New paper: Abuse and humiliation in the delivery room: Obstetric violence in Ghana

Link to paper
 

Background: Obstetric violence, conceptualized as the abuse and mistreatment of women during pregnancy and delivery has been recognized as a threat to women’s reproductive health. It is a major barrier to women's use of health facilities, increasing the risk of preventable complications and maternal mortality. Obstetric violence is particularly humiliating, reducing women’s autonomy over their bodies and the reproductive process. Although the phenomenon is gaining worldwide attention, there is yet limited evidence of the depths and dynamics of obstetric violence in Ghana where maternal mortality is excessively high and skilled birthing is on a decline.

Significance: Against this background, this paper presents a facility-based, cross-sectional study of the prevalence of obstetric violence (OV) and its associated factors in the Ashanti and Western Regions of Ghana. What is the magnitude of obstetric violence in Ghana? How does obstetric violence manifest in Ghana and which categories of women are more vulnerable to abuse? Why do healthcare professionals abuse women? How is obstetric violence perceived by healthcare workers? Does gender inequality within health systems contribute to women’s experiences of abuse? 

Methodology: A facility-based cross-sectional survey was conducted in eight public health facilities from September to December 2021. Specifically, close-ended questionnaires were administered to 1,854 women, aged 15-45 who gave birth in the health facilities. The data collected include the sociodemographic attributes of women, their obstetric history and experiences of OV based on the seven typologies according to the categorization by Bowser and Hills.

Findings: We find that about two in every three women (65.3%) experience OV. The most common form of OV is non-confidential care (35.8%), followed by abandoned care (33.4%), non-dignified care (28.5%) and physical abuse (27.4%). Furthermore, 7.7% of women were detained in health facilities for their inability to pay their bills, 7.5% received non-consented care while 11.0% reported discriminated care. A test for associated factors of OV yielded few results. Single women (OR 1.6, 95% CI 1.2-2.2) and women who reported birth complications (OR 3.2, 95% CI 2.4-4.3) were more likely to experience OV compared with married women and women who had no birth complications. In addition, teenage mothers (OR 2.6, 95% CI 1.5-4.5) were more likely to experience physical abuse compared to older mothers. Rural vs. urban location, employment status, gender of birth attendant, type of delivery, time of delivery, the ethnicity of the mothers and their social class were all not statistically significant.

Conclusion: The prevalence of OV in the Ashanti and Western Regions was high and only few variables were strongly associated with OV, suggesting that all women are at risk of abuse. Interventions should aim at promoting alternative birth strategies devoid of violence and changing the organizational culture of violence embedded in the obstetric care in Ghana.

Abena Asefuaba Yalley, Dare Abioye, Seth Christopher Yaw Appiah and Anke Hoeffler. Front. in Public Health 2023 (11). DOI.