Women’s perspectives of mistreatment during childbirth at health facilities in Ghana: findings from a qualitative study

Abstract

Mistreatment of women during childbirth at health facilities violates their human rights and autonomy and may be associated with preventable maternal and newborn mortality and morbidity. In this paper, we explore women's perspectives on mistreatment during facility-based childbirth as part of a bigger World Health Organization (WHO) multi-country study for developing consensus definitions, and validating indicators and tools for measuring the burden of the phenomenon. Focus group discussions (FGDs) and in-depth interviews (IDIs) were used to explore experiences of mistreatment from women who have ever given birth in a health facility in Koforidua and Nsawam, Ghana. Interviews were audio-recorded, transcribed and thematic analysis conducted. A total of 39 IDIs and 10 FGDs involving 110 women in total were conducted. The major types of mistreatment identified were: verbal abuse (shouting, insults, and derogatory remarks), physical abuse (pinching, slapping) and abandonment and lack of support. Mistreatment was commonly experienced during the second stage of labour, especially amongst adolescents. Inability to push well during the second stage, disobedience to instructions from birth attendants, and not bringing prescribed items for childbirth (mama kit) often preceded mistreatment. Most women indicated that slapping and pinching were acceptable means to "correct" disobedient behaviours and encourage pushing. Women may avoid giving birth in health facilities in the future because of their own experiences of mistreatment, or hearing about another woman's experience of mistreatment. Consensus definitions, validated indicators and tools for measuring mistreatment are needed to measure prevalence and identify drivers and potential entry points to minimise the phenomenon and improve respectful care during childbirth.

A qualitative study on acceptability of the mistreatment of women during childbirth in Myanmar

“…These findings on conditions where mistreatment may be acceptable are in accordance similar findings in West Africa (Guinea and Ghana) where these type of mistreatment behaviors were not acceptable for most women unless used to save the life of the woman [17,21]. Furthermore, in Nigeria and Ghana [19,21] some women and providers considered these mistreatment behaviors as appropriate and acceptable measures to gain compliance from the woman, correct perceived "disobediences", and ensure a good outcome for the baby. In our study, some scenarios were found to be more unacceptable for women when their emotions would be affected (feeling sad or angry); for example being shouted at or being refused help during labor.…”

“…The study used a mixedmethods design to understand and measure the mistreatment of women during childbirth in Myanmar, Nigeria, Ghana and Guinea. In the first phase, formative qualitative research was conducted to understand women's and providers' experiences and acceptability of mistreatment during childbirth [16][17][18][19][20][21]. The formative findings and systematic review [15] were used to inform the development of two measurement tools in the second phase (direct observations of labor and childbirth) and a community-based survey with women during the postpartum period in the same settings [22,23].…”

Promoting Respectful Maternity Care for Adolescents In Ghana: a Quasi-Experimental Research Study Protocol

“…The most reported forms of facility-based mistreatment which often occur in a continuum are categorized as physical abuse, non-consented care, non-con dential care, non-digni ed care, discrimination based on speci c patient attributes, abandonment of care, and detention in facilities 4 . Whilst intrapartum mistreatment traverses geographical boundaries and socio-economic levels, 1,2,[5][6][7] certain factions of women appear to bear a markedly high burden of the phenomenon [8][9][10] . As a group of interest, adolescent women appear disproportionately predisposed to disrespectful treatment attributable to their young age, lower educational attainment, lower socio-economic status, lack of autonomy, as well as provider and social prejudices about their engagement in pre-marital and early sex [11][12][13][14][15] .…”

Normative Beliefs and Values Shape Mother’s Care Seeking Behaviours for Skilled Birth Attendance (Sba) During Birthing in Africa: A Scoping Review Protocol

“…Health system factors that hinder care seeking for childbirth have been reported to include limited availability of healthcare workers, lack of equipment and supplies [5,6], and the attitude [7]and practices of health care workers,such as disrespectful and abusive care [8]. Individual level factors,such as the mother's age [9], marital status [10], level of education,economic status of the household [11,12], andcultural and religious beliefs [13][14][15][16] have also been reported as negative predictors to care seeking behaviours of mothers.The location of services available is another important contextual factor hindering utilisation of SBA for childbirth from the health facilities [17].…”