa Boubacar
authors.initials: AB
authors.lastname: Diallo
authors.affiliation: Cellule de Recherche en Santé de la Reproduction en Guinée (CERREGUI), Enceinte Hôpital National Donka, Conakry, Guinea. safiatoudiallo.k@gmail.com.
authors.forename: Safiatou
authors.initials: S
authors.lastname: Diallo
authors.affiliation: Department of Medical Research, Yangon, Myanmar. themgmg.dr@gmail.com.
authors.forename: Khin Thet
authors.initials: KT
authors.lastname: Wai
authors.affiliation: Maternal and Reproductive Health Division, Department of Public Health, Naypyitaw, Myanmar. themgmg.dr@gmail.com.
authors.forename: Theingi
authors.initials: T
authors.lastname: Myint
authors.affiliation: Department of Sociology, Faculty of The Social Sciences, University of Ibadan, Ibadan, Nigeria. lantopamtu@yahoo.com.
authors.forename: Lanre
authors.initials: L
authors.lastname: Olutayo
authors.affiliation: Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria. msbnsmtiti@yahoo.com.
authors.forename: Musibau
authors.initials: M
authors.lastname: Titiloye
authors.affiliation: Department of Obstetrics & Gynaecology, Maitama District Hospital, Abuja, Nigeria. drfrankalu@yahoo.com.
authors.forename: Frank
authors.initials: F
authors.lastname: Alu
authors.affiliation: Department of Obstetrics & Gynaecology, Nyanya General Hospital, Abuja, Nigeria. hadizabage2009@gmail.com.
authors.forename: Hadiza
authors.initials: H
authors.lastname: Idris
authors.affiliation: Department of Reproductive Health and Research, including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Avenue Appia 20, 1201, Geneva, Switzerland. gulmezoglum@who.int.
authors.forename: Metin A
authors.initials: MA
authors.lastname: Gülmezoglu
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005869:Ghana; D016701:Guinea; D006297:Health Services Accessibility; D006801:Humans; D002052:Myanmar; D009549:Nigeria; D036801:Parturition / Q000523:psychology*; D017060:Patient Satisfaction; D011787:Quality of Health Care; D063508:Social Discrimination; D012938:Social Perception; D014930:Women / Q000523:psychology*