Health workers’ and hospital administrators’ perspectives on mistreatment of women during facility-based childbirth: a multicenter qualitative study in Ghana

Abstract

Background Globally, mistreatment of women during facility-based childbirth continues to impact negatively on the quality of maternal healthcare provision and utilization. The views of health workers are vital in achieving comprehensive understanding of mistreatment of women, and to design evidence-based interventions to prevent it. We explored the perspectives of health workers and hospital administrators on mistreatment of women during childbirth to identify opportunity for improvement in the quality of maternal care in health facilities. Methods A qualitative study comprising in-depth interviews (IDIs) with 24 health workers and hospital administrators was conducted in two major towns (Koforidua and Nsawam) in the Eastern region of Ghana. The study was part of a formative mixed-methods project to develop an evidence-based definition, identification criteria and two tools for measuring mistreatment of women in facilities during childbirth. Data analysis was undertaken based on thematic content via the inductive analytic framework approach, using Nvivo version 12.6.0. Result Health workers and hospital administrators reported mixed feelings regarding the quality of care women receive. Almost all respondents were aware of mistreatment occurring during childbirth, describing physical and verbal abuse and denial of preferred birthing positions and companionship. Rationalizations for mistreatment included limited staff capacity, high workload, perceptions of women’s non-compliance and their attitudes towards staff. Health workers had mixed responses regarding the acceptability of mistreatment of women, although most argued against it. Increasing staff strength, number of health facilities, refresher training for health workers and adequate education of women about pregnancy and childbirth were suggestions to minimize such mistreatment. Conclusion Health workers indicated that some women are mistreated during birth in the study sites and provided various rationalizations for why this occurred. There is urgent need to motivate, retrain or otherwise encourage health workers to prevent mistreatment of women and promote respectful maternity care. Further research on implementation of evidence-based interventions could help mitigate mistreatment of women in health facilities.

Continuum of maternal health care services among peri-urban women- a community-based cross-sectional study in North India

“…19 approximately 90% of pregnant women receive four or more antenatal visits in Ghana. 20 NFHS-5 district (Aligarh) fact sheet reported 44.7% mothers had at least 4 ANC visits. 21 About 60 % women received at least one ANC by skilled health professionals, of them >80% had four or more ANC visits.…”

“…This study reported 73.5% coverage of institutional deliveries better than Ethiopia (14.4%), (71%) and (20.5%) but lesser than Aligarh (82.6%), Ghana (80%) and East Godavari district (86%). [19][20][21][24][25][26] Better uptake of INC was probably due to increase in awareness regarding safe delivery practices due to regular contact with health workers and provision of monetary incentive under JSY and free of cost facilities through JSSK.…”

Second Victims in Maternity Care – The Hidden Fallout of Parental Birth Plans

“…This is how things are. This is how they should be and how they would be if we simply allowed them to do so [9].…”

“We Beat Them to Help Them Push”: Midwives’ Perceptions on Obstetric Violence in the Ashante and Western Regions of Ghana

“…Other studies in Ghana have found obstetric violence to be highly pervasive in institutional deliveries with a prevalence rate of 83% and a significant enabler to women's use of unskilled birth attendants [16,[26][27][28][29]. The literature also reveals healthcare professionals are aware of the occurrence of obstetric violence and associate it with poor working conditions of caregivers [30,31]. Women have reported physical abuse, humiliation, verbal abuse, neglect, and sometimes detention in health facilities [16,25,26].…”