title: Exposure to disrespectful patient care during training: Data from midwifery students at 15 midwifery schools in Ghana.
abstract: OBJECTIVE
  to determine what midwifery students throughout Ghana were witnessing, perceiving, and learning with regard to respectful care during labour and childbirth.
  
  
  METHODS
  cross-sectional survey.
  
  
  METHODS
  public midwifery schools in all 10 regions of Ghana.
  
  
  METHODS
  all graduating midwifery students in Ghana.
  
  
  METHODS
  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.
  
  
  RESULTS
  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
  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.
authors: University of Michigan Medical School, 1111 Catherine Street, Ann Arbor, MI 48109, USA. Electronic address: camoyer@umich.edu.
authors: Cheryl A
authors: CA
authors: Moyer
authors: University of Michigan Medical School, 1111 Catherine Street, Ann Arbor, MI 48109, USA. Electronic address: sarahrom@umich.edu.
authors: Sarah
authors: S
authors: Rominski
authors: Kwame Nkrumah University of Science and Technology, Accra Road, Kumasi, Ghana. Electronic address: manyorogh@yahoo.com.
authors: Emmanuel Kweku
authors: EK
authors: Nakua
authors: Kwame Nkrumah University of Science and Technology, Accra Road, Kumasi, Ghana. Electronic address: vmdzomeku@gmail.com.
authors: Veronica Millicent
authors: VM
authors: Dzomeku
authors: Kwame Nkrumah University of Science and Technology, Accra Road, Kumasi, Ghana. Electronic address: agyeibaffour@yahoo.co.uk.
authors: Peter
authors: P
authors: Agyei-Baffour
authors: University of Michigan School of Nursing, 400 North Ingalls Street, Ann Arbor, MI 48109, USA. Electronic address: jrlori@umich.edu.
authors: Jody R
authors: JR
authors: Lori
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D005260:Female; D005869:Ghana; D006801:Humans; D008880:Midwifery / Q000193:education; D009721:Nurse Midwives / Q000193:education / Q000523:psychology*; D005791:Patient Care / Q000523:psychology / Q000592:standards*; D011795:Surveys and Questionnaires
keywords: Africa; Developing countries; Disrespect and abuse; Maltreatment; Midwifery education; Respectful maternity care