Skip to content
MHTF logo

Maternal Health Task Force

  • Facebook
  • Twitter
  • Vimeo
  • Flickr
  • Email
  • About
  • Topics
  • Resources
  • Buzz
    • People’s Choice Buzz
  • Blog
MHTF Blog ›

Measuring Women’s Autonomy and Respect During Maternity Care

Posted on May 18, 2017May 18, 2017

By: Sarah Hodin, MPH, CD(DONA), LCCE, National Senior Manager of Maternal Newborn Health Programs, Steward Health Care

Mistreatment during maternity care can come in many forms, including physical or emotional abuse, non-consented care, abandonment or detention in facilities, all of which are violations of women’s rights. Furthermore, it is well documented that women who encounter poor treatment during facility-based maternity care are less likely to seek health care at a facility in the future.

Ensuring that women receive high quality, respectful maternity care is essential, but designing and using indicators to accurately measure women’s experiences can be challenging. Professor Saraswathi Vedam, along with a diverse group of women, non-governmental organization leaders and researchers who led the Changing Childbirth in British Columbia (BC) Study, recently published two papers describing new measures related to the quality of maternal health care using data from over 1,600 women in BC. Both scales were developed using community-based participatory research methods.

Mothers on Respect index

The Mothers on Respect index (MORi) is a 14-item scale measuring women’s experiences when interacting with maternity care providers:

 

The majority of the Canadian women who participated in the survey reported that they felt comfortable asking their maternity care providers questions and that their providers respected their personal preferences. However, fewer women were comfortable declining care that their providers offered, and 10% of women reported feeling coerced into accepting their providers’ suggestions.

A number of factors were associated with a higher likelihood that a woman would fall into the bottom 10th percentile of MORi scores:

Medical risk factors Social risk factors
High blood pressure Lack of social support
Diabetes Unstable housing or history of homelessness
Compromised fetal status Refugee or recent immigrant status
Depression History of incarceration
History of substance abuse History of poverty

Women who received maternity care from a midwife tended to have higher MORi scores compared to those who saw a family physician or obstetrician.

Mother’s Autonomy in Decision-Making scale

The seven-item Mother’s Autonomy in Decision-Making scale (MADM) measures women’s autonomy and role in decision-making during maternity care:

 

Over 90% of women surveyed said that leading decisions about their maternity care was either important or very important to them, and yet a majority of women who experienced interventions reported that providers led the decisions. A number of women reported feeling dissatisfied with their role in decision-making about their care:

Type of care % women dissatisfied with decision-making role
Pregnancy 6.2%
Labor and delivery 15.2%
Postpartum 15.8%
Baby care 12.9%
At any time 2.7%

Implications for research, policy and practice

Both the MORi and MADM scales were developed in close collaboration with women in the target community, which was crucial to ensuring that the scale items would be meaningful and relevant to participants. These studies exemplify the benefits of using community-based participatory research methods for designing reliable, valid measurement tools. Involving women at all stages of the research, program implementation and evaluation processes could produce more effective, sustainable results.

Women’s experiences of mistreatment during maternity care are not isolated incidents, but rather symptoms of wider health systems issues. Several contributing factors have been proposed by researchers, including a lack of supervision and support for frontline health workers, structural gender-based violence and a shortage of material and human resources. Spending enough time with their care providers emerged as a priority for many women during maternity care, but health systems—especially those structured around productivity—often incentivize providers to see as many patients as possible, regardless of how long those visits last. In low-resource settings, severe health worker shortages can also lead to short, poor quality visits. Improving women’s experiences with maternal health care will require addressing these types of root causes. The MADM scale and the MOR index could be used by institutions and maternity care providers as simple, evidence-based tools that encourage women to rate the quality of their experiences.

All women have a basic right to respectful maternity care. Educating women about this right and helping them to advocate for themselves can be a powerful tool to combat mistreatment. The global health community must be ready to support women around the world as they demand higher quality maternal health care and assist national health systems as they prepare to deliver those services.

