Aim: Encouraging women to deliver in facility settings is one strategy to improve maternal and neonatal outcomes in the developing world. However, in much of sub-Saharan Africa, fewer than half of pregnant women deliver in health facilities. Fear of maltreatment during labor and delivery has been shown to be one barrier to facility delivery, yet previous studies have focused solely on reports from women, rarely seeking insights from practicing midwives. Method: All seven practicing midwives from a rural hospital in Ghana and ten pregnant women seeking antenatal care from the same hospital were recruited to participate in in-depth interviews regarding their perceptions of care during labor and delivery. A semi-structured interview tool and qualitative field interviewing approach were utilized. All interviews were audio taped, transcribed, and analyzed using NVivo 9.0. Results: Respondents described situations that precipitate abuse during facility deliveries, yet not all abuse was seen as acceptable. Two overarching themes emerged: 1) The interaction between midwives and their patients is analogous to a mother/daughter relationship, including both a knowledge imbalance and the need for disciplinary action when necessary; and 2) Midwives feel a strong sense of responsibility for the delivery outcomes and as a result, they will do whatever it takes to deliver a live baby to a healthy mother. Hitting, yelling, and neglecting women were reported as common occurrences in the labor and delivery ward. However, each was undertaken to encourage women to do what was needed to deliver safely. Conclusion: These findings suggest that the issue of patient maltreatment in low-resource labor and delivery settings is complex and may be undertaken in what is perceived to be the laboring woman’s best interest. The exploration of alternative strategies to facilitate labor and delivery is warranted, as well as the provision of adequate support and resources for practicing midwives in rural settings.
Cite this paper
Yakubu, J. , Benyas, D. , Emil, S. , Amekah, E. , Adanu, R. and Moyer, C. (2014) It’s for the Greater Good: Perspectives on Maltreatment during Labor and Delivery in Rural Ghana. Open Journal of Obstetrics and Gynecology
, 383-390. doi: 10.4236/ojog.2014.47057
 Lozano, R., Wang, H., Foreman, K.J., Rajaratnam, J.K., Naghavi, M., Marcus, J.R., Dwyer-Lindgren, L., Lofgren ,K.T., Phillips, D., Atkinson, C., Lopez, A.D. and Murray, C.J. (2011) Progress towards Millennium Development Goals 4 and 5 on Maternal and Child Mortality: An Updated Systematic Analysis. The Lancet, 378, 1139-1165.
 Friberg, I.K., Kinney, M.V., Lawn, J.E., Kerber, K.J., Odubanjo, M.O., et al. (2010) Sub-Saharan Africa’s Mothers, Newborns, and Children: How Many Lives Could Be Saved with Targeted Health Interventions? PLoS Medicine, 7, e1000295. http://dx.doi.org/10.1371/journal.pmed.1000295
 Campbell, O.M.R. and Graham, W.J. (2006) Getting On With What Works. The Lancet, 368, 1284-1299.
 Ghana Statistical Service (GSS), Ghana Health Service (GHS), and ICF Macro (2009) Ghana Demographic and Health Survey 2008. GSS, GHS, and ICF Macro, Accra.
 Crissman, H., Engmann, C., Adanu, R.M., Crespo, K., Nimako, D. and Moyer, C.A. (2013) Shifting Norms: Pregnant Women’s Increasingly Positive Perspective on Facility Delivery in Rural Ghana. African Journal of Reproductive Health, 17, 15-26.
 Moyer, C.A., Adongo, P.B., Aborigo, R.A., Hodgson, A., Engmann, C.M. and Devries, R. (2013) “It’s Up to the Woman’s People”: How Social Factors Influence Facility-Based Delivery in Rural Northern Ghana. Maternal and Child Health Journal, in press.
 Abrahams, N., Jewkes, R. and Mvo, Z. (1998) Why Do Nurses Abuse Patients? Reflections from South African Obstetric Services. Social Science & Medicine, 47, 1781-1795. http://dx.doi.org/10.1016/S0277-9536(98)00240-8
 Moyer, C., Aborigo, R., Logonia, G., Affah, G., Rominski, S., Adongo, P., Williams, J. and Hodgson, A. (2012) Clean Delivery Practices in Rural Northern Ghana: A Qualitative Study of Community and Provider Knowledge, Attitudes, and Beliefs. BMC Pregnancy and Childbirth, 12, 50. http://dx.doi.org/10.1186/1471-2393-12-50