Exposure to disrespectful patient care during training: Data from midwifery students at 15 midwifery schools in Ghana. (October 2016) - Moyer, Cheryl A.
Abstract: Objective: to determine what midwifery students throughout Ghana were witnessing, perceiving, and learning with regard to respectful care during labour and childbirth. Design: cross-sectional survey. Setting: public midwifery schools in all 10 regions of Ghana. Participants: all graduating midwifery students in Ghana. Measurements: 929 final-year students at 15 public midwifery schools in Ghana were asked to complete a self-administered computerised survey addressing a range of topics, including experiences during training. All data were collected anonymously and analyzed using Stata 13.0. Findings: 853 students completed the questionnaire (91.8% response rate): 72.0% said maltreatment was a problem in Ghana and 77.4% said women are treated more respectfully in private than public facilities. Students described providers: telling women to stop making noise (78.5%), shouting at women (68.8%), scolding women if they didn't bring birth supplies (54.5%), treating educated/wealthy women better than less educated / poor women (41.5%/38.9%), detaining women who couldn't pay (37.9%), and speaking disrespectfully to women (34%). Only 4% of students reported not witnessing any disrespectful treatment. Students reported providers being overworked (76.5%), stressed (74.2%), and working without adequate resources (64.1%). Where students performed their clinical training (teaching hospital, district hospital, public health clinic, private facility) had no effect on perception of maltreatment as a problem. However, students who trained in district hospitals witnessed more types of disrespectful care than those who did not train in district hospitals ( p =0.01). Conclusions and implications: a majority of midwifery students throughout Ghana witness disrespectful care during their training. Implications include the need for provider curricula that address psychosocial elements of care, as well as the need to improve monitoring, accountability, and consequences for maltreatment within facilities without creating a culture of blame. Highlights: 72.0% of final-year midwifery students said maltreatment was a problem in Ghana. Only 4% of students reported not witnessing disrespectful care during training. Disrespectful and abusive care is being role modelled for graduating midwives. Provider curricula that address psychosocial elements of care are needed. Mechanisms to improve accountability without creating a culture of blame are needed.