—

Watch the webcast of Professor Vedam’s presentation at “Too Much Too Soon: Addressing Over-Intervention in Maternity Care,” a panel discussion that took place in April 2017 as part of the Advancing Dialogue in Maternal Health Series.

Listen to Professor Vedam discuss her work and learn more on the Birth Place Lab website.

Access resources related to respectful maternity care.

Read more about measuring the quality of maternal health care.

Share this:FacebookTwitterLinkedInReddit
CATEGORIESCATEGORIES: Quality of Maternal Health Care Respectful Maternity Care Series
TOPICSTOPICS: Barriers to Health Care Access Facility-based Births Human Resources for Health Inequities & Inequalities Intrapartum Care Midwifery Monitoring & Evaluation Policy & Advocacy Quality of Care Respectful Maternity Care Social Determinants
GEOGRAPHIESGEOGRAPHIES: Canada

Looking for something specific?

Blog Series

  • Improving Maternal Health Measurement
  • Noncommunicable Diseases and Maternal Health
  • The Global Maternal Health Workforce
  • Quality of Maternal Health Care
  • See more>>

Archives

Blogs we follow

  • Healthy Newborn Network
  • Jacaranda Health
  • Jhpiego Field Notes
  • MamaYe
  • Maternal and Child Survival
  • NPR Goats and Soda
  • White Ribbon Alliance
  • Women Deliver

MHTF Disclaimer

The posts on this blog do not necessarily reflect the views of the Maternal Health Task Force. Our objective is to provide a platform for our Editorial Committee and other experts to post a myriad of data and evidence, as well as opinions/views that exist in the field which will contribute to expanding the maternal health dialogue.
  • About
  • Topics
  • Resources
  • Buzz
    • People’s Choice Buzz
  • Blog

MATERNAL HEALTH TASK FORCE

Harvard Chan School Center of Excellence in Maternal and Child Health
677 Huntington Avenue
Boston, MA 02115
MHTF@hsph.harvard.edu

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant T76MC00001 and entitled Training Grant in Maternal and Child Health. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.
  • About
    • Key Facts
    • Renaming the School
    • Office of the Dean
    • Location and Facilities
    • Administrative Offices
    • Contact Information
  • Admissions
    • Office of Admissions
    • Harvard Chan Viewbook
    • Financial Aid
    • Registrar’s Office
    • Summer at the School
  • Academics
    • Departments
    • Degrees
    • Online Degree Program
    • Programs and Requirements
    • Executive/Summer Programs
    • Interdisciplinary Concentrations
    • Office of Education
    • Division of Biological Sciences
    • Division of Policy Translation and Leadership Development
    • Executive and Continuing Professional Education
    • Fellowships and Residencies
    • Academic Calendar
    • Harvard Chan Viewbook
  • Exec Ed
  • Research
    • Office of Research Strategy and Development
    • Harvard Longwood Campus Research Administration
    • Office of Regulatory Affairs and Research Compliance
    • Office of Human Research Administration
    • Centers & Institutes
    • Researchers Directory
    • Postdoctoral Research Fellows
    • Export Controls
    • International Research
  • Faculty
    • Office of Faculty Affairs
    • Office of Diversity and Inclusion
    • Faculty Directory
    • Faculty Searches
  • Students
    • Student Life Main
    • Academic Calendar
    • Career Advancement
    • Countway Library
    • Housing
    • Student News
    • Office for Student Affairs
    • Office of Education
    • Office of Diversity and Inclusion
    • Office of Financial Aid
    • Registrar’s Office
    • Student Billing
    • Orientation
    • Commencement
  • Alumni
  • News
    • News Main
    • Press Releases
    • Harvard Public Health Magazine
    • Explore Research by Topic
    • Mailing Lists
    • Multimedia
    • Office of Communications
  • Make a Gift
    • Campaign for Harvard Chan School
  • Facebook
  • Twitter
  • Vimeo
  • Flickr
  • Email
Maternal Health Task Force Proudly powered by WordPress
 

Loading Comments...