{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T12:55:23Z","timestamp":1793105723207,"version":"4.5.0"},"reference-count":66,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,2,13]],"date-time":"2023-02-13T00:00:00Z","timestamp":1676246400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100010583","name":"Universit\u00e4t Konstanz","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100010583","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Abuse and mistreatment of women during childbirth is a major barrier to facility-based delivery, putting women at risk of avoidable complications, trauma and negative health outcomes including death. We study the prevalence of obstetric violence (OV) and its associated factors in the Ashanti and Western Regions of Ghana.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methodology<\/jats:title><jats:p>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\u201345 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>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\u20132.2) and women who reported birth complications (OR 3.2, 95% CI 2.4\u20134.3) 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\u20134.5) 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2023.988961","type":"journal-article","created":{"date-parts":[[2023,2,13]],"date-time":"2023-02-13T04:49:34Z","timestamp":1676263774000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":44,"title":["Abuse and humiliation in the delivery room: Prevalence and associated factors of obstetric violence in Ghana"],"prefix":"10.3389","volume":"11","author":[{"given":"Abena Asefuaba","family":"Yalley","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dare","family":"Abioye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seth Christopher Yaw","family":"Appiah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anke","family":"Hoeffler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,2,13]]},"reference":[{"key":"B1","unstructured":"Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population DivisionGenevaDepartment of Reproductive Health and Research; 2019Trends in Maternal Mortality 2000\u20132017"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s13104-018-3140-0","article-title":"Skilled delivery service utilization and its association with the establishment of women's health development army in Yeky District, South West Ethiopia: a multilevel analysis","volume":"11","author":"Negero","year":"2018","journal-title":"BMC Res Notes."},{"key":"B3","doi-asserted-by":"publisher","first-page":"270","DOI":"10.4314\/mmj.v30i4.10","article-title":"Patient satisfaction with services at a tertiary hospital in South-East Nigeria","volume":"30","author":"Obi","year":"2018","journal-title":"Malawi Med J."},{"key":"B4","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s41182-019-0172-7","article-title":"Women's overall satisfaction with health facility delivery services in Ghana: a mixed-methods study","volume":"47","author":"Adjei","year":"2019","journal-title":"Trop Med Health."},{"key":"B5","unstructured":"Accra, GhanaGSS, GHS, ICF;Maternal Health Survey 20172018"},{"key":"B6","unstructured":"GenevaWold Health OrganizationMaking Pregnancy Safer: the Critical Role of the Skilled Attendant: Joint Statement of WHO, ICM and FIGO2004"},{"key":"B7","doi-asserted-by":"publisher","first-page":"a1884","DOI":"10.4102\/phcfm.v11i1.1884","article-title":"Trends in patients' overall satisfaction with healthcare delivery in Accra, Ghana","volume":"11","author":"Odonkor","year":"2019","journal-title":"African J PrimHeal Care Fam Med."},{"key":"B8","unstructured":"AccraGhana Health Service.2016 Annual Report2017"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3389\/fpubh.2021.779404","article-title":"The association between pregnancy-related factors and health status before and after childbirth with satisfaction with skilled delivery in multiple dimensions among postpartum mothers in the Akatsi South District, Ghana","volume":"9","author":"Tuglo","year":"2022","journal-title":"Front Public Health."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/1742-4755-11-71","article-title":"Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis","volume":"11","author":"Bohren","year":"2014","journal-title":"Reprod Health."},{"key":"B11","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1080\/09688080.2018.1502020","article-title":"Women's perspectives of mistreatment during childbirth at health facilities in ghana: findings from a qualitative study","volume":"26","author":"Maya","year":"2018","journal-title":"Reprod Health Matters."},{"key":"B12","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12884-018-2026-4","article-title":"Women suffer more from disrespectful and abusive care than from the labor pain itself: a qualitative study from women's perspective","volume":"18","author":"Gebremichael","year":"2018","journal-title":"BMC Pregnancy Childbirth."