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Table 1 Typology of the mistreatment of women during childbirth (Reprinted with permission from [19])

From: How women are treated during facility-based childbirth: development and validation of measurement tools in four countries – phase 1 formative research study protocol

Third order Second order First order
Physical abuse Use of force Women beaten, slapped, kicked, and pinched during delivery
Physical restraint Women physically restrained to the bed or gagged during delivery
Sexual abuse Sexual abuse Sexual abuse or rape
Verbal abuse Harsh language Harsh or rude language
Judgmental and accusatory comments
Threats and blaming Threats of withholding treatment or poor outcomes
Blaming for poor outcomes
Stigma and discrimination Discrimination based on sociodemographic characteristics Discrimination based on ethnicity/race/religion
Discrimination based on age
Discrimination based on socioeconomic status
Discrimination based on medical conditions Discrimination based on HIV status
Failure to meet professional standards of care Lack of informed consent and confidentiality Lack of informed consent process
Breaches of confidentiality
Physical examinations and procedures Painful vaginal exams
Refusal to provide pain relief
Performance of unconsented surgical operations
Neglect and abandonment Neglect, abandonment and long delays
Skilled attendant absent at time of delivery
Poor rapport between women and providers Ineffective communication Poor communication
Dismissal of women’s concerns
Language and interpretation issues
Poor staff attitudes
Lack of supportive care Lack of supportive care from health workers
Denial or lack of birth companions
Loss of autonomy Women treated as passive participants during childbirth
Denial of food, fluids and mobility
Lack of respect for women’s preferred birth positions
Denial of safe traditional practices
Objectification of women
Detainment in facilities
Health systems conditions and constraints Lack of resources Physical condition of facilities
Staffing constraints
Supply constraints
Lack of privacy
Lack of policies Lack of redress
Facility culture Bribery and extortion
Unclear fee structures
Unreasonable requests of women by health workers
  1. The typology presented in this table is an evidence-based classification system of how women are mistreated during childbirth, based on the findings of the evidence syntheses. The first order themes are identification criteria describing specific events or instances of mistreatment. The second and third order themes further classify these first-order themes into meaningful groups based on common attributes. The third-order themes are ordered from the level of interpersonal relations through the level of the health system