Mistreatment during facility-based childbirth in Benin City, Nigeria: A convergent mixed-methods study of prevalence and drivers
- 1Department of Gynecology and Obstetrics, Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD 21287 USA
- 2Department of Obstetrics and Gynecology, University of Benin Teaching Hospital, Benin City, Nigeria
- 3Department of Gynecology and Obstetrics, University of Miami Health Systems, Miami, USA
Abstract
Background: Mistreatment during facility-based childbirth undermines maternal health outcomes and trust in health systems, particularly in low- and middle-income countries. Nigeria bears one of the highest global burdens of maternal mortality, yet limited large-scale mixed-methods studies have examined how mistreatment is both experienced by women and shaped by health system conditions. This study assessed the prevalence, forms, and drivers of mistreatment during childbirth in Benin City, Nigeria, integrating women’s and skilled birth attendants’ (SBAs) perspectives.
Methods: We conducted a convergent parallel mixed-methods study between July–August 2024 across three healthcare facilities (tertiary, secondary, and private) in Benin City. Postpartum women (≤ 12 months since delivery) completed a 45-item mistreatment survey (n = 656). Mistreatment was categorized across eight domains. Descriptive statistics and chi-square analyses were performed. In-depth interviews were conducted with postpartum women (n = 20), and four focus group discussions were held with SBAs (n = 26). Qualitative data were analyzed using constructivist grounded theory. Findings were integrated using a joint display matrix to assess convergence, divergence, and complementarity.
Results: Overall, 89.5% of women reported experiencing at least one form of mistreatment, though only 2.6% labeled their experience as mistreatment. The most common domains were undignified care (70%) and loss of autonomy (48.2%), followed by physical abuse (37.5%) and abandonment (16.3%). Vaginal delivery, higher education, and antenatal care attendance were significantly associated with reported mistreatment (p < 0.05).
Qualitative analysis identified five themes: divergent expectations between women and SBAs; shared labeling of laboring women as “uncooperative”; inconsistent definitions of mistreatment; provider burnout; and structural constraints including understaffing, limited infrastructure, and financial barriers. Both groups used the term “uncooperative” to describe laboring behavior, though with different interpretations. Women emphasized disrespect, lack of consent, and loss of autonomy, while SBAs contextualized care within systemic constraints and workload pressures. Integration showed strong convergence between quantitative autonomy violations and qualitative accounts of restricted companionship, hierarchical communication, and limited shared decision-making.
Comclusions: Mistreatment during childbirth in urban Nigeria is highly prevalent and sustained by intersecting interpersonal and structural health system factors. Efforts to improve maternal health outcomes must address workforce capacity, institutional norms, accountability mechanisms, and rights-based antenatal education to ensure that clinical safety and respectful maternity care are jointly prioritized.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12884-026-09541-z.
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BibTeX
@article{eluobaju2026mistreatment,
title = {{Mistreatment during facility-based childbirth in Benin City, Nigeria: A convergent mixed-methods study of prevalence and drivers}},
author = {Debra Eluobaju and Friday Okonofua and Marika Toscano and Chi Chiung Grace Chen and Gelila Goba and Ahizechukwu Eke},
journal = {BMC Pregnancy and Childbirth},
year = {2026},
month = aug,
doi = {10.1186/s12884-026-09541-z},
url = {https://doi.org/10.1186/s12884-026-09541-z},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Mistreatment during facility-based childbirth in Benin City, Nigeria: A convergent mixed-methods study of prevalence and drivers
AU - Debra Eluobaju
AU - Friday Okonofua
AU - Marika Toscano
AU - Chi Chiung Grace Chen
AU - Gelila Goba
AU - Ahizechukwu Eke
PY - 2026
DA - 2026/08/10
JO - BMC Pregnancy and Childbirth
DO - 10.1186/s12884-026-09541-z
UR - https://doi.org/10.1186/s12884-026-09541-z
AB - Background: Mistreatment during facility-based childbirth undermines maternal health outcomes and trust in health systems, particularly in low- and middle-income countries. Nigeria bears one of the highest global burdens of maternal mortality, yet limited large-scale mixed-methods studies have examined how mistreatment is both experienced by women and shaped by health system conditions. This study assessed the prevalence, forms, and drivers of mistreatment during childbirth in Benin City, Nigeria, integrating women’s and skilled birth attendants’ (SBAs) perspectives. Methods: We conducted a convergent parallel mixed-methods study between July–August 2024 across three healthcare facilities (tertiary, secondary, and private) in Benin City. Postpartum women (≤ 12 months since delivery) completed a 45-item mistreatment survey (n = 656). Mistreatment was categorized across eight domains. Descriptive statistics and chi-square analyses were performed. In-depth interviews were conducted with postpartum women (n = 20), and four focus group discussions were held with SBAs (n = 26). Qualitative data were analyzed using constructivist grounded theory. Findings were integrated using a joint display matrix to assess convergence, divergence, and complementarity. Results: Overall, 89.5% of women reported experiencing at least one form of mistreatment, though only 2.6% labeled their experience as mistreatment. The most common domains were undignified care (70%) and loss of autonomy (48.2%), followed by physical abuse (37.5%) and abandonment (16.3%). Vaginal delivery, higher education, and antenatal care attendance were significantly associated with reported mistreatment (p < 0.05). Qualitative analysis identified five themes: divergent expectations between women and SBAs; shared labeling of laboring women as “uncooperative”; inconsistent definitions of mistreatment; provider burnout; and structural constraints including understaffing, limited infrastructure, and financial barriers. Both groups used the term “uncooperative” to describe laboring behavior, though with different interpretations. Women emphasized disrespect, lack of consent, and loss of autonomy, while SBAs contextualized care within systemic constraints and workload pressures. Integration showed strong convergence between quantitative autonomy violations and qualitative accounts of restricted companionship, hierarchical communication, and limited shared decision-making. Comclusions: Mistreatment during childbirth in urban Nigeria is highly prevalent and sustained by intersecting interpersonal and structural health system factors. Efforts to improve maternal health outcomes must address workforce capacity, institutional norms, accountability mechanisms, and rights-based antenatal education to ensure that clinical safety and respectful maternity care are jointly prioritized. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12884-026-09541-z.
SN - 1471-2393
ER -