Abuse and humiliation in the delivery room: Prevalence and associated factors of obstetric violence in Ghana

Global prevalence and risk factors of obstetric violence: A systematic review and meta-analysis

BACKGROUND

Obstetric violence (OBV), defined as mistreatment or abuse during childbirth, is a pervasive global issue, albeit with regional differences, affecting women's physical and emotional well-being.

OBJECTIVES

The purpose of this systematic review and meta-analysis is to assess the prevalence of OBV to identify risk factors associated with OBV and to make suggestions for improving maternal healthcare practices and policies.

SEARCH STRATEGY

In a systematic review and meta-analysis, we searched four electronic databases for studies published over 10 years up to 31 January 2024: Medline (PubMed), Scopus, Embase, and Web of Science (WOS). The search was conducted among English language papers using a carefully curated set of keywords.

SELECTION CRITERIA

We conducted a comprehensive review, including all observational reporting data on the prevalence of and risk factors associated with OBV, irrespective of geographical location. The studies included in the review were required to be published in peer-reviewed. journals and available in the English language.

DATA COLLECTION AND ANALYSIS

The data of the studies were summarized in an Excel file (version 19) and analyzed using R (version 4.2.3). A meta-analysis was performed to evaluate the pooled prevalence of and identify risk factors associated with OBV.

MAIN RESULTS

The global prevalence of OBV estimated based on 25 studies, calculated with a random-effects model, was 59% (95% confidence interval [CI] 0.48-0.70; I2 = 99.5%). The most prevalent subdomain of OBV was non-consented care (37%; 95% CI 0.23-0.50; I2 = 99.7%). The following factors were found to be significantly associated with OBV: the presence of a midwife as skilled personnel beside the woman during childbirth (odds ratio [OR] [95% CI] = 0.4 [0.2-0.9]), which might reduce the likelihood of OBV; middle and high levels of income (OR [95% CI] = 0.5 [0.2-0.7]), which might also reduce the likelihood of OBV; and vaginal delivery (OR [95% CI] = 2.08 [1.1-3.08]), which is liable to increase the likelihood of OBV.

CONCLUSION

This systematic review and meta-analysis highlights the considerable prevalence and multifaceted nature of OBV, underscoring the urgent need for interventions at multiple levels to address this pervasive issue and ensure respectful, safe, and dignified maternal healthcare for all women.

"It shows that I belong": a qualitative study assessing birth companionship of choice in a maternity clinic in Freetown, Sierra Leone

BACKGROUND

Despite existing evidence supporting birth companionship of choice as a simple, low-cost measure to improve quality of care in childbirth, it is inconsistently practiced in many regions. In Sierra Leone, one of the least safe countries for women to deliver a baby, Princess Christian Maternity Hospital (PCMH) began encouraging companionship of choice for women during childbirth in March 2022. However, little is known about the perspectives of healthcare workers or the perinatal experiences of women and their companions. Our objective was to describe the experiences and perceptions surrounding birth companionship of choice among healthcare workers, women, and their companions.

METHODS

We conducted a qualitative assessment at PCMH in August 2022 through eleven focus group discussions and thirteen in-depth interviews with healthcare workers, women, and their companions. Discussions and interviews were recorded, transcribed, and thematically coded for analysis.

RESULTS

Women described various means of support from their birth companion and cited trust and the ability to provide expertise as key criteria when choosing a companion. Healthcare workers emphasized that, despite initial hesitation, companionship has been advantageous. However, there were still many challenges for healthcare workers when companions were present in the labor ward, such as maintaining patient privacy. Companions revealed that they were learning about facility-based delivery through companionship and sharing their positive experiences with their community. With a few exceptions, both companions and women reported overall satisfaction with their treatment in the labor ward.

CONCLUSION

Findings suggest that birth companionship of choice is a key component of a positive birth experience, improving perceived quality of care and potentially increasing the number of women giving birth in facilities. It also presents many advantages and challenges for healthcare workers. The presence of a birth companion inside the labor ward increases appreciation for facility-based care and potentially alleviates mistrust between the healthcare system and the community.

