. 2021 Oct 1;18:194. doi: 10.1186/s12978-021-01241-5

Table 2.

Operationalization of categories of respectful care during childbirth, for frontline healthcare workers providing maternity care

Categories of respectful care during childbirth	Operationalization of the categories of respectful care during childbirth	References
Right to be free from harm (violence, torture, harmful practices) and ill treatment (physical, sexual and verbal abuse)	1. Doctors/nurses/midwives provide only medically-indicated, evidence-based interventions 2. Doctors/nurses/midwives avoid harmful practices, including: a. Overuse of interventions, drugs and technology, b. Unnecessary separation of mother and baby 3. Doctors/nurses/midwives protect their clients from individual and institutional violence so that no client is subjected to abuse or mistreatment, including: a. physical, b. sexual, or c. verbal 4. Doctors/nurses/midwives provide: a. Food and fluids to women in normal labor b. Encouragement for early breastfeeding, including skin-to-skin contact with baby, immediately postpartum 5. Doctors/nurses/midwives provide to women in labor and birth (to strengthen their capabilities): a. Pharmacological and b. Non-pharmacological pain relief options and supportive care	Reis et al. [36]; International Federation of Gynecology and Obstetrics and others. [27]; Rosen et al. [37]; Thompson et al. [38]; Warren [15]; Miller et al. [39]; Sheferaw et al. [40]; Sheferaw [41] ; World Health Organization [22]; Kujawski [42]; Oosthuizen [43]; Asefa [44]; Bohren [45]; Dynes [46]; Shakibazadeh [47]; Taavoni [48]; Wassihun [49]; World Health Organization [50]; Afulani [51, 52]; Giordano [53]; Oliveira [54]; Perkins [55]; Afulani [56]; Bante [57]; Bohren [58]; Butler [59]; Lothian [24]; Montoya [60]; Moridi [61]; Devries [62] Page [63] Wagner [64] GarciadeLimaParada [65] Behruzi [66] Behruzi [67] Behruzi [68] Binfa [69] Ouedraogo [70] ConesaFerrer [71] Binfa [72]
Right to dignity and respect	1. Doctors/nurses/midwives provide culturally competent care, including respect for beliefs, traditions and culture 2. Doctors/nurses/midwives treat every client with respect, including respect for their personhood, experiences, and feelings 3. Doctors/nurses/midwives treat each other and all other cadres of collaborating providers and staff with respect 4. Doctors/nurses/midwives communicate effectively with clients, by: a. Using language that is respectful and positive, b. Using language they can understand, c. Greeting and addressing women politely and by name, and d. Providing verbal support and encouragement 5. Doctors/nurses/midwives provide positive, supportive non-verbal communication to clients 6. Doctors/nurses/midwives demonstrate sensitivity and empathy for women and partners experiencing loss and bereavement	Reis et al. [36]; Warren et al. [73]; International Federation of Gynecology and Obstetrics and others. [27]; Rosen et al. [37]; Thompson et al. [38]; Warren [15]; Miller et al. [39]; Patel et al. [74]; Sheferaw et al. [40]; Solnes et al. [75]; World Health Organization [22]; Kambala [76]; Kujawski [42]; Ndwiga [77]; Oosthuizen [43]; Sheferaw [41]; Vedam et al. [78], Vedam et al. [79]; Asefa [44]; Bohren [45]; Dynes [46]; Shakibazadeh [47]; Taavoni [48]; Wassihun [49]; World Health Organization [50]; Afulani [51, 52, 80]; Feijen-deJong [81]; Giordano [53]; Oliveira [54]; Afulani [56]; Ayoubi [82]; Bante [57]; Bohren [58]; Butler [59]; Lothian [24]; Moridi [61]; Montoya [60]; Page [63] Jorge [83] Guimaraes [84] Behruzi [66] [68] Behruzi 2011 Binfa [69] Ouedraogo [70] ConesaFerrer [71] Binfa [72] Lokugamage [85]
Right to information, informed consent and refusal, and respect for choices and preferences, including the right to companionship of choice wherever possible	1. Doctors/nurses/midwives encourage and support women to: a. Move freely during labor and b. Assume the position of their choice for birth 2. Doctors/nurses/midwives offer women the option to experience labor and birth with the companion of their choice and involve their family members in care and decisions if desired 3. Doctors/nurses/midwives provide information to clients about their health and care options, including: a. What to expect during labor and birth,, postpartum and newborn care b. Information on proposed interventions, tests