Correlates of obstetric violence by maternity care providers during antenatal consultations and childbirth in two referral hospitals in Bafoussam (West-Cameroon)

Technical Summary: Correlates of Obstetric Violence in Bafoussam, Cameroon

Problem Statement
Obstetric violence (OV), defined as violence against women by obstetric care providers regarding their bodies and reproductive processes, remains a significant barrier to accessing maternal healthcare and a contributor to maternal morbidity and mortality. While recognized globally as a violation of human rights, evidence regarding the prevalence and specific correlates of OV in Cameroon, particularly in the West Region, is limited. This study addresses the gap in local data by investigating the prevalence of OV during antenatal care (ANC) and childbirth, identifying its specific forms, and analyzing associated risk factors in two referral hospitals in Bafoussam.

Methodology
The researchers conducted a quantitative, cross-sectional, hospital-based survey between October 15 and December 15, 2023. The study took place at the Bafoussam Regional Hospital (BRH) and the Mifi District Hospital (MDH), which serve as referral centers for the region.

• Population and Sampling: The study included 512 consenting women who had given birth (vaginally or via Cesarean section) during the study period. A consecutive, exhaustive sampling technique was used to recruit participants from post-partum wards.
• Data Collection: Trained data collectors conducted face-to-face interviews using a pretested, structured questionnaire adapted from a WHO Multi-country Study instrument validated in Brazil. Data were also cross-referenced with medical records. Interviews were conducted in private to ensure confidentiality and anonymity.
• Statistical Analysis: Data were analyzed using SPSS 26.0. The study employed chi-square tests for independence and binary/multiple logistic regressions to determine associations between variables. A p-value of < 0.05 was considered statistically significant. The primary outcome was the prevalence of OV, with "inability to pay for healthcare" and socio-demographic factors serving as exposure variables.

Key Results
The study included 512 women with a median age of 27 years. The findings revealed distinct prevalence rates for OV during different stages of care:

• Prevalence:
  • Antenatal Care (ANC): 8.1% (40/492) of women reported experiencing OV. Among those who experienced OV during ANC, 40.0% (16 women) switched health facilities for subsequent care. The most common forms were scolding (42.5%), poor reception (37.5%), and neglect (12.5%).
  • Intrapartum (Childbirth): 54.7% (274/512) of women reported experiencing OV. The most frequent forms included:
    • Perineal suture without anesthesia (43.6%).
    • No greetings or self-introduction by personnel (38.2%).
    • Digital vaginal examination without consent (24.6%).
    • Non-preservation of intimacy (21.8%).
• Correlates:
  • Multivariable logistic regression identified inability to pay for healthcare services as the only significant independent factor associated with OV.
  • Women unable to pay were significantly more likely to experience OV during ANC (Adjusted Odds Ratio [aOR]: 2.9; 95% CI: 1.3–64) and during childbirth (aOR: 19.6; 95% CI: 1.7–26.9).
  • Other factors such as age, parity, and number of ANC visits did not show statistically significant associations in the multivariate model.

Key Contributions

• First Regional Data: This is the first study of its kind in Cameroon to quantify the prevalence of obstetric violence specifically within the West Region.
• Granular Categorization: The study provides a detailed breakdown of OV types, distinguishing between physical abuse, non-consented care, lack of confidentiality, and non-dignified care, highlighting that physical abuse (specifically unanesthetized suturing) and lack of consent are predominant issues.
• Economic Determinants: The research empirically links economic vulnerability to the receipt of violent care, demonstrating that financial inability is a strong predictor of mistreatment in this setting.

Significance and Claims
The authors assert that obstetric violence is "quite common and varied" in Bafoussam, affecting more than half of women during childbirth and one in ten during prenatal care. The study claims that the drivers of this violence, particularly the economic vulnerability of patients and the resulting power dynamics, must be investigated to inform effective mitigation strategies.

The authors note that the high prevalence of intrapartum violence may be linked to the stress of childbirth and structural issues within delivery rooms (e.g., lack of privacy), which they characterize as "institutional violence." They suggest that the disparity in care based on the ability to pay reflects the impact of poor working conditions for healthcare providers and the economic precarity of patients.

The paper concludes that addressing these issues is vital for promoting respectful maternity care, which is essential for ensuring the health and well-being of the woman-baby dyad and for achieving Sustainable Development Goal 3 (reducing maternal mortality). The authors acknowledge limitations, specifically the potential for recall bias regarding ANC events due to the time elapsed since the consultations, but maintain that the findings highlight a critical need for policy and structural interventions.