Effect of person-centered intervention on women's knowledge and attitude towards obstetric violence during facility childbirth in southwest Ethiopia: a quasi-experimental study

BACKGROUND

Obstetric violence (OV) constitutes a serious violation of women's rights and represents a form of gender-based violence. This abuse not only undermines women's dignity but also poses significant risks to their health and overall well-being. Many women lack awareness of their rights during childbirth, and this gap in knowledge, coupled with unfavorable attitudes toward the issue, allows obstetric violence to persist and become entrenched within healthcare systems. The normalization of such behavior among both healthcare providers and women themselves further exacerbates the prevalence of obstetric violence. A review of existing literature reveals a notable scarcity of studies employing experimental designs to evaluate the impact of interventions on women's knowledge and attitudes regarding obstetric violence. Consequently, this study aims to assess the effectiveness of a person-centered intervention in enhancing women's understanding and attitudes toward obstetric violence among those who have given birth in public hospitals in southwest Ethiopia.

METHODS

A quasi-experimental study with a control group was conducted in public hospitals in southwest Ethiopia, involving a randomly selected sample of 396 postpartum women (198 in the control group and 198 in the intervention group). A person-centered intervention comprising a respectful maternity care workshop, maternity open days, and the provision of maternal certificates of recognition was implemented for the 198 women in the intervention group, while the control group received standard care. The chi-square test, independent t-test, and paired sample t-test were used to analyze differences between and within the groups, respectively. Additionally, a generalized linear regression model was employed to determine the effect size of the intervention on women's knowledge and attitudes, adjusting for background variables.

RESULTS

The mean scores for women's knowledge significantly improved in the intervention group, increasing from 14.82 ± 7.08 to 19.17 ± 5.25 (P < 0.001). A paired t-test revealed a significant difference (P < 0.001) between the pre-test and post-test scores within the intervention group. Furthermore, an independent t-test showed a significant difference in all aspects of knowledge between the intervention and control groups in the post-test (P < 0.001), whereas no significant difference was observed during the pre-test stage for either group (P > 0.05). On average, women who received the person-centered intervention scored 4.13 points higher in their understanding of rights compared to those in the control group. The study also highlighted a significant difference in women's attitudes toward obstetric violence between the experimental and control groups after the intervention, with scores of 21.80 ± 5.43 for the intervention group and 32.65 ± 7.40 for the control group (P < 0.01). Additionally, being part of the intervention group reduced women's unfavorable attitudes nearly elevenfold (β = -10.81, 95% CI = -12.17, -9.45). Women's knowledge increased by an average of four points (β = 4.21, 95% CI = 2.98, 5.43) in the intervention group compared to the control group.

CONCLUSIONS

The findings demonstrated that implementing a person-centered intervention significantly enhanced women's knowledge and decreased unfavorable attitudes toward obstetric violence, ultimately promoting respectful maternal care. Therefore, we recommend adopting and integrating such interventions into existing maternal health programs in Ethiopia to strengthen maternal health initiatives.

CLINICAL TRIAL NUMBER

Not applicable.

Women at crossroads: a qualitative study of induced abortion and violence in a Ghanaian region

Unsafe abortions contribute significantly to maternal mortality and morbidity in Ghana. To reduce this, in 1982 abortion laws in Ghana underwent reform to broaden the conditions under which abortion is accessed. Although, evidence in other contexts highlights the contribution of violence to women's experience of unwanted pregnancy and abortion, such evidence is limited within the Ghanaian abortion literature. This study aims to fill that gap. Informed by phenomenology, interviews were conducted with 10 women who had experienced various forms of violence leading to unwanted pregnancy and unsafe abortions. Participants were recruited between June 2017 and March 2018 in the Ashanti region of Ghana where they sought hospital care for unsafe abortion related complications. Participants mentioned intimate partners as the main perpetrators of violence. Financial challenges were also identified as important in increasing women's vulnerability to violence. Verbal abuse from health workers contributed to denying women access to safe abortion. This paper advances dialogue about the ways in which women's experience of violence from intimate/non-intimate partners and healthcare workers impacts their overall abortion experience. It advocates the empowerment of women to enable them to leave violent relationships, and the retraining of health workers to enable them to adopt respectful and empathetic care practices.