and treatments, and c. Any out-of-pocket costs of care to be provided 4. Doctors/nurses/midwives encourage clients to: a. Ask questions and b. Express opinions or concerns 5. Doctors/nurses/midwives: a. Provide honest and complete information, b .Involve clients in decision making about their care, c. Solicit consent for all interventions, and d. Respect choices including refusal of interventions	Reis et al. [36]; Warren et al. [73]; International Federation of Gynecology and Obstetrics and others. [27]; Rosen et al. [37]; Thompson et al. [38]; Warren [15]; Miller et al. [39]; Patel et al. [74]; Sheferaw et al. [40]; Solnes et al. [75]; World Health Organization [22]; Kambala [76]; Kujawski [42]; Ndwiga [77]; Oosthuizen [43]; Sheferaw [41]; Vedam et al. [78, 79]; Asefa [44]; Bohren [45]; Dynes [46]; Shakibazadeh [47]; Taavoni [48]; World Health Organization [50]; Afulani [51, 52, 80]; Feijen-deJong [81]; Giordano [53]; Perkins [55]; Afulani [56]; Ayoubi [82]; Bohren [58]; Butler [59]; Lothian [24]; Moridi [61]; Montoya [60]; Page [63] Wagner [64] Guimaraes [84] GarciadeLimaParada [65] Behruzi [66, 67] Behruzi [68] Binfa [69] Ouedraogo [70] ConesaFerrer [71] Binfa [72] Lokugamage [85]
Right to privacy and confidentiality	1. Doctors/nurses/midwives provide visual and auditory privacy to clients during labor and birth, e.g., by providing care in a private room, or using curtains, screens, or drapes, and limiting the people present to those clinically indicated or desired by the woman 2. Doctors/nurses/midwives keep patient information confidential and do not share patient information unless indicated for the provision of effective care	Warren et al. [73]; International Federation of Gynecology and Obstetrics and others. [27]; Rosen et al. [37]; Thompson et al. [38]; Miller et al. [39]; Patel et al. [74]; Solnes et al. [75]; World Health Organization [22]; Kambala [76]; Kujawski [42]; Ndwiga [77]; Vedam et al. [78, 79]; Asefa [44]; Bohren [45]; Dynes [46]; Shakibazadeh [47]; Taavoni [48]; World Health Organization [50]; Afulani [51, 52, 80]; Giordano [53]; Afulani [56]; [82] Ayoubi 2020; [24, 59–61] Butler; Lothian; Moridi; Montoya; Behruzi [67] Ouedraogo [70] ConesaFerrer [71]
Right to non-discrimination, equality and equitable care	1. Doctors/nurses/midwives adhere to policies on non-discrimination 2. Doctors/nurses/midwives treat every client with equal respect and dignity, regardless of any specific personal attributes, including but not limited: to age, wealth, class, education, race or ethnicity, religion, LGBTQ+ , HIV or other health status	Warren et al. [15, 73] International Federation of Gynecology and Obstetrics and others. [27]; Solnes et al. [75]; World Health Organization [22]; Vedam et al. [79] Shakibazadeh [47]; Afulani; Ayoubi; Bohren; Butler; Lothian [24, 56, 58, 59, 82] Moridi [61]
Right to timely healthcare and to the highest attainable level of health	1. Doctors/nurses/midwives provide prompt attention and are responsive to clients’ needs for: a. Medical care and b. Comfort care 2. Doctors/nurses/midwives ensure that every woman has a skilled attendant present at her birth 3. Doctors/nurses/midwives ensure that no client is neglected or denied needed care, regardless of ability to pay 4. Doctors/nurses/midwives ensure continuity of care by coordinating effectively across settings and between providers	Reis et al. [36]; Warren et al. [15, 73] International Federation of Gynecology and Obstetrics and others. [27]; Sheferaw et al. [40]; Solnes et al. [75]; Kambala; Kujawski; Ndwiga, Oosthuizen [42, 43, 76, 77]; Asefa; Bohren; Dynes; Shakibazadeh; Taavoni; Wassihun; World Health Organization [44–50]; Afulani; Afulani; Ayoubi; Bante; Butler; Lothian; Moridi; [24, 52, 56, 57, 59, 61, 80, 82] Behruzi [68] Ouedraogo [70] Binfa [72]
Right to liberty, autonomy, self-determination, and freedom from coercion	1. Doctors/nurses/midwives do not illegally detain or physically restrain clients in the facility for any reason, including inability to pay 2. Doctors/nurses/midwives do not prevent clients from seeing or holding their babies for any reason, including inability to pay	Reis et al. [36]; International Federation of Gynecology and Obstetrics and others. [27]; World Health Organization [22]; Ndwiga [77] Taavoni [48]; Afulani [56]; Lothian [24];

