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

Abstract

Obstetric violence has been recognized as a major impediment to facility-based delivery, increasing the risk of preventable complications and maternal mortality. In Ghana, studies on women’s birth experiences reveal enormous and brutal acts of violence during delivery; however, inquiries into why midwives abuse women have not been extensively studied. This study explored the perspectives of midwives on the drivers of obstetric violence in the Western and Ashante Regions of Ghana. A qualitative study was conducted involving 30 in-depth interviews with midwives in eight health facilities. The data were analyzed thematically using NVivo 12. The results of the study reveal a normalization of violence in the delivery room and the intensity of violence is heightened during the second stage of labor. Midwives reported perpetrating or witnessing physical violence, abandonment of women, stigmatization of HIV women, verbal abuses such as shouting, and the detention of women in the health facilities. Midwives abuse women as a result of the pressures of the midwifery profession, poor maternal efforts of women, disrespect of midwives, women’s disobedience, and uncooperative attitudes. The culture of acceptability of obstetric violence is a major driver, contributing to its normalization. Midwives do not consider obstetric violence as abuse, but rather, as a delivery strategy which aids a successful delivery. It is therefore justified and viewed as a necessary part of the delivery process. There is a critical need for retraining midwives on alternative birthing strategies devoid of violence.

Abuse and humiliation in the delivery room: Prevalence and associated factors of obstetric violence in Ghana

“…Furthermore, our study also found that single women were about 60% more likely than married women to be abused during childbirth, revealing how gender constructions of marriage shape women's treatment. Marriage is considered a symbol of responsibility, honor and a prestigious identity for Ghanaian women ( 46 ), earning married women more respect in society with single mothers being perceived as irresponsible and somewhat sexually immoral. Our finding is consistent with Bohren et al ( 31 ) study on mistreatment during childbirth in Ghana, Guinea, Myanmar and Nigeria, where abuse was much higher among single mothers than married women.…”

Addressing obstetric violence: a scoping review of interventions in healthcare and their impact on maternal care quality

“…Obstetric violence as a concept is relatively new in the global health literature with researchers adopting various terminologies such as ‘disrespect and abuse (D&A),’ ‘mistreatment and abuse,’ ‘dehumanized childbirth,’ and ‘disrespectful maternity care’ to describe violence and abuse in obstetric care. While these terminologies help to clearly categorize the different manifestations of violence, the term ‘obstetric violence’ emphasizes the ‘structural dimensions as a gender-based violence that intersects with institutional violence’ ( 3 , 4 ). Nonetheless, all the terminologies acknowledge the harmful effects of violence, the dehumanization of childbirth and the violation of women’s rights and dignity.…”

“…In this study, we use the term ‘obstetric violence’ interchangeably with the other terminologies to cover vast literature. Obstetric violence could manifest in the form of physical violence, denial of birth companion, intimidation, forced medical care, neglect or abandonment, lack of confidentiality, failure to seek consent, unjustified cesarean sections, restrictions on food and mobility, and excessive use of oxytocin to induce labor ( 3 , 5–7 ). Women are often stripped of the agency to make decisions over their bodies, while some are subjected to dehumanizing treatments.…”

“…The psychological consequences of obstetric violence following childbirth include depression and post-traumatic stress disorder (PTSD) ( 24 ). The (anticipated) experience of obstetric violence prevents many women from utilizing facility-based services for childbirth ( 3 ). Violence during childbirth is the most cited reason for women’s refusal to reuse health facilities in subsequent pregnancies in Latin America ( 25 ).…”

Cultural Adaptation, Validation and Evaluation of the Psychometric Properties of an Obstetric Violence Scale in the Spanish Context

“…However, the prevalence figures vary largely in different countries [ 1 , 23 , 24 , 25 ]. Reported prevalence rates of mistreatment or abuse of women during labor range from 11% in Mexico [ 26 ] and 49.4% in Latin America [ 27 ] to more than 70% in some African countries [ 28 , 29 , 30 ]. High OV prevalence rates have also been reported in Europe [ 1 , 23 , 25 ].…”