1 Forms of support and experiencing maltreatment and disrespect during 2 childbirth at a health facility: a self-reported cross-sectional study in 3 Ghana

11 Providing support to women and encouraging women to deliver in health facility settings 12 (skilled delivery) is one strategy to improve maternal health outcomes in developing 13 countries. However, fear of maltreatment and disrespect during labour and delivery, have been reported as barriers to facility delivery. This study was therefore conducted to assess postnatal women’s self-reported experience and type of maltreatment and disrespect during delivery. Using a cross sectional study design, 313 women were randomly selected from 17 the three health facilities located in the La-Nkwantenang-Madina Municipality in the 18 Greater Accra region. The data was analysed using STATA 15. Bivariable data analysis 19 using Pearson’s Chi-square was used to determine the association between socio-20 demographic characteristics, reproductive history and experience of maltreatment. Logistic 21 regression analysis was done to determine the strengths of association. More than half 22 (54.3%) of the postnatal women were encouraged to have support persons during labour 23 and delivery. About 75.7% reported experiencing some form of maltreatment and 24 disrespect. About a fifth (19.8%, n=62) of the women experienced physical abuse, 9.3% 25 (n=29) experienced undignified care, 7.7% (n=24) of the women were detained or confined 26 against their will, and 60.4% (n=189) indicated they did not receive consented care. The instrumental or caesarean deliveries.


Introduction
excluded from the study. Women who had experienced stillbirth were excluded because 106 they may be going through emotional distress which made it unethical to interview them. 107 108 Sample Size Determination 109 A single population proportion formula was used to estimate the sample size with an 110 assumption of 5% precision and 95% confidence. An assumption that 72% of labouring 111 mothers would face at least one form of disrespect and abuse during childbirth was used 112 based on earlier study [18]. Based on this, a minimum sample size of 309 was 113 determined. In studies using postnatal women, it has been reported that a non-response 114 rate of 2-10% should be expected. However, during the pilot study, no non-response was 115 recorded. Nonetheless, the minimum response rate was adopted as advised. This, 116 therefore, increased the sample size to 316.  . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

(which was not certified by peer review)
The copyright holder for this preprint this version posted July 22, 2022. The postnatal clinic runs every week hence the sample size of mothers to be interviewed Kekele respectively. The mothers whose names corresponded to the numbers selected at 136 each facility were recruited into the study. If a client declined to participate, a replacement 137 was done.

Study variables
. CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted July 22, 2022. ; https://doi.org/10.1101/2022.07.19.22277809 doi: medRxiv preprint Disrespect has seven categories: (1). Physical abuse: slapping/hitting or physical force 143 on the mother; (2). Non-dignified care: mother experience rudeness, scolding or insults; (3).

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Non-consented care: No informed consent or information dissemination; (4). No privacy: 145 curtains or other visual barriers not use; (5). Discrimination: mother prejudiced on grounds 146 of clinic state; (6). Neglect: mother was left alone or unattended to; (7). Detention: mother 147 delayed in health facility against her will. CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted July 22, 2022. ; https://doi.org/10.1101/2022.07.19.22277809 doi: medRxiv preprint for beliefs, traditions and culture; the right to information and privacy; confidentiality; 167 consent and preference in care; choice of a companion during labour and birth; freedom of 168 movement during labour; non-separation of mother and newborn and prevention of    (Table 2).
. CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted July 22, 2022.  is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

(which was not certified by peer review)
The copyright holder for this preprint this version posted July 22, 2022. given to them immediately after birth (Table 3). . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

Self-reported experience and forms of disrespect during labour and childbirth
The woman was discrminated against The woman received undignified care The woman was not respectfully greeted The woman experienced verbal abuse The woman was deteined or confined against her will The woman did not received consented care Information was not well disseminated to woman The woman was was not well informed & consented The woman's privacy or confidentiality was... The woman's privacy was not protected The woman's confidentiality was not protected The woman was left unattended when needed care Self-report and experience of forms of Disrespectful care among Postnatal women during labour and child birth at LNMM 2019 % of women . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

(which was not certified by peer review)
The copyright holder for this preprint this version posted July 22, 2022.   is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

(which was not certified by peer review)
The copyright holder for this preprint this version posted July 22, 2022. analgesia (χ2=20.32, p<0.001) and the baby given to mother immediately after delivery 249 (χ2=11.06, p=0.001) were the forms of support significantly associated with the experience 250 of at least one form of disrespectful care. (Table 4).
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(which was not certified by peer review)
The copyright holder for this preprint this version posted July 22, 2022.  is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

(which was not certified by peer review)
The copyright holder for this preprint this version posted July 22, 2022. Correlates of the experience of disrespect during labour and delivery 257 Table 5 shows a multivariable analysis of the factors associated with the experience of at 258 least one form of disrespectful care towards women delivering at the health care facility.

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The simple logistic regression model was used to estimate the unadjusted odds ratio whilst odds of experiencing at least one form of disrespectful care compared to those who did not . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

(which was not certified by peer review)
The copyright holder for this preprint this version posted July 22, 2022.  . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

(which was not certified by peer review)
The copyright holder for this preprint this version posted July 22, 2022.   is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

(which was not certified by peer review)
The copyright holder for this preprint this version posted July 22, 2022. abuse, about one in ten (9.3%) were discriminated against, about four in ten (38.9%) had 325 undignified care, six in ten (60.4%) received unconsented care, about four in ten (34.5%) 326 received non-confidential care, about one in five (17.9%) felt neglected and one in ten 327 (7.7%) experienced detention against their will. The high prevalence of disrespectful care 328 coupled with the representation of all the seven categories of disrespect and abuse in the 329 study indicates that it is a problem requiring strengthening of the policy of respectful 330 maternity care and institutional reforms. Failure to address this menace will cause clients to 331 mistrust the healthcare system leading to poor health-seeking behaviour and the loss in 332 battle against maternal morbidity and mortality.

Conclusion
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(which was not certified by peer review)
The copyright holder for this preprint this version posted July 22, 2022. ; https://doi.org/10.1101/2022.07.19.22277809 doi: medRxiv preprint The study concludes that women received some forms of support during childbirth and . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted July 22, 2022. ; https://doi.org/10.1101/2022.07.19.22277809 doi: medRxiv preprint