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.
Highlights
IntroductionGlobal efforts to improve maternal health care include strategies to reduce maternal mortality, increase the proportion of births attended by a skilled provider, and ensure access to quality reproductive health services for all women.[1,2]
Global efforts to improve maternal health care include strategies to reduce maternal mortality, increase the proportion of births attended by a skilled provider, and ensure access to quality reproductive health services for all women.[1,2]This article has been republished with minor changes
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
Summary
Global efforts to improve maternal health care include strategies to reduce maternal mortality, increase the proportion of births attended by a skilled provider, and ensure access to quality reproductive health services for all women.[1,2]. This article has been republished with minor changes. These changes do not impact the academic content of the article. Addressing preventable maternal and newborn mortality and morbidity is a key component of the sustainable development goals.[1] there was a substantial reduction (43%) in maternal mortality from 1990 to 2015 globally, still 99% of maternal deaths occur in developing countries.[3]. Ghana has recorded improvements in its maternal health indicators, with a decline in the maternal mortality ratio from 634 in 1990 to 319 per 100,000 live births in 20153 while the rate of
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