**1. Introduction**

Worldwide, a growing body of research suggests that, many women experience poor treatment during childbirth [1–4]. While the WHO [5] continues to emphasise that every woman has the right to the highest attainable standard of health, which includes the right to dignified and respectful healthcare, many women are reported to experience disrespectful and abusive treatment during pregnancy and childbirth in health facilities worldwide [1–4]. Such mistreatment includes physical abuse, non-consented care, non-confidential care, non-dignified care including verbal abuse, discrimination based on specific attributes, abandonment of care and detention in health facilities [1–4].

The study reported in this chapter was therefore undertaken to respond to the WHO's call for greater research on the topic of mistreatment of women during childbirth. Specifically, the objective was to determine the prevalence and forms of mistreatment of women by midwives during childbirth and associated factors. Results, which are presented and discussed below, suggest that mistreatment of childbearing women in health facilities is indeed an important issue in contemporary midwifery and nursing care in Ghana that needs to be urgently

Mistreatment of Women in Health Facilities by Midwives during Childbirth in Ghana: Prevalence…

http://dx.doi.org/10.5772/intechopen.82432

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The rest of the chapter proceeds as follows. The empirical research methods are next described. Results are then presented, followed by a discussion of the results. The final section concludes

A health facility-based retrospective cross-sectional quantitative survey was conducted. Validated survey questionnaires were used to collect data to estimate the prevalence of mistreatments women received during their most recent childbirth, and also determine the association between various exposure variables and the outcome of interest—mistreatment.

Empirical research was conducted in Ghana, a low-income country in West Africa. Ghana is one of the countries in Africa where maternal mortality remains a challenge. For instance, out of 5247 deaths among women aged 15–49 in 2014, 12.1% (634) were pregnancy-related [4]. Low levels of health facility delivery are partly responsible for this relatively high number of maternal deaths [11, 12]. Recent data suggest that out of 794,000 live births annually in Ghana, only 76% are attended by skilled professionals [14]. Despite the fact that the Government of Ghana has implemented initiatives to increase facility-based delivery, including making antenatal care and skilled delivery free [15], giving special attention to pregnant women to easily complete the processes of the National Health Insurance Scheme (NHIS) registration and waiving enrolment fees into the NHIS, as well as scaling up safe motherhood and child survival interventions [16], many women in Ghana still give birth outside health facilities without skilled care [14]. Recent studies have suggested poor quality of maternal healthcare services and mistreatment of women as key reasons why some women in Ghana do not

Within Ghana, empirical data collection took place in the Tema General Hospital in the Tema Metropolis of the Greater Accra region. The population of the Tema Metropolis, according to the 2010 Population and Housing Census, is 292,773, representing 7.3% of the region's total population [17]. Females represent 52.2% of the total population of the metropolis. Also,

addressed.

with some recommendations.

**2. Materials and methods**

deliver in health facilities [4, 11, 12].

**2.1. Study design**

**2.2. Study setting**

Mistreatment of women in health facilities during childbirth is particularly worse in many low-income countries in Africa [6, 7]. For instance, a recent study showed that the prevalence of any form of mistreatment in an exit survey among a sample of 641 women who recently delivered in healthcare facilities in Kenya was 20% [8]. Another study revealed that 15% of women who delivered in a referral hospital in Tanzania reported experiencing one or more forms of abusive and disrespectful care, and this proportion reached to 78% among women who delivered in healthcare facilities in Ethiopia [2]. A systematic review also mentions in southeastern Nigeria that mistreatment of women in a teaching hospital was almost universal such that all of the women reported at least one kind of mistreatment during childbirth [9]. Women commonly reported physical abuse (35.7%), including being "restrained or tied down during labour" (17.3%) and being "beaten, slapped, or pinched" (7.2%); while being "sexually abused by a health worker" was reported by 2.0% of the women [9]. Similarly, a qualitative study exploring mistreatment of women in rural Tanzania estimated that 19.5% of women who reported experiencing any form of mistreatment during childbirth in the facility increased to 28.2% during a follow up survey of same women within 5–10 weeks postpartum [10]. Some 18.9% of the women reported receiving non-dignified care; 13.8% reported being abused verbally; 15.5% reported being neglected; and 5.1% reported being abused physically [10]. In Ghana, previous qualitative research has also documented that mistreatment during facility-based delivery is a salient issue, that sometimes prevent women from seeking skilled birth services [4, 11, 12].

Given the potential for mistreatment during childbirth to undermine future use of skilled birth services in health facilities, the WHO [5] has called for greater research, action, advocacy and dialogue on this important public health issue, in order to ensure safe, timely, and respectful care during childbirth for all women. Likewise, respectful care is a key component of both the mother-baby friendly birth facility initiative currently being implemented in many low-income settings, and the WHO's vision for quality of care for childbearing women and newborns [5]. To date, however, there have been few quantitative estimates of the prevalence of mistreatment of women during facility-based childbirth in Ghana and the determinants of such mistreatment [4, 13]. This knowledge gap could potentially hamper efforts to ensure that all women receive respectful and dignified care during pregnancy and childbirth in Ghana. The study reported in this chapter was therefore undertaken to respond to the WHO's call for greater research on the topic of mistreatment of women during childbirth. Specifically, the objective was to determine the prevalence and forms of mistreatment of women by midwives during childbirth and associated factors. Results, which are presented and discussed below, suggest that mistreatment of childbearing women in health facilities is indeed an important issue in contemporary midwifery and nursing care in Ghana that needs to be urgently addressed.

The rest of the chapter proceeds as follows. The empirical research methods are next described. Results are then presented, followed by a discussion of the results. The final section concludes with some recommendations.
