Measuring the unknown: we need to measure all experiences important to women regarding their antenatal care

Implications for practice and research:• Outcome measures of maternity care are limited in scope to evaluating experiences of intrapartum care, and therefore may not capture women's experiences of care during the entire antenatal period • Research that explores aspects of antenatal care that are important to maternity service-users themselves would be beneficial to inform the development of instruments and measures to capture a broader range of antenatal care experiences. Context:Antenatal healthcare (ANC) is the care given to women by healthcare professionals throughout pregnancy to childbirth, which should commence in early pregnancy.This is the first opportunity for most mothers to encounter their healthcare 1 , and has the potential to support women to enjoy a "positive pregnancy" 2 .As such, high quality ANC has the potential to improve a woman's perception of motherhood, build trust prior to childbirth, and offer emotional and physical support.However, whilst the World Health Organization standards suggest maternity care should be free from mistreatment 3 , currently there is a concerning lack of measurement of women's experiences of ANC more broadly 4 . Methods:The authors conducted a scoping review to identify and evaluate the validity of instruments and measures of women's experiences of ANC.They categorised the instruments according to the WHO (2016) quality of care framework and other relevant literature.This conceptual framework comprised of four typologies: antenatal quality of care, person centred antenatal care, mistreatment of women during childbirth, and respectful maternity care.Each typology captured between 3 and 12 domains.A four-step process was followed where the authors 1) identified papers published or produced (but unpublished) between 2007-2023; 2) described instruments and measures of women's experiences of ANC; 3) mapped the measures to the conceptual framework and 4) discussed the gaps and opportunities for novel measures of women's experiences of ANC. Findings:The authors identified 36 articles, mainly from high income countries, with 591 measures of ANC.Half (292/591) of the measures mapped to women's experiences of care and were included in the scoping review; those examining clinical care were excluded.All included measures mapped to the 'mistreatment of women during childbirth' typology.The respectful maternity care typology had fewer measures (40/292 14%); with no measures identified for the remaining two typologies.The authors suggest that these findings can be used to inform monitoring of care using existing tools and development of future tools for ANC.