Structural Determinants of Obstetric Violence in Nigerian Public Hospitals: An Ethnographic and Critical Theory Investigation

Obstetric violence, encompassing physical, verbal, and procedural mistreatment of women during childbirth, is a form of gender-based violence with documented impacts on care-seeking and birth outcomes, yet its structural determinants in Nigerian public hospitals have not been examined through an integrated ethnographic and critical theory lens. This dissertation investigates the structural determinants of obstetric violence in Nigerian public hospitals across four geopolitical zones, using an ethnographic design embedded in a critical feminist theoretical framework. Eighteen months of ethnographic fieldwork was conducted in labour wards of public hospitals in Kaduna (North West), Enugu (South East), Lagos (South West), and Bayelsa (South South), involving participant observation of 120 births, 60 in-depth interviews with women who recently gave birth, and 30 interviews with midwives and obstetricians. Critical discourse analysis and grounded theory coding were applied. Structural determinants identified include chronic understaffing creating compassion fatigue, hierarchical power relations suppressing midwife advocacy, institutional impunity normalising mistreatment, and gender-based power asymmetries between providers and patients amplified by social class differentials. The dissertation develops an original Structural Obstetric Violence Framework (SOVF) that situates individual mistreatment episodes within institutional, regulatory, and societal structural layers. SOVF advances existing respectful maternity care discourse by providing a structural explanation for the persistence of obstetric violence despite awareness campaigns. Recommendations address institutional accountability, provider welfare, and regulatory enforcement. Keywords: obstetric violence, respectful maternity care, structural determinants, ethnography, Nigeria