Disrespect, Abuse and Psychological Consequences of Facility-based Childbirth in Northern Ghana: Evidence from a Cross-Sectional Study

Abstract

Introduction: Disrespect and abuse while giving birth in health facilities undermines the basic maternal health care women deserve and builds distrust in health systems. Although access to skilled birth attendance has improved, many women report maltreatment and even abuse during child birth. This maltreatment includes care without consent, inadequate privacy, discriminatory, and neglectful treatment, and even detention in the facilities. Purpose: The main purpose of the study was to assess the prevalence and forms of disrespect and abuse experienced by women during facility-based childbirth in Northern Ghana. Method: This study took place in the Northern Region of Ghana. It focused on five hospitals in the area: The Northern Regional Hospital, Tamale West Hospital, Tamale Teaching Hospital, The Seventh-Day Adventist (SDA) Hospital and the Sevelugu Municipal Hospital. The research used a descriptive, cross-sectional design with a quantitative approach to collect data from mothers who had recently delivered and were receiving postnatal care from these hospitals. The target population for the study was mothers receiving postnatal care from of the five selected hospitals, with a total sample size of 1,347 participants from March 2024 to May, 2024. A probability sampling method was used to ensure each mother had an equal chance of being selected for the study. After data collection, all data was cleaned, coded and entered into the IBM Statistical Package For Social Science (SPSS) version 27, for the purpose of analysis. Results: The extensive disrespect and abuse experienced by women during facility-based childbirth indicates the need for immediate improvement in maternity care. Around 48% of women reported having been physically abused during their labour or delivery, and approximately 52.3% stated they were verbally abused or humiliated. Almost 66.0% of the women reported being subjected to medical procedures without being given prior informed consent (i.e., serious violations of their autonomy and bodily integrity) and numerous women reported being detained or imprisoned in a health facility as a result of their inability to pay for health services. Additionally, these women frequently expressed feelings of helplessness and anger and fear of retaliation from healthcare providers, and most reported experiencing significant levels of psychological distress (including depression and anxiety) related to the aforementioned issues. When experiencing difficulty related to payment, many women also stated that they had been threatened with abandonment by healthcare providers. In sum, these findings demonstrate that the physical disrespect and abuse suffered during childbirth has had a significant negative impact on women's mental health, maternal identity and future healthcare-seeking behaviour, thereby necessitating large-scale reform of maternity care to ensure accountability and respect for women during childbirth. Conclusion: Collectively, the results highlight the urgent need to reposition respectful maternity care as a central component of quality obstetric services in Northern Ghana. therefore, there is an urgent need for health system–level reforms to address disrespect and abuse during childbirth.