The impact of obstetric violence on postpartum quality of life through psychological pathways

Pregnancy and childbirth as important events in women's lives should be guided based on quality and humanized principles. This study aimed to test a conceptual model considering the interrelated role of obstetric violence, mental health, self-esteem, and PTSD on the postpartum quality of life (PQOL) using path analysis. This cross-sectional study was conducted on 385 parturient women who have given birth from January to May 2022 using the convenience sampling method. Data were collected using a socio-demographic checklist, EPREVO, DASS-21, PCL-5, Rosenberg Self-Esteem Scale, and PQOL scales. Path analysis was applied to generate specified patterns of causal relationships between variables and to determine the type of relationships between predictor and response variables using LISREL software ver.8.8. We found that obstetric violence (β = - 0.659), self-esteem (β = 0.223), mental health (β = - 0.396), and PTSD (β = 0.345) are the main predictors of postpartum QoL. In addition to its direct effect, obstetric violence can impress the PQOL through the effect on mental health (β = 0.533), self-esteem (β = 0.222), and PTSD (β = 0.229), indirectly. Our finding highlighted the negative effect of obstetric violence on mental health, self-esteem, PTSD, and PQOL. Therefore, it is recommended that policymakers and managers adopt programs to promote respectful maternal care and prevent obstetric violence to prevent the occurrence of adverse effects in parturient women.

A Cry for dignity: Verbal, physical, and emotional abuse experienced by postpartum women in Nigerian healthcare

OBJECTIVE

This study explores and describes the lived experiences of postpartum women of Obstetric Violence (OV) in selected secondary health facilities in Oyo State, Nigeria.

METHODS

The study utilized a qualitative research design. A purposive sampling technique was used to recruit thirty participants for the study. A Focus Group Discussion interview guide was used as an instrument of data collection. Thematic analysis was used in analyzing the data using Collaizi's seven stages of data analysis.

RESULTS

The analyzed data on the OV experienced by postpartum women during pregnancy and childbirth generated five themes, which include verbal abuse, abandonment of care, physical abuse, non-dignified care, and non-consented care.

CONCLUSION

Addressing OV requires targeted policies promoting respectful care, healthcare provider training on ethical practices and informed consent, and improved healthcare infrastructure. Empowering women and establishing accountability systems are critical for fostering a dignified and safe maternal healthcare environment.

Dignified care and associated factors among mothers who gave birth at public hospitals, in Sidama Regional State, southern Ethiopia, 2023

BACKGROUND

Dignified care is an important priority for childbearing mothers. Threats to this deteriorate the therapeutic relationship between healthcare providers and clients, which leads to a negative effect on the quality of care. However, little evidence is identified about dignified care and associated factors in the Ethiopian context. Therefore, this study aimed to assess dignified care and associated factors among mothers who gave birth at public hospitals in Sidama Regional States, southern Ethiopia, 2023.

METHOD

An institution-based cross-sectional study was conducted among 418 mothers who gave birth at public hospitals in Sidama Regional States from July 30 to August 30, 2023. A systematic random sampling technique was employed to select study participants. An interviewer-administered structured questionnaire was used, and the data was collected by Kobotool and analyzed using SPSS Version 25. Bivariable and multivariable logistic regression analyses were conducted, and the crude and adjusted odds ratios, together with their corresponding 95% confidence, were computed. A P value < 0.05 was considered a level of statistical significance in this study.

RESULTS

In this study, the overall study participants' magnitude of dignified care was found to be 44.1%. Secondary education (AOR: 3.91, 95% CI: 1.56, 9.82), spontaneous vaginal delivery (AOR: 2.68, 95% CI: 1.31, 5.46), the presence of a companion during labor and delivery (AOR: 12.35, 95% CI : 7.08, 21.53), and less than two days hospital stay (AOR: 3.26, 95% CI: 1.37, 7.75), and midwife attendance of labour and delivery (AOR = 4.47 (1.40-14.25) were significantly associated with dignified care.

CONCLUSIONS

The findings of this study showed that the dignified care of mothers who gave birth at public hospitals in Sidama Regional State was relatively low to the pooled prevalence of respectful maternity care in Ethiopia. In light of these results, it is recommended to prioritize midwife attendance during labor and delivery, promote the presence of companions, facilitate a shorter hospital stay, and enhance educational opportunities.