Categories of respectful care during childbirth

Operationalization of the categories of respectful care during childbirth

References

Right to be free from harm (violence, torture, harmful practices) and ill treatment (physical, sexual and verbal abuse)

1. Doctors/nurses/midwives provide only medically-indicated, evidence-based interventions

2. Doctors/nurses/midwives avoid harmful practices, including:

a. Overuse of interventions, drugs and technology,

b. Unnecessary separation of mother and baby

3. Doctors/nurses/midwives protect their clients from individual and institutional violence so that no client is subjected to abuse or mistreatment, including:

a. physical,

b. sexual, or

c. verbal

4. Doctors/nurses/midwives provide:

a. Food and fluids to women in normal labor

b. Encouragement for early breastfeeding, including skin-to-skin contact with baby, immediately postpartum

5. Doctors/nurses/midwives provide to women in labor and birth (to strengthen their capabilities):

a. Pharmacological and

b. Non-pharmacological pain relief options and supportive care

Reis et al. [36];

International Federation of Gynecology and Obstetrics and others. [27];

Rosen et al. [37];

Thompson et al. [38];

Warren [15];

Miller et al. [39];

Sheferaw et al. [40];

Sheferaw [41] ;

World Health Organization [22]; Kujawski [42];

Oosthuizen [43];

Asefa [44];

Bohren [45];

Dynes [46];

Shakibazadeh [47];

Taavoni [48]; Wassihun [49];

World Health Organization [50];

Afulani [51, 52];

Giordano [53];

Oliveira [54];

Perkins [55];

Afulani [56];

Bante [57];

Bohren [58];

Butler [59];

Lothian [24];

Montoya [60];

Moridi [61];

Devries [62]

Page [63]

Wagner [64]

GarciadeLimaParada [65]

Behruzi [66]

Behruzi [67]

Behruzi [68]

Binfa [69]

Ouedraogo [70]

ConesaFerrer [71]

Binfa [72]

Right to dignity and respect

1. Doctors/nurses/midwives provide culturally competent care, including respect for beliefs, traditions and culture

2. Doctors/nurses/midwives treat every client with respect, including respect for their personhood, experiences, and feelings

3. Doctors/nurses/midwives treat each other and all other cadres of collaborating providers and staff with respect

4. Doctors/nurses/midwives communicate effectively with clients, by:

a. Using language that is respectful and positive,

b. Using language they can understand,

c. Greeting and addressing women politely and by name, and

d. Providing verbal support and encouragement

5. Doctors/nurses/midwives provide positive, supportive non-verbal communication to clients

6. Doctors/nurses/midwives demonstrate sensitivity and empathy for women and partners experiencing loss and bereavement

Reis et al. [36];

Warren et al. [73];

International Federation of Gynecology and Obstetrics and others. [27];

Rosen et al. [37];

Thompson et al. [38];

Warren [15];

Miller et al. [39];

Patel et al. [74];

Sheferaw et al. [40];

Solnes et al. [75];

World Health Organization [22];

Kambala [76];

Kujawski [42];

Ndwiga [77];

Oosthuizen [43];

Sheferaw [41];

Vedam et al. [78],

Vedam et al. [79];

Asefa [44];

Bohren [45];

Dynes [46];

Shakibazadeh [47];

Taavoni [48];

Wassihun [49];

World Health Organization [50];

Afulani [51, 52, 80];

Feijen-deJong [81];

Giordano [53];

Oliveira [54];

Afulani [56];

Ayoubi [82];

Bante [57];

Bohren [58];

Butler [59];

Lothian [24];

Moridi [61];

Montoya [60];

Page [63]

Jorge [83]

Guimaraes [84]

Behruzi [66]

[68] Behruzi 2011

Binfa [69]

Ouedraogo [70]

ConesaFerrer [71]

Binfa [72]

Lokugamage [85]

Right to information, informed consent and refusal, and respect for choices and preferences, including the right to companionship of choice wherever possible

1. Doctors/nurses/midwives encourage and support women to:

a. Move freely during labor and

b. Assume the position of their choice for birth

2. Doctors/nurses/midwives offer women the option to experience labor and birth with the companion of their choice and involve their family members in care and decisions if desired

3. Doctors/nurses/midwives provide information to clients about their health and care options, including:

a. What to expect during labor and birth,, postpartum and newborn care

b. Information on proposed interventions, tests and treatments, and

c. Any out-of-pocket costs of care to be provided

4. Doctors/nurses/midwives encourage clients to:

a. Ask questions and

b. Express opinions or concerns

5. Doctors/nurses/midwives:

a. Provide honest and complete information,

b .Involve clients in decision making about their care,

c. Solicit consent for all interventions, and

d. Respect choices including refusal of interventions

Reis et al. [36];

