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While Canadian maternal mortality rates suggest widespread access to high-quality care, perinatal health care outcomes and care experiences among pregnant people in Canada vary widely, particularly among communities that have been historically oppressed, excluded, and marginalized. The lack of patient-oriented research and measurement in perinatal services led to the RESPCCT (Research Examining the Stories of Pregnancy and Childbirth in Canada Today) Study which used a community participatory action research (CPAR) approach to examine experiences of pregnancy and childbirth care. In this paper, we describe co-creation of a person-centered survey instrument that measures respect, disrespect and mistreatment during pregnancy-related care of individuals with diverse identities, backgrounds and circumstances. The study was co-led by a Community Steering Council alongside a multi-disciplinary group of researchers and clinicians, and pilot tested by service users from across Canada. The final survey instrument includes items that assess respectful care across 17 domains, including validated measures of autonomy, respect, mistreatment, trauma, and discrimination. It also captures information about respondents' identities, backgrounds, circumstances, access to care, provider type, and outcomes. A total of 6096 individuals participated in the survey. We describe how we implemented CPAR best practices, strengths, challenges, and lessons learned for instrument development in reproductive justice research.

AbstractAntenatal care is essential to promote maternal health. Prior research has focused on barriers women face to attending antenatal care, and improving quality of care is seen as a precondition for better attendance. Digital health tools are seen as a promising instrument to increase the quality of healthcare. It is less clear to what extent the use of digital health tools in low- and middle-income counties would be perceived as beneficial by end-users. The aim of this research was to explore women’s experiences with antenatal care, and whether digital health tools would change their perceptions of quality of care. This qualitative research utilised an interpretative phenomenological approach on data from semi-structured in-depth interviews collected in 2016 with 19 randomly selected pregnant women from six different dispensaries in Magu District. Findings showed that pregnant women are motivated to attend antenatal care and are grateful for the services received. However, they also articulated a need for improvements in antenatal care services such as the availability of diagnostic tests and more interactions with healthcare workers. Participants indicated that a digital health tool could help in storing patient files and improving communication with health workers. Our results indicate that pregnant women are positive about the use of digital health tools during antenatal care but that the implementation of such a tool should be implemented in parallel to structural service delivery improvements, such as testing availability.