Investigating Obstetric Violence in Ecuador: A Cross-Sectional Study Spanning the Last Several Years

This pilot cross-sectional study was designed to determine the profile of obstetric violence in Ecuador in recent years. An online survey was conducted between March 2022 and April 2022, including women over 18 years who granted their informed consent to participate (n = 1598). We used non-probabilistic sampling to obtain our sample. Fisher's exact test was performed to assess the association between violence and type of birth, healthcare facility, and education level. Out of the women who participated in the study, 89.2% (n = 1426) identified themselves as Mestiza. Additionally, 88.3% (n = 1411) had completed university-level education. The majority of the participants, specifically 63.6% (n = 1017), received their care in public institutions, and 98.2% (n = 1569) reported structural negligence, while 74.5% (n = 1190) reported violation of their right to information. The entire sample affirmed to have experienced violation of the right of presence. This report shows that obstetric violence is present in Ecuador in different ways and that women experience negligence and violation of their right to receive ethical healthcare during childbirth.

Addressing obstetric violence: a scoping review of interventions in healthcare and their impact on maternal care quality

Background

The mistreatment and abuse of women during childbirth have been recognized as a major global health challenge, impeding facility-based delivery and contributing to the high maternal mortalities globally. The World Health Organization has specifically called for interventions to deal with obstetric violence. This scoping review consolidates the existing literature on interventions aimed at reducing obstetric violence and synthesizes existing knowledge on their impact in promoting respectful maternity care.

Methodology

Thirteen electronic databases were searched for relevant articles from January 2001 to March 2023. A total of 863 records were identified, and 72 full-text articles were retrieved for further screening. The review includes 16 studies, particularly from low- and middle-income countries, with interventions implemented at medical facilities and involving both women and healthcare providers. Eight of the studies were quantitative, three were qualitative and five used a mixed-methods approach.

Findings

The results reveal a promising trend in reducing obstetric violence through various interventions. Ten different types of interventions were identified, highlighting strategies to improve the quality of maternity care and enhance patient-centered care. Improved patient-provider communication skills, increased privacy measures, and reduced abuse and mistreatment emerged as common themes. Enhanced communication skills, including open discussions and the right to be informed, were crucial in reducing obstetric violence. Privacy measures, such as separate rooms, curtains, and birth companions effectively decreased incidents of non-confidential care. General abuse and mistreatment, including physical abuse and neglect, were also reduced, leading to improved perceptions of respectful care during childbirth.

Conclusion

Overall, the interventions had a favorable impact on obstetric violence reduction and women's childbirth experiences. However, despite promising results, obstetric violence remains prevalent worldwide, necessitating more efforts to implement effective interventions. To the best of our knowledge, this is the first scoping review on obstetric violence interventions, providing a comprehensive overview of the state of the art. We suggest that further research is needed to explore new interventions, particularly gender-sensitive interventions, to contribute to a growing body of knowledge on the prevention of obstetric violence.

Effect of childbirth experience on the psychological well-being of postpartum women in Accra, Ghana

BACKGROUND

Women's experience of childbirth can affect their mental health outcomes, many years after the delivery. Consequently, the World Health Organisation has provided recommendations to ensure women receive positive birth experiences during intrapartum care. Yet, negative childbirth experience is widespread in Ghana. This study examined the association between women's childbirth experience (i.e. own capacity, professional support, perceived safety, and participation) and their psychological well-being, and whether or not perceived social support and resilience moderate the childbirth experience - psychological well-being relationship.

METHODS

Mothers (N = 117) who had given birth in the past month and were receiving postnatal care at two health facilities in the Greater Accra Region of Ghana provided the data for the current analysis. Data were collected using the Childbirth Experience Questionnaire, WHO-5 Well-Being Index, Multidimensional Scale of Perceived Social Support, and Brief Resilience Scale. Hierarchical Linear Regression was used to analyse the data.

RESULTS

Results showed that childbirth experience domains of own capacity and perceived safety were significantly, and positively associated with psychological well-being. The domains of professional support and participation were not associated with psychological well-being in this sample. Perceived social support and resilience did not moderate the association between childbirth experience and psychological well-being.

