The Mothers on Respect (MOR) index: measuring quality, safety, and human rights in childbirth

Saraswathi Vedam; Kathrin Stoll; Nicholas Rubashkin; Kelsey Martin; Zoe Miller-Vedam; Hermine Hayes-Klein; Ganga Jolicoeur; CCinBC Steering Council

doi:10.1016/j.ssmph.2017.01.005

The Mothers on Respect (MOR) index: measuring quality, safety, and human rights in childbirth

SSM Popul Health. 2017 Jan 19:3:201-210. doi: 10.1016/j.ssmph.2017.01.005. eCollection 2017 Dec.

Authors

Saraswathi Vedam¹, Kathrin Stoll², Nicholas Rubashkin^{3

4}, Kelsey Martin¹, Zoe Miller-Vedam⁵, Hermine Hayes-Klein⁵, Ganga Jolicoeur⁶; CCinBC Steering Council

Affiliations

¹ Birth Place Research Lab, Division of Midwifery, University of British Columbia, 5950 University Boulevard, Vancouver, BC, Canada V6T 1Z3.
² School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada V6T 1Z3.
³ Department of Global Health Sciences, University of California San Francisco, Mission Hall Building, 550 - 16th Street, 3rd Floor, San Francisco, CA 94158, USA.
⁴ Department of Obstetrics and Gynecology, University of California San Francisco, Mission Hall Building, 550 - 16th Street, 3rd Floor, San Francisco, CA 94158, USA.
⁵ Human Rights in Childbirth, 6312 SW Capitol Highway St, 234 Portland, OR 97239, USA.
⁶ Midwives Association of British Columbia, 2-175 E. 15th Avenue, Vancouver, BC, Canada V5T 2P6.

Abstract

Background: Abuse of human rights in childbirth are documented in low, middle and high resource countries. A systematic review across 34 countries by the WHO Research Group on the Treatment of Women During Childbirth concluded that there is no consensus at a global level on how disrespectful maternity care is measured. In British Columbia, a community-led participatory action research team developed a survey tool that assesses women's experiences with maternity care, including disrespect and discrimination.

Methods: A cross-sectional survey was completed by women of childbearing age from diverse communities across British Columbia. Several items (31/130) assessed characteristics of their communication with care providers. We assessed the psychometric properties of two versions of a scale (7 and 14 items), among women who described experiences with a single maternity provider (n=2514 experiences among 1672 women). We also calculated the proportion and selected characteristics of women who scored in the bottom 10th percentile (those who experienced the least respectful care).

Results: To demonstrate replicability, we report psychometric results separately for three samples of women (S1 and S2) (n=2271), (S3, n=1613). Analysis of item-to-total correlations and factor loadings indicated a single construct 14-item scale, which we named the Mothers on Respect index (MORi). Items in MORi assess the nature of respectful patient-provider interactions and their impact on a person's sense of comfort, behavior, and perceptions of racism or discrimination. The scale exhibited good internal consistency reliability. MORi- scores among these samples differed by socio-demographic profile, health status, experience with interventions and mode of birth, planned and actual place of birth, and type of provider.

Conclusion: The MOR index is a reliable, patient-informed quality and safety indicator that can be applied across jurisdictions to assess the nature of provider-patient relationships, and access to person-centered maternity care.

Keywords: Childbirth; Human rights; Participatory research; Provider–patient communication; Psychometrics; Respectful maternity care; Scale development; Survey research.