Gender and intersecting inequalities in the healthcare system: A primary driver of obstetric violence in Nigeria

Background The mistreatment and abuse of women during childbirth in Nigeria is pervasive, contributing greatly to the high maternal mortality and morbidity rates. Although the prevalence and patterns of obstetric violence have been well studied, there is little insight into the gendered drivers of obstetric violence. Aim This study aims to explore the gender inequalities in the Nigerian healthcare system and how it contributes to obstetric violence in Nigeria . Methods The feminist phenomenological research approach was employed in this study. Specifically, in-depth interviews were conducted with 10 medical doctors, 33 midwives and 8 community health officers in eight public health facilities in Nigeria. The qualitative data were coded using the Dedoose software for analysis and thematically analyzed. Findings The study revealed enormous gender inequalities embedded in the healthcare system. They include gender gaps in leadership positions, devaluation of midwifery, intra-professional inequalities, disparities in resources and conditions of service, and discriminatory practices. The inequalities have resulted in poor rapport with women, leading to more authoritative care, agitation and abandonment of women, intentional negligence and physical abuse. The inequalities also fuel discontentment among midwives and this is transferred to the labouring women through constant yelling and shouting. The poor treatment of midwives also contributes to the mass emigration of female health workers, resulting in increased workload and burnout of midwives, which leads to poor care and abuse in the maternity wards. Conclusion Dealing with obstetric violence requires structural changes that focus on dismantling the patriarchal patterns embedded in the healthcare system in Nigeria.