CONCLUSION

The results suggest that efforts by birth practitioners (i.e. midwives, obstetricians, and gynaecologists) to give Ghanaian women positive childbirth experiences through the encouragement of personal control over the birthing process as well as ensuring the safety of the birthing procedure and environment would provide women with optimal mental health outcomes.

Ethical reflections on organizing the first human trial of artificial womb technologies

OBJECTIVE

To investigate how to protect participants in the artificial womb technology (AWT) human trials.

METHOD

We compared randomized controlled trials and single arm trials to understand which trial design best balances the interests of science and participants. We also compared AWT trials with comparable settings to understand how to protect participants.

RESULTS

Randomized trials might fail in reaching a sizeable sample, which could pointlessly expose participants to risks. Furthermore, parents who choose to participate in the trial might expect to receive AWT. Failed expectations might distress parents and hinder the therapeutic relationship. The trial is divided into two steps. First, delivery into AWT involves two participants: the mother and the fetus. As AWT requires a C-section, the procedure cannot be carried out without the mother's consent regardless of fetal benefit. Treatment in AWT, involves one participant: the infant. As for any other invasive intervention, the AWT trial should be suspended if harmful.

CONCLUSIONS

A single arm trial could prevent some of the methodological and ethical challenges of the randomized trials. Moreover, better decisional tools should be developed to help parents decide whether to participate in the AWT trial. For example, using visual aids or showing the AWT.

L'expérience de l'accouchement en milieu surveillé dans la province d'Essaouira au Maroc: Quelle réalité?

RésuméUne expérience positive de l'accouchement (EPA) est fondamentale pour des soins maternels de qualité. Toutefois, de nombreuses femmes subissent des comportements non respectueux lors de ce moment crucial. Au Maroc, peu d'études ont mesuré cette expérience, et les éléments l'influençant demeurent insuffisamment documentés. Nous avons conduit une recherche mixte dans la province d'Essaouira entre avril et décembre 2021. Notre enquête, basée sur un questionnaire, a sollicité l'avis de 240 femmes issues de huit centres de santé choisis au hasard. Par ailleurs, des entretiens semi-directifs ont été conduits avec 20 femmes, 47 professionnels de santé et quatre responsables administratifs. Les données quantitatives ont été soumises à des analyses descriptives, bi- et multivariées, tandis que les entretiens ont été analysés selon une approche de contenu thématique. Les données révèlent que 59.2% des participantes ont eu une expérience défavorable lors de leur dernier accouchement. Parmi elles, la majorité a déploré des soins non consentis (86.7%), un manque de respect de leur intimité (45.4%) et des abus verbaux (25%). L'EPA était principalement associée à la qualité de l'environnement de l'accouchement, au soutien pour l'allaitement, à la propreté des installations, au type d'établissement (privé) et à l'absence de complications médicales pendant le travail. Les entretiens ont révélé que le manque de motivation des professionnels de santé, l'absence de formation continue appropriée et des lacunes organisationnelles et managériales ont affecté l'EPA. Notre étude souligne le besoin crucial de formation continue axée sur le respect des patients, l'éthique et la déontologie, et met en lumière l'importance d'une politique motivante pour les professionnels de santé, notamment dans le secteur public.

Did Ghana Do Enough? A Scientometric Analysis of COVID-19 Research Output from Ghana within the African Context

The COVID-19 pandemic has generated worldwide research efforts to provide knowledge about the disease. Yet little is known about how Ghana contributed to this critical knowledge production. This scientometric analysis was conducted to ascertain Ghana’s COVID-19 research output within the African context to gain understanding and identify potential future directions. The study retrieved relevant research, spanning 2019 to 2022, from the Scopus database in December 2022. The retrieved data were assessed using various established indices, including collaboration patterns, productive institutions, citation patterns, and major research sponsors, among others. Ghana came seventh in Africa with a total of 1112 publications. For international collaborations, the United States and the United Kingdom were the major partners, while South Africa was the main African collaborator with Ghana. Out of the top 21 most productive authors, 85.7% were males and 14.3% were females, demonstrating a great gender gap in research output in Ghana. Although Ghana has made some contributions to the global COVID-19 research output, there are few intra-continental research collaborations, which limits Africa’s overall research output. Our study demonstrates a critical need for the Ghanaian government to prioritize research and funding and address barriers to women’s research productivity.