An estimated 800 pregnancy-related deaths occur daily, with about two-thirds occurring in sub-Saharan Africa (SSA) alone. Poor Person-Centered Maternal Health Care (PCMC) is a key factor driving the high maternal mortality. PCMC refers to care that is respectful and responsive to women’s preferences, needs, and values. Documentation of disrespectful, abusive, and neglectful treatment of women in health facilities during childbirth has highlighted a global crisis of poor PCMC. Such mistreatment deters women from giving birth in health facilities, leading to high mortality from lack of skilled care for complications. Poor PCMC also leads to delayed, inadequate, unnecessary, or harmful care. Additionally, disparities in PCMC are driving disparities in maternal and neonatal outcomes. Yet, little research exists on the drivers of poor PCMC, especially from a provider perspective, and consequently, little is known about effective interventions to improve PCMC in low-resource settings like SSA.

To be able to design effective evidence-based interventions to improve PCMC, we need to understand how various factors interact to produce poor PCMC. The objective of this project is to examine the drivers of poor PCMC in Ghana. In addition to an exploratory approach to examine the drivers of PCMC more broadly, we focus on understanding the role of three factors—provider stress, implicit bias, and difficult situations—that we posit to be key elements driving poor PCMC and contributing to disparities in PCMC. We focus on these three factors because they have received little attention in the quality of care dialogue in SSA, although literature from high income settings show that these factors contribute to poor patient provider interactions as well as to disparities in care.