Warren et al. [73];

International Federation of Gynecology and Obstetrics and others. [27];

Rosen et al. [37]; Thompson et al. [38];

Warren [15];

Miller et al. [39];

Patel et al. [74];

Sheferaw et al. [40];

Solnes et al. [75];

World Health Organization [22];

Kambala [76];

Kujawski [42];

Ndwiga [77];

Oosthuizen [43];

Sheferaw [41];

Vedam et al. [78, 79];

Asefa [44];

Bohren [45];

Dynes [46];

Shakibazadeh [47];

Taavoni [48];

World Health Organization [50];

Afulani [51, 52, 80];

Feijen-deJong [81];

Giordano [53];

Perkins [55]; Afulani [56];

Ayoubi [82];

Bohren [58];

Butler [59];

Lothian [24];

Moridi [61];

Montoya [60];

Page [63]

Wagner [64]

Guimaraes [84]

GarciadeLimaParada [65]

Behruzi [66, 67]

Behruzi [68]

Binfa [69]

Ouedraogo [70]

ConesaFerrer [71]

Binfa [72]

Lokugamage [85]

Right to privacy and confidentiality

1. Doctors/nurses/midwives provide visual and auditory privacy to clients during labor and birth, e.g., by providing care in a private room, or using curtains, screens, or drapes, and limiting the people present to those clinically indicated or desired by the woman

2. Doctors/nurses/midwives keep patient information confidential and do not share patient information unless indicated for the provision of effective care

Warren et al. [73];

International Federation of Gynecology and Obstetrics and others. [27];

Rosen et al. [37];

Thompson et al. [38];

Miller et al. [39];

Patel et al. [74];

Solnes et al. [75];

World Health Organization [22];

Kambala [76];

Kujawski [42];

Ndwiga [77];

Vedam et al. [78, 79];

Asefa [44];

Bohren [45];

Dynes [46];

Shakibazadeh [47];

Taavoni [48];

World Health Organization [50];

Afulani [51, 52, 80];

Giordano [53];

Afulani [56];

[82] Ayoubi 2020;

[24, 59–61] Butler; Lothian; Moridi; Montoya;

Behruzi [67]

Ouedraogo [70]

ConesaFerrer [71]

Right to non-discrimination, equality and equitable care

1. Doctors/nurses/midwives adhere to policies on non-discrimination

2. Doctors/nurses/midwives treat every client with equal respect and dignity, regardless of any specific personal attributes, including but not limited: to age, wealth, class, education, race or ethnicity, religion, LGBTQ+ , HIV or other health status

Warren et al. [15, 73]

International Federation of Gynecology and Obstetrics and others. [27];

Solnes et al. [75];

World Health Organization [22];

Vedam et al. [79]

Shakibazadeh [47];

Afulani; Ayoubi; Bohren; Butler; Lothian [24, 56, 58, 59, 82]

Moridi [61]

Right to timely healthcare and to the highest attainable level of health

1. Doctors/nurses/midwives provide prompt attention and are responsive to clients’ needs for:

a. Medical care and

b. Comfort care

2. Doctors/nurses/midwives ensure that every woman has a skilled attendant present at her birth

3. Doctors/nurses/midwives ensure that no client is neglected or denied needed care, regardless of ability to pay

4. Doctors/nurses/midwives ensure continuity of care by coordinating effectively across settings and between providers

Reis et al. [36];

Warren et al. [15, 73]

International Federation of Gynecology and Obstetrics and others. [27];

Sheferaw et al. [40];

Solnes et al. [75];

Kambala; Kujawski; Ndwiga, Oosthuizen [42, 43, 76, 77];

Asefa; Bohren; Dynes; Shakibazadeh; Taavoni; Wassihun; World Health Organization [44–50];

Afulani; Afulani; Ayoubi; Bante; Butler; Lothian; Moridi; [24, 52, 56, 57, 59, 61, 80, 82]

Behruzi [68]

Ouedraogo [70]

Binfa [72]

Right to liberty, autonomy, self-determination, and freedom from coercion

1. Doctors/nurses/midwives do not illegally detain or physically restrain clients in the facility for any reason, including inability to pay

2. Doctors/nurses/midwives do not prevent clients from seeing or holding their babies for any reason, including inability to pay

Reis et al. [36];

International Federation of Gynecology and Obstetrics and others. [27];

World Health Organization [22];

Ndwiga [77]

Taavoni [48];

Afulani [56];

Lothian [24];