title: Women's status and experiences of mistreatment during childbirth in Uttar Pradesh: a mixed methods study using cultural health capital theory.
abstract: Mistreatment of women in healthcare settings during childbirth has been gaining attention globally. Mistreatment during childbirth directly and indirectly affects health outcomes, patient satisfaction, and the likelihood of delivering in a facility currently or in the future. It is important that we study patients' reports of mistreatment and abuse to develop a deeper understanding of how it is perpetrated, its consequences, and to identify potential points of intervention. Patients' perception of the quality of care is dependent, not only on the content of care, but importantly, on women's expectations of care.
  
  
  
  This study uses rich, mixed-methods data to explore women's characteristics and experiences of mistreatment during childbirth among slum-resident women in Uttar Pradesh, India. To understand the ways in which women's social and cultural factors influence their expectations of care and consequently their perceptions of respectful care, we adopt a Cultural Health Capital (CHC) framework. The quantitative sample includes 392 women, and the qualitative sample includes 26 women.
  
  
  
  Quantitative results suggest high levels of mistreatment (over 57 % of women reported any form of mistreatment). Qualitative findings suggest that lack of cultural health capital disadvantages patients in their patient-provider relationships, and that women use resources to improve care they receive. Participants articulated how providers set expectations and norms regarding behaviors in facilities; patients with lower social standing may not always understand standard practices and are likely to suffer poor health outcomes as a result. Of importance, however, patients also blame themselves for their own lack of knowledge.
  
  
  
  Lack of cultural health capital disadvantages women during delivery care in India. Providers set expectations and norms around behaviors during delivery, while women are often misinformed and may have low expectations of care.
authors: Department of Epidemiology and Biostatistics and Global Health Sciences, University of California, San Francisco. 550 16th Street, Box 1224, San Francisco, CA, 94158, USA. May.Sudhinaraset@ucsf.edu.
authors: May
authors: M
authors: Sudhinaraset
authors: Department of Social and Behavioral Sciences, University of California, San Francisco. 3333 California St., San Francisco, CA, 94143, USA.
authors: Emily
authors: E
authors: Treleaven
authors: Division of Global Public Health, Department of Medicine, University of California, San Diego. 9500 Gilman Drive, La Jolla, CA, 92093, USA.
authors: Jason
authors: J
authors: Melo
authors: Foundation for Research in Health Systems, 214, Sydicate House, Inderlok, Delhi, India.
authors: Kanksha
authors: K
authors: Singh
authors: Department of Epidemiology and Biostatistics and Global Health Sciences, University of California, San Francisco. 550 16th Street, Box 1224, San Francisco, CA, 94158, USA.
authors: Nadia
authors: N
authors: Diamond-Smith
mesh_terms: D000328:Adult; D065246:Culturally Competent Care; D036861:Delivery, Obstetric / Q000523:psychology*; D005260:Female; D006282:Health Personnel / Q000523:psychology; D006801:Humans; D007194:India; D036801:Parturition / Q000523:psychology*; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011203:Poverty / Q000523:psychology*; D011204:Poverty Areas; D011247:Pregnancy; D036301:Qualitative Research; D012923:Social Class; D055815:Young Adult
keywords: Cultural health capital; Disrespectful care; India; Mistreatment; Quality of care; Slum; Women