BACKGROUND:
Global efforts to improve maternal and neonatal outcomes are promoting facility-based maternity care, particularly in lower-middle-income countries such as Ghana. While strategies to reduce maternal and neonatal mortality emphasise hospital-based deliveries, there have also been reports of increased medicalisation even for low-risk births.

OBJECTIVES:
This study aimed to examine how and why medicalised childbirth practices occur in two Ghanaian public health facilities and assess their impact on the provision, experience, and outcomes of care, using the WHO Quality of Care Framework.

METHODS:
A focused ethnographic study was conducted in two public health facilities in Ghana. Data collection involved non-participant observation, document analysis, and semi-structured interviews with maternity care providers. Thematic analysis generated four core themes.

RESULTS:
The findings revealed significant deficiencies in the practical provision of maternity care. Interventions such as intravenous fluids and urethral catheterisation were routinely administered to low-risk women, often without clinical indication. Care was inconsistent, provider-centred, and unsupported by formal clinical guidelines. Infrastructural inadequacies, including staff shortages and limited material resources, further constrained the timely and appropriate delivery of care. Providers commonly framed childbirth as inherently risky and justified medical interventions based on institutional norms and fear of blame, rather than evidence-based guidance. Interprofessional dynamics, hierarchical decision-making, and power imbalances influenced decisions regarding the use of medical interventions. These factors contributed to the exclusion of women from decision-making processes and a lack of respectful, person-centred care. Collectively, these conditions compromised quality across all domains of the WHO Quality of Care Framework: provision of care, experience of care, and outcomes

CONCLUSIONS:
Medicalisation in Ghana’s maternity facilities is driven by institutional norms, resource constraints, professional perspectives and power hierarchies. Addressing this requires structural investment, midwifery empowerment, and a shift towards woman-centred, evidence-based care.

KEY MESSAGE:
Improving quality requires more than protocols. Midwife-led, respectful, and relational care must be prioritised to rehumanise childbirth. Poster session 1 (Group A)