Obstetric violence among HIV positive and negative women in Ghana: A cross sectional study in two regions

Abstract Background: Although the problem of obstetric violence (OV) is receiving increasing attention among academics and policy makers, the prevalence and associated factors of OV are still poorly understood. The fear of OV prevents women from giving birth in health facilities, which is crucial for the effectiveness of HIV prevention programs, such as the Prevention of Mother to Child Transmission (PMTCT) program. Objective: The aim of this paper is to determine the prevalence of OV, the comparative burden and associated predictors between HIV positive and negative women in Ghana. Methods: The present study is a facility-based cross-sectional study enrolling 2,142 women, of which 310 were HIV positive and 1,832 HIV negative with a birth history of 0-24 months. The women were enrolled consecutively using a two stage sampling technique from eight hospitals with antiretroviral clinics across two regions in Ghana. The primary outcome variable was the experience of OV and its various forms. Descriptive data is presented in tables and reported in frequencies. The inferential analysis has been performed by estimating the Adjusted Odds Ratios (AOR) using multivariate logistic regression. Results: Prevalence of OV was slightly lower among HIV positive women (61.0%) compared to HIV negative women (65.1%), though this was not statistically significant (χ2=1.99; p=0.158) . The most common sub-category of OV experienced by all women was non-confidential care (35.2%). HIV positive women experienced more abandoned care (32.6%) with non-consented care being the least prevalent form of OV. Experience of discrimination was higher among HIV positive women (13.5%) than HIV negative women (10.8%). The multivariate regression analysis of the predictors of OV suggests that HIV positive women are not more likely to experience OV. Instead, we find evidence that HIV positive women are less likely to be subjected to physical violence (AOR=0.512; CI: 0.369-0.710), non-consented care (AOR=0.457; CI: 0.244-0.859) and non-dignified care (AOR= 0.688; CI: 0.513-0.923). Conclusions: The study shows high rates of OV among all women. However, we found no evidence that HIV positive women were at higher risk to experience OV than HIV negative women. Evidence based interventions are required to address OV due to its threat to facility-based childbirth and the PMTCT cascade of care.