Titelaufnahme

With this critical review, we aim to describe and synthesize different conceptual lenses and measurement approaches used to assess maternity care conditions and maternity care provision (MCCP), birth experiences and perceptions of birth (BEP) in epidemiological, quantitative research studies (e.g., disrespect and abuse during in maternity care, obstetric violence, maternal satisfaction, mistreatment during facility-based childbirth, person-centered care, childbirth experiences). On the 82 studies included, we conduct a meta-ethnography (ME) using reciprocal translation, in-line argumentation, and higher-level synthesis to propose the birth integrity concept and multilevel framework. We perform ME steps for the conceptual level and the measurement level. At the conceptual level, and to determine the relationship between studies, we first organize the studies according to the similarity of approaches into conceptual clusters and derive key concepts (definitions) for each cluster. Then, we ‘translate’ the study clusters into one another by elaborating each approaches’ specific angle and pointing out the affinities and differences between the clusters. Finally, we present an in-line argumentation that prepares ground for the synthesis by identifying three components of measures (determinants, and subjective and objective outcome measures). At the measurement level, we first identify themes from the items used to measure MCCP and BEP. Second, we organize the themes into 14 categories and further differentiate in dimension and subdimensions. Finally, we synthesize our result from the analysis at the conceptual and measurement levels by introducing the birth integrity conceptual model and multilevel framework of birth integrity determinants. The macro-to-micro level birth integrity six-field framework is a tool to analytically distinguish between the complex and interwoven contributing factors that can influence the birth situation as such and the integrity of those who give birth. It can guide the development of survey instruments, qualitative interviews, interventional studies, or mixed method studies.