What factors are associated with forms of mistreatment during facility-based childbirth? A survey of referral health facilities in south-east Nigeria.

Mistreatment during childbirth in health facilities contributes significantly to suboptimal levels of skilled birth attendance. This study determined the factors associated with mistreatment during facility-based childbirth in two referral facilities in south-east Nigeria. A survey of 620 women whose childbirth occurred in two high-patronage referral hospitals of Ebonyi, Nigeria, was conducted in July-September 2018 using interviewer-administered questionnaires. Data analysis was performed using SPSS version 20. Logistic regression was used to identify predictors. The mean age of the respondents was 29.86 ± 4.4 years. Most had post-secondary education (71.0%), and had attended at least four antenatal visits (83.4%). The prevalence of any mistreatment during childbirth was 56%. Rural residence (adjusted odds ratio [AOR]: 0.53; CI: 0.35, 0.78, = 0.002) and childbirth facilitated by a doctor (AOR: 1.7; CI: 1.14, 2.39, = 0.007) were predictors of reporting at least one form of mistreatment during childbirth. Childbirth facilitated by a doctor (AOR: 1.66; CI: 1.05, 2.63, = 0.031) and unemployment (AOR: 1.84; CI: 1.01, 3.07, = 0.011) increased the odds of non-consented and non-dignified care, respectively. Rural residence (AOR: 0.57; CI: 0.37, 0.88, = 0.011) and childbirth facilitated by a doctor (AOR: 0.65; CI: 0.45, 0.94, = 0.020) were protective against abandonment/neglect. Vaginal birth (AOR: 0.33; CI: 0.16, 0.69, = 0.003) reduced the odds of detention in the health facility following childbirth. Almost three-fifths of the women whose childbirths occurred in the surveyed facilities experienced at least one form of mistreatment during childbirth. Place of residence, health professional type, mode of childbirth, employment status and frequency of antenatal attendance were predictors of mistreatment during childbirth. Rights-based sensitization for women, especially in the rural areas, female empowerment, provider capacity-building on respectful client care and provision of subsidized maternal health services are recommended.