title: 'They treat you like you are not a human being': maltreatment during labour and delivery in rural northern Ghana.
abstract: OBJECTIVE
  to explore community and health-care provider attitudes towards maltreatment during delivery in rural northern Ghana, and compare findings against The White Ribbon Alliance's seven fundamental rights of childbearing women.
  
  
  METHODS
  a cross-sectional qualitative study using in-depth interviews and focus groups.
  
  
  METHODS
  the Kassena-Nankana District of rural northern Ghana between July and October 2010.
  
  
  METHODS
  128 community members, including mothers with newborn infants, grandmothers, household heads, compound heads, traditional healers, traditional birth attendants, and community leaders, as well as 13 formally trained health-care providers.
  
  
  RESULTS
  7 focus groups and 43 individual interviews were conducted with community members, and 13 individual interviews were conducted with health-care providers. All interviews were transcribed verbatim and entered into NVivo 9.0 for analysis. Despite the majority of respondents reporting positive experiences, unprompted, maltreatment was brought up in 6 of 7 community focus groups, 14 of 43 community interviews, and 8 of 13 interviews with health-care providers. Respondents reported physical abuse, verbal abuse, neglect, and discrimination. One additional category of maltreatment identified was denial of traditional practices.
  
  
  CONCLUSIONS
  maltreatment was spontaneously described by all types of interview respondents in this community, suggesting that the problem is not uncommon and may dissuade some women from seeking facility delivery.
  
  
  CONCLUSIONS
  provider outreach in rural northern Ghana is necessary to address and correct the problem, ensuring that all women who arrive at a facility receive timely, professional, non-judgmental, high-quality delivery care.
authors.affiliation: Global REACH, Department of Medical Education, University of Michigan Medical School, 5115 Med Sci 1; 1301 Catherine St. Ann Arbor, MI 48109, USA. Electronic address: camoyer@umich.edu.
authors.forename: Cheryl A
authors.initials: CA
authors.lastname: Moyer
authors.affiliation: Department of Social and Behavioral Science, School of Public Health, University of Ghana, Legon, Ghana. Electronic address: pbadongo@ug.edu.gh.
authors.forename: Philip B
authors.initials: PB
authors.lastname: Adongo
authors.affiliation: Navrongo Health Research Centre, PO Box 114, Navrongo UE/R, Ghana; Department of Public Health, School of Medical and Health Sciences, MONASH University, Jalan Lagoon Selatan, 46150 Bandar Sunway, Selangor Darul Ehasan, Malaysia. Electronic address: raborigo@navrongo.mimcom.org.
authors.forename: Raymond A
authors.initials: RA
authors.lastname: Aborigo
authors.affiliation: Navrongo Health Research Centre, PO Box 114, Navrongo UE/R, Ghana. Electronic address: abraham.hodgson@ghsmail.org.
authors.forename: Abraham
authors.initials: A
authors.lastname: Hodgson
authors.affiliation: Departments of Pediatrics and Maternal and Child Health, Schools of Medicine and Public Health, University of North Carolina at Chapel Hill, CB# 7596, 4th Floor, UNC Hospitals, Chapel Hill, NC 27599-7596, USA. Electronic address: Cyril_engmann@med.unc.edu.
authors.forename: Cyril M
authors.initials: CM
authors.lastname: Engmann
mesh_terms: D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D005260:Female; D017144:Focus Groups; D005869:Ghana; D006801:Humans; D007407:Interviews as Topic; D036801:Parturition / Q000523:psychology*; D018743:Perinatal Care; D011247:Pregnancy; D012424:Rural Population
keywords: Africa; Facility-based delivery; Maternal health service utilisation; Respectful care