Measurement of violation of maternal integrity in childbirth: review from a multilevel perspective

Abstract Background Violation of maternal integrity (VMI) during childbirth is reported by women and observed by researchers globally. It has serious health consequences for the mother and the infant in the short and long-term. The terminology to capture VMI ranges from disrespect and abuse to mistreatment and obstetric violence. This variety of terms and concepts is reflected in a multitude of operationalisation and measurement strategies. Methods In a scoping review, we examined how VMI has been measured in quantitative studies. Using a theoretically informed framework differentiating between the macro, meso, and microlevel, we reflected on the dimensions of VMI included as items in measurement instruments and categorised them in the framework, aiming to highlight the dominantly chosen approaches to VMI as well as the still under-researched fields and perspectives on drivers, expressions and consequences of VMI. Results The majority of scales and surveys described in the studies concentrated on the interactional aspects of VMI, located on the microlevel (e.g. verbal abuse, neglect by care providers). Only a few studies dealt with meso-level factors potentially associated with VMI (e.g. staff shortage). Macro-level perspectives on health policies and legislation, gender equity or societal norms remained rare. Instruments used to measure VMI were very heterogeneous and therefore non-comparable with regard to the outcomes and prevalence of VMI. Conclusions There is a need to adopt a multilevel perspective to identify further expressions and effects of VMI. Furthermore, the role of macro-level, structural determinants should be investigated. Last, the use of compatible instruments is required to obtain comparable data on VMI nature and prevalence. Key messages Measurement instruments of VMI mainly cover interactional aspects of the phenomenon. The meso-, and macrolevel dimensions of VMI are under-researched. The heterogeneity of the instruments measuring VMI hinders comparison of the outcomes and their prevalence.