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Table 1 Construct map (matrix)

From: Study protocol for promoting respectful maternity care initiative to assess, measure and design interventions to reduce disrespect and abuse during childbirth in Kenya

Type of abuse Legal definition (where it exists) Observable element Examples
Physical abuse The right not to be subjected to cruel, inhuman, or degrading treatment   Pinching /Slapping/Pushing/Beating
Stitching episiotomy without anesthesia
FGM during labor/Re-stitching FGM scar
Rape/ Inappropriate touching during exam- genital/thighs
Non consented care Medical procedures that are performed without a client’s consent may constitute an actionable tort of “trespass” to the patient’s body. A woman’s right to information is respected Non explanation of medical procedures e. g Tubal Ligation, hysterectomy
“Staff take time to explain: procedures, diagnosis, progress, results, options”
“Information is given in an open and friendly manner”
“Clients are encouraged to ask questions”
Non dignified care The right to dignity: “Every individual shall have the right to the respect of the dignity inherent in a human being”. A woman’s right to dignity is respected Use of non dignified language/not addressed rudely “staff are polite and use appropriate language”
Threats e.g. if you do not cooperate I take you to theater
Failure to provide services due to personal values
A woman’s right to information is respected No explanation of the scope of services offered
No choice of gender of provider,
Not exposed unnecessarily
Un hygienic conditions: Bed sharing/No change of linen/Several babies sharing incubators/Mothers being asked to clean delivery couches/Dirty bathroom/toilets
Discrimination The right to be free from discrimination   Mothers record clearly marked HIV positive
Failure to provide medical procedures to HIV clients e.g. limit VE exam done
The rights to equality and non-discrimination Denial of services due to lack of money, poverty
Abandonment /neglect The right to health “Every woman has access to skilled attendance during delivery” Delay in receiving care after a decision has been made e.g. to perform C/S
The Penal Code provides that any person who renders medical or surgical treatment “in a manner so rash or negligent as to endanger human life or to be likely to cause harm to any other person” is guilty of an offence Failure to provide supplies even if the supplies are available
Failure to offer service even when the staffs are adequate on duty
Failure to examine clients/mothers according to the national guidelines even when the resources are available
Neglect post delivery
Detention The right to liberty and   When a woman is unable to pay if the baby is sick- welfare of the mother in the facility
security of person The right not to be detained for non -payment of debt “Payment for health care services, as well as services related to the underlying determinants of health, has to be based on the principle of equity, ensuring that these services, whether privately or publicly provided, are affordable for all, including socially disadvantaged groups.
Non confidential The right to privacy and family A woman’s right to privacy and confidentiality is respected “ history taking and examination is done in as much privacy as possible”
    “Staff actively protect women’s privacy /confidentiality”
    “Every woman is examined or attended to behind screens”
    “Staff do not discuss or disclose client information to non-health care staff”