Senkyire Ephraim, Senkyire Gloria, Asiedua Ernestina, Tawose-Adebayo Victor, Ohaja Magdalena
Ga West Municipal Hospital-Ghana Health Service, Amasaman-Accra, Ghana (Senkyire).
Sunyani Technical University, Sunyani, Ghana (Senkyire).
AJOG Glob Rep. 2025 May 16;5(3):100505. doi: 10.1016/j.xagr.2025.100505. eCollection 2025 Aug.
This essay explores obstetric violence (OV) from a Ghanaian perspective, applying theories of intersectionality, oppression, and power dynamics to critically analyze its causes and manifestations. OV, defined as mistreatment during childbirth, includes acts of physical abuse, nonconsensual care, discrimination, and breaches of privacy. Despite efforts to reduce maternal mortality in Ghana, systemic challenges persist, contributing to a high prevalence of OV, particularly among vulnerable groups such as adolescents, the socioeconomically disadvantaged, and ethnic minorities. The essay highlights that midwives, while essential to maternal care, often operate within oppressive healthcare systems characterized by poor resourcing, rigid hierarchies, and systemic gender bias. Through the lens of intersectionality, the study reveals how overlapping social identities-such as age, ethnicity, and socioeconomic status-influence women's vulnerability to mistreatment. Oppressed group theory explains how midwives, themselves marginalized within patriarchal and medically dominated structures, may internalize oppression and perpetuate violence toward patients. Foucault's theory of power and knowledge is used to illustrate how institutional norms and knowledge hierarchies empower midwives to exercise control over birthing women, often compromising women's autonomy and dignity. The essay further discusses how systemic issues, including underinvestment in healthcare infrastructure, inadequate training on respectful maternity care, and normalization of abusive practices, contribute to the persistence of OV. It calls for comprehensive reforms such as empowering midwives through education and leadership training, decentralizing healthcare authority, promoting respectful maternity care practices, and addressing systemic inequities. Raising awareness, fostering accountability, and embedding patient-centered care principles into healthcare institutions are critical steps toward eliminating OV. Ultimately, the essay argues that addressing OV in Ghana requires not only confronting individual behaviors but dismantling the deeper structural and institutional forces that sustain power imbalances and systemic oppression. Empowering both midwives and birthing women is essential for transforming maternity care and advancing equitable, respectful maternal health outcomes in Ghana.
本文从加纳的视角探讨产科暴力（OV），运用交叉性、压迫和权力动态理论批判性地分析其成因及表现形式。产科暴力被定义为分娩期间的虐待行为，包括身体虐待、未经同意的护理、歧视以及侵犯隐私等行为。尽管加纳在降低孕产妇死亡率方面做出了努力，但系统性挑战依然存在，导致产科暴力高发，尤其是在青少年、社会经济弱势群体和少数民族等弱势群体中。本文强调，助产士虽然对孕产妇护理至关重要，但他们往往在资源匮乏、等级森严且存在系统性性别偏见的压迫性医疗体系中工作。通过交叉性视角，该研究揭示了年龄、种族和社会经济地位等重叠的社会身份如何影响女性遭受虐待的易感性。被压迫群体理论解释了助产士自身在父权制和医学主导结构中处于边缘地位，可能会内化压迫并延续对患者的暴力行为。福柯的权力与知识理论用于说明机构规范和知识等级制度如何赋予助产士对分娩女性行使控制权的权力，这往往损害了女性的自主权和尊严。本文进一步讨论了系统性问题，包括医疗基础设施投资不足、缺乏对尊重孕产妇护理的培训以及虐待行为的常态化，这些都导致了产科暴力的持续存在。它呼吁进行全面改革，如通过教育和领导力培训增强助产士的能力、下放医疗权力、推广尊重孕产妇护理的做法以及解决系统性不平等问题。提高认识、加强问责并将以患者为中心的护理原则融入医疗机构是消除产科暴力的关键步骤。最终，本文认为在加纳解决产科暴力不仅需要应对个人行为，还需要消除维持权力不平衡和系统性压迫的更深层次的结构和制度力量。增强助产士和分娩女性的权能对于转变孕产妇护理并在加纳实现公平、尊重的孕产妇健康结果至关重要。