},{"key":"B13","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s13104-019-4614-4","article-title":"Obstetric violence and its associated factors among postnatal women in a specialized comprehensive hospital, Amhara Region, Northwest Ethiopia","volume":"12","author":"Mihret","year":"2019","journal-title":"BMC Res Notes."},{"key":"B14","doi-asserted-by":"publisher","first-page":"815","DOI":"10.1080\/13691058.2017.1384572","article-title":"\u2018Safe', yet Violent? Women's experiences with obstetric violence during hospital births in rural Northeast India","volume":"20","author":"Chattopadhyay","year":"2018","journal-title":"Cult Health Sex."},{"key":"B15","doi-asserted-by":"publisher","first-page":"e1001847","DOI":"10.1371\/journal.pmed.1001847","article-title":"The mistreatment of women during childbirth in health facilities globally: a mixed-methods systematic review","volume":"12","author":"Bohren","year":"2015","journal-title":"PLoS Med."},{"key":"B16","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1016\/j.socscimed.2016.09.039","article-title":"Disrespectful intrapartum care during facility-based delivery in Sub-Saharan Africa: a qualitative systematic review and thematic synthesis of women's perceptions and experiences","volume":"169","author":"Bradley","year":"2016","journal-title":"Soc Sci Med."},{"key":"B17","doi-asserted-by":"publisher","first-page":"1769","DOI":"10.1007\/s10995-016-2004-2","article-title":"Striving for respectful maternity care everywhere","volume":"20","author":"Molina","year":"2016","journal-title":"Matern Child Health J."},{"key":"B18","unstructured":"SimonovicD\n          New YorkUnited Nations General Assembly.A Human Rights-Based Approach to Mistreatment Violence Against Women in Reproductive Health Services with a Focus on Childbirth Obstetric Violence. A\/74\/1372019"},{"key":"B19","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1016\/j.rhm.2016.05.001","article-title":"Obstetric violence: a new framework for identifying challenges to maternal healthcare in argentina","volume":"24","author":"Vacaflor","year":"2016","journal-title":"Reprod Health Matters."},{"key":"B20","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12978-017-0403-5","article-title":"Measuring mistreatment of women during childbirth: a review of terminology and methodological approaches","volume":"14","author":"Savage","year":"2017","journal-title":"Reprod Health."},{"key":"B21","unstructured":"GenevaWorld Health Organization.The Prevention and Elimination of Disrespect and Abuse during Facility-Based Childbirth: WHO Statement2014"},{"key":"B22","unstructured":"ParisUNESCO.Universal Declaration of Bioethics and Human Rights2006"},{"key":"B23","unstructured":"GenevaWorld Health Organization.WHO Recommendations: Intrapartum Care for a Positive Childbirth Experience2018"},{"key":"B24","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12978-016-0264-3","article-title":"Human rights in childbirth, narratives and restorative justice: a review","volume":"14","author":"Lokugamage","year":"2017","journal-title":"Reprod Health."},{"key":"B25","doi-asserted-by":"publisher","first-page":"1821","DOI":"10.1007\/s10995-017-2298-8","article-title":"Associations between mistreatment by a provider during childbirth and maternal health complications in Uttar Pradesh, India","volume":"21","author":"Raj","year":"2017","journal-title":"Maternal Child Health J."},{"key":"B26","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1002\/ijgo.13938","article-title":"Observations and reports of incidents of how birthing persons are treated during childbirth in two public facilities in Argentina","volume":"158","author":"Correa","year":"2022","journal-title":"Int J Gynecol Obstetrics."},{"key":"B27","doi-asserted-by":"publisher","first-page":"555","DOI":"10.1177\/1077801219836732","article-title":"Obstetric violence in Mexico: results from a 2016 national household survey","volume":"26","author":"Castro","year":"2020","journal-title":"Violence Against Women."},{"key":"B28","doi-asserted-by":"publisher","first-page":"e028688","DOI":"10.1136\/bmjopen-2018-028688","article-title":"Labor room violence in Uttar Pradesh, India: evidence from longitudinal study of pregnancy and childbirth","volume":"9","author":"Goli","year":"2019","journal-title":"BMJ Open."},{"key":"B29","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12978-019-0729-2","article-title":"The Giving Voice to Mothers study: Inequity and Mistreatment during Pregnancy and Childbirth in the United States","volume":"16","author":"Vedam","year":"2019","journal-title":"Reprod Health."},{"key":"B30","doi-asserted-by":"publisher","first-page":"262","DOI":"10.1016\/j.midw.2013.05.006","article-title":"'They treat you like you are not a human being': maltreatment during labor and delivery in rural northern Ghana","volume":"30","author":"Moyer","year":"2014","journal-title":"Midwifery."},{"key":"B31","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12884-019-2337-0","article-title":"A qualitative study on rural women's experiences relating to the utilization of birth care provided by skilled birth attendants in the rural areas of Bongo District in the Upper East Region of Ghana","volume":"19","author":"Adatara","year":"2019","journal-title":"BMC Pregnancy Childbirth."