{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T03:47:32Z","timestamp":1778816852515,"version":"3.51.4"},"reference-count":38,"publisher":"BMJ","issue":"Suppl 2","license":[{"start":{"date-parts":[[2023,7,21]],"date-time":"2023-07-21T00:00:00Z","timestamp":1689897600000},"content-version":"unspecified","delay-in-days":20,"URL":"https:\/\/creativecommons.org\/licenses\/by\/3.0\/igo\/"}],"funder":[{"name":"UNDP\/UNFPA\/UNICEF\/WHO\/World Bank Special Programme of Research, Development and Research Training"},{"DOI":"10.13039\/100000200","name":"United States Agency for International Development","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100000200","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Glob Health"],"accepted":{"date-parts":[[2023,6,5]]},"published-print":{"date-parts":[[2023,7]]},"abstract":"\n Background<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n 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\u2019s 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 \u2018true\u2019 prevalence in women\u2019s 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\u22640.50 or IF\u22652.0).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n 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\u2019s self-report or observations can be used with low-moderate bias for most mistreatment items. However, given the dynamicity, complexity, and limitations in \u2018objectivity\u2019, some experiences of mistreatment (stigma, pain relief, labour companionship, easy access to fluids) require measurement via women\u2019s self-report. More work is needed to understand how subjectivity influences how well a measure represents individual\u2019s experiences.<\/jats:p>\n <\/jats:sec>","DOI":"10.1136\/bmjgh-2023-012122","type":"journal-article","created":{"date-parts":[[2023,7,21]],"date-time":"2023-07-21T13:26:14Z","timestamp":1689945974000},"page":"e012122","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Comparing observed occurrence of mistreatment during childbirth with women\u2019s self-report: a validation study in Ghana, Guinea and Nigeria"],"prefix":"10.1136","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4991-616X","authenticated-orcid":false,"given":"Hedieh","family":"Mehrtash","sequence":"first","affiliation":[{"name":"UNDP\/UNFPA\/UNICEF\/WHO\/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland"},{"name":"Department of Global Health, University of Washington School of Public Health, Seattle, Washington, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4179-4682","authenticated-orcid":false,"given":"Meghan A","family":"Bohren","sequence":"additional","affiliation":[{"name":"Gender and Women's Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kwame","family":"Adu-Bonsaffoh","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, University of Ghana Medical School, Accra, Ghana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Theresa Azonima","family":"Irinyenikan","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, University of Medical Sciences, Ondo, Ondo State, Nigeria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7962-0522","authenticated-orcid":false,"given":"Blair O","family":"Berger","sequence":"additional","affiliation":[{"name":"Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ernest","family":"Maya","sequence":"additional","affiliation":[{"name":"Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon, Ghana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mamadou Dioulde","family":"Balde","sequence":"additional","affiliation":[{"name":"Cellule de Recherche en Sante de la Reproduction en Guinee (CERREGUI), Conakry, Guinea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1265-3813","authenticated-orcid":false,"given":"Thae Maung","family":"Maung","sequence":"additional","affiliation":[{"name":"Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4333-9093","authenticated-orcid":false,"given":"Adeniyi Kolade","family":"Aderoba","sequence":"additional","affiliation":[{"name":"Mother and Child Hospital Akure, Obstetrics and Gynaecology Oke-Aro, Akure, Ondo, Nigeria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5370-682X","authenticated-orcid":false,"given":"\u00d6zge","family":"Tuncalp","sequence":"additional","affiliation":[{"name":"UNDP\/UNFPA\/UNICEF\/WHO\/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7464-3645","authenticated-orcid":false,"given":"Hannah H","family":"Leslie","sequence":"additional","affiliation":[{"name":"Division of Prevention Science, Department of Medicine, University of California, San Francisco, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2023,7,21]]},"reference":[{"key":"2025073013544042000_5.Suppl_2.e012122.1","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1001847","article-title":"The Mistreatment of women during childbirth in health facilities globally: A mixed-methods systematic review","volume":"12","author":"Bohren","year":"2015","journal-title":"PLoS 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WHO labour care guide: user\u2019s manual. Geneva Switzerland, 2021."},{"key":"2025073013544042000_5.Suppl_2.e012122.37","unstructured":"World Health Organization . WHO recommendations: Intrapartum care for a positive childbirth experience. 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