**Conflict of interest**

thus far in many countries in Africa has clear implications for midwifery and future research. First, we think our findings provide a basis for large-scale further quantitative and qualitative studies in different contexts in Ghana and in other African countries to estimate the prevalence and forms of mistreatment of women during childbirth, identify important determinants, and explore detailed contextual, structural and personal level explanatory factors as well as relevant remedial policy options and interventions. Second, and beyond this proposed research agenda, we think the time has come for this evidence to be taken up more seriously not just by individual countries like Ghana or health facilities like the Tema General Hospital, but also by midwifery training institutions and professional bodies in different African countries such as the Ghana College of Nurses and Midwives and the West African College of Nurses and Midwives. In addition to a need for critical self-reflection and professional re-orientation of the practice of contemporary nursing and midwifery care within these training institutions and professional organisations to uphold human rights and patient dignity, there should also be professional ethics training for midwives as part of both the core curriculum for training midwives and routine in-service or on-the-job training. This training could also include

patient-centred care and interpersonal communication and relationships building.

detention after birth, which contributes to mistreatment.

**Acknowledgements**

82 Selected Topics in Midwifery Care

Given that women who experience mistreatments from healthcare providers are less likely to go to the health facility again during future pregnancy and childbirth, our results also have specific practical implications for the Ghana Health Service more generally, and the Tema General Hospital more specifically. It is important that interventions are put in place to train service providers in patient-centred care and interpersonal communication and relationships so as to minimise mistreatment. Specifically, the Tema General Hospital, together with the Ghana Health Service (GHS), and the Ministry of Health (MoH) should strengthen education of both patients and healthcare providers on patients' rights and responsibilities under the Patients' Charter, and to establish reporting mechanisms in the hospital so that women who suffer unjust mistreatments during childbirth could feel free to report and be responded to appropriately. A sanctions regime, including temporary suspension and total dismissal from work, should also be considered in this regard to deter healthcare providers who unjustifiably mistreat women. Before the above recommendations are implemented however, we recommend expansion in health infrastructure especially in urban areas as well as increasing the human resource base especially the number of midwives so as to reduce work overload and overwork. Finally, there is a need for both public and private sector health facilities that provide maternity care to women to liaise with the GHS and the MoH to ensure that the free maternal health benefit package under the NHIS is comprehensive and covers all women in order to eliminate all informal payments. Also, sanctions should be meted out to healthcare providers who charge unofficial fees. This could help reduce the phenomenon of maternity

This manuscript was first drafted when the first author (JKG) was a Fellow at the Stellenbosch Institute for Advanced Study (STIAS), Stellenbosch University, South Africa. Writing space for the manuscript was graciously provided by STIAS. We are grateful for this support.

The authors declare that they have no conflict of interest.