},{"key":"B32","doi-asserted-by":"publisher","first-page":"10210","DOI":"10.1016\/S0140-6736(19)31992-0","article-title":"How women are treated during facility-based childbirth in four countries: a cross-sectional study with labor observations and community-based surveys","volume":"394","author":"Bohren","year":"2019","journal-title":"Lancet."},{"key":"B33","first-page":"66","article-title":"Mistreatment of women in health facilities by midwives during childbirth in Ghana: Prevalence and associated Factors,","volume-title":"Selected Topics in Midwifery Care","author":"Ganle J","year":"2018"},{"key":"B34","unstructured":"New YorkUnited Nations Population Fund.Accelerating Progress toward MDG52015"},{"key":"B35","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12913-015-1005-y","article-title":"Can she make it? Transportation barriers to accessing maternal and child health care services in rural Ghana","volume":"15","author":"Atuoye","year":"2015","journal-title":"BMC Health Serv Res."},{"key":"B36","doi-asserted-by":"publisher","first-page":"101","DOI":"10.3389\/fpubh.2018.00101","article-title":"Maternal death in rural Ghana: a case study in the upper east region of Ghana","volume":"6","author":"Apanga","year":"2018","journal-title":"Front. Public Health"},{"key":"B37","unstructured":"AccraGhana Statistical Service.Population Housing Census2021"},{"key":"B38","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12914-016-0096-9","article-title":"Does the operations of the National Health Insurance Scheme (NHIS) in Ghana align with the goals of primary health care? perspectives of key stakeholders in Northern Ghana","volume":"16","author":"Awoonor-Williams","year":"2016","journal-title":"BMC Int Health Hum Rights"},{"key":"B39","volume-title":"Sampling Techniques","author":"Cochran","year":"1977"},{"key":"B40","unstructured":"USAID-TRAction Project\n            BowserD\n            HillK\n          BostonHarvard School of Public Health.Exploring Evidence for Disrespect Abuse in Facility-based Childbirth: Report of a Landscape Analysis2010"},{"key":"B41","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1016\/j.ijgo.2014.08.015","article-title":"Disrespect and abuse during facility-based childbirth in a low-income Country","volume":"20","author":"Okafor","year":"2015","journal-title":"Int J Gynaecol Obstet."},{"key":"B42","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12884-016-1019-4","article-title":"The prevalence of disrespect and abuse during facility-based childbirth in urban Tanzania","volume":"16","author":"Sando","year":"2016","journal-title":"BMC Pregnancy Childbirth"},{"key":"B43","doi-asserted-by":"publisher","first-page":"e2018029","DOI":"10.4178\/epih.e2018029","article-title":"Prevalence of disrespect and abuse of women during child birth and associated factors in Bahir Dar Town, Ethiopia","volume":"40","author":"Wassihun","year":"2018","journal-title":"Epidemiol Health."},{"key":"B44","doi-asserted-by":"publisher","first-page":"640","DOI":"10.1016\/j.ssmph.2016.07.003","article-title":"\u201cBy slapping their laps, the patient will know that you truly care for her\u201d: a qualitative study on social norms and acceptability of the mistreatment of women during childbirth in Abuja, Nigeria","volume":"2","author":"Bohren","year":"2016","journal-title":"SSM Popul Health."},{"key":"B45","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12978-016-0262-5","article-title":"A qualitative study of women's and health providers' attitudes and acceptability of mistreatment during childbirth in health facilities in Guinea","volume":"14","author":"Balde","year":"2017","journal-title":"Reprod Health."},{"key":"B46","doi-asserted-by":"publisher","first-page":"22","DOI":"10.3390\/women3010002","article-title":"\u201cWe Beat Them to Help Them Push\u201d: midwives' perceptions on obstetric violence in the Ashanti and western regions of Ghana","volume":"3","author":"Yalley","year":"2023","journal-title":"Women"},{"key":"B47","doi-asserted-by":"publisher","first-page":"22","DOI":"10.3390\/socsci9030022","article-title":"Proverbs and patriarchy: analysis of linguistic prejudice and representation of women in traditional Akan Communities of Ghana","volume":"9","author":"Gyan","year":"2020","journal-title":"Soc Sci."},{"key":"B48","unstructured":"GenevaWorld Health Organization.Global Health Workforce Statistics: Nurses and Midwives2022"},{"key":"B49","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12884-021-03762-0","article-title":"Challenges experienced by midwives working in rural communities in the upper east region of Ghana: a qualitative study","volume":"21","author":"Adatara","year":"2021","journal-title":"BMC Pregnancy Childbirth"},{"key":"B50","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12978-020-0909-0","article-title":"Providers' perceptions of disrespect and abuse during childbirth: a mixed-methods study in Kenya","author":"Afulani","year":"2020","journal-title":"Health Policy Plan."