Dress the way you want to be addressed:” Factors Contributing to Differential Care during Childbirth

Background: Maternal and newborn health outcomes remain a critical public health challenge, particularly in sub-Saharan Africa, where maternal and neonatal mortality rates are disproportionately high. Differential care, where care quality varies based on socioeconomic status or other attributes, exacerbates health inequities. This study explores maternal healthcare providers' perceptions of factors contributing to differential care during childbirth. Methods: We conducted in-depth interviews with 20 healthcare providers working in maternity units across 13 health facilities in the Upper East Region of Ghana from January to March 2021. Providers were selected based on their experience and involvement in childbirth care. We used a semi-structured guide to explore providers' views on factors contributing to poor and differential care, particularly regarding person-centered maternity care (PCMC)—respectful and responsive care during childbirth. Data were analyzed using thematic analysis. Results: Eight themes emerged from the qualitative analysis on factors contributing to differential care during childbirth. These included provider stress, client’s attitude and behavior, client’s appearance, client’s perceived knowledge and understanding, communication gaps, relationship with clients, birth preparedness, and severity or type of medical condition. The findings reveal a complex interplay of environment, provider, and client-related factors that contribute to differential care during childbirth. Conclusions: The study highlights the importance of addressing environmental, provider, and client-related factors to improve quality and equity in maternal health care. By addressing these issues, healthcare systems can work towards reducing disparities in maternal health care and improving outcomes for all women, particularly the most vulnerable women.