},{"key":"B51","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12978-016-0265-2","article-title":"Mistreatment of women during childbirth in Abuja, Nigeria: a qualitative study on perceptions and experiences of women and healthcare providers","volume":"14","author":"Bohren","year":"2017","journal-title":"Reprod Health"},{"key":"B52","doi-asserted-by":"publisher","first-page":"e3069","DOI":"10.1590\/1518-8345.2450.3069","article-title":"Obstetric violence in the daily routine of care and its characteristics","volume":"26","author":"Jardim","year":"2018","journal-title":"Rev Lat Am Enfermagem"},{"key":"B53","first-page":"7","volume-title":"Compassionate and Respectful Maternity Care and Associated Factors Among Women Attending Delivery Services at Public Health Facilities of Hawassa City, Southern Ethiopia.","author":"Wochefu","year":"2021"},{"key":"B54","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.ijgo.2008.09.015","article-title":"Intensive caring","volume":"104","author":"Johnson","year":"2009","journal-title":"Int J Gynecol Obstet."},{"key":"B55","doi-asserted-by":"publisher","first-page":"S67","DOI":"10.1016\/S0020-7292(01)00511-2","article-title":"From \u2018culture of dehumanization of childbirth' to \u2018childbirth as a transformative experience': changes in five municipalities in North-East Brazil","volume":"75","author":"Misago","year":"2001","journal-title":"Int J Gynecol Obstet."},{"key":"B56","first-page":"36","article-title":"Rural-urban disparities in health and health care in Africa: cultural competence, lay-beliefs in narratives of diabetes among the rural poor in the Eastern Cape Province of South Africa","volume":"21","author":"Oloyede","year":"2017","journal-title":"S Afr Sociol Rev."},{"key":"B57","doi-asserted-by":"publisher","first-page":"e0218682","DOI":"10.1371\/journal.pone.0218682","article-title":"Resource requirements for community-based care in rural, deep-rural and Peri-urban Communities in South Africa: a comparative analysis in 2 South African Provinces","volume":"15","author":"Besada","year":"2020","journal-title":"PLoS ONE."},{"key":"B58","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1038\/s41371-022-00688-8","article-title":"Rural-urban difference in the prevalence of hypertension in West Africa: a systematic review and meta-analysis","volume":"16","author":"Sani","year":"2022","journal-title":"J Hum Hypertens"},{"key":"B59","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1177\/186810261504400404","article-title":"Healthcare-seeking practices of African and rural-to-urban migrants in Guangzhou","volume":"44","author":"Bork-H\u00fcffer","year":"2015","journal-title":"J Curr Chin Aff."},{"key":"B60","unstructured":"Armah-AttohD\n            SelormeyE\n            HouessoumR\n          AccraAfrobarometer.Despite Gains, Barriers keep Health Care high on Africa's Priority List2016"},{"key":"B61","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12884-019-2532-z","article-title":"Disrespect and abuse during facility-based childbirth in southern Mozambique: a cross-sectional study","volume":"19","author":"Galle","year":"2019","journal-title":"BMC Pregnancy Childbirth"},{"key":"B62","doi-asserted-by":"publisher","DOI":"10.1016\/j.aogh.2014.08.139","article-title":"It's for the greater good: perspectives on maltreatment during labor and delivery in Rural Ghana","author":"Yakubu","year":"2014","journal-title":"Open J Obstet Gynecol."},{"key":"B63","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12884-019-2691-y","article-title":"\u201cI wouldn't have hit you, but you would have killed your Baby:\u201d exploring midwives' perspectives on disrespect and abusive care in Ghana","volume":"20","author":"Dzomeku","year":"2020","journal-title":"BMC Pregnancy Childbirth"},{"key":"B64","first-page":"622","article-title":"Corruption in Ghanaian healthcare system: the consequences","volume":"3","author":"Agbenorku","year":"2012","journal-title":"J Med Med Sci."},{"key":"B65","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1111\/j.1523-536X.1991.tb00103.x","article-title":"Just another day in a woman's life? Women's long-term perceptions of their first birth experience part I","volume":"18","author":"Simkin","year":"1991","journal-title":"Birth."},{"key":"B66","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1111\/j.1523-536X.1992.tb00382.x","article-title":"Just another day in a woman's life? Part 11: nature and consistency of women's long-term memories of their first birth experiences","volume":"19","author":"Simkin","year":"1992","journal-title":"Birth."}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2023.988961\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,2,13]],"date-time":"2023-02-13T04:49:44Z","timestamp":1676263784000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2023.988961\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,13]]},"references-count":66,"alternative-id":["10.3389\/fpubh.2023.988961"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2023.988961","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,13]]},"article-number":"988961"}}