Exploring ethical dilemmas in the care of pregnant women in Ghana: a case of "maternal-foetal conflicts in a peri-urban hospital in Ghana".

introductionBioethics judgments often involve health care decisions, requiring careful consideration of rights, principles, beliefs, and interests. Maternal–foetal conflict presents ethical challenges regarding the balance between a mother’s rights, the needs of the foetus, and medical treatment. The changing landscape of reproductive technologies and medical treatments requires a rethinking of existing ethical frameworks to ensure their relevance and adequacy in tackling new concerns.

aimThis study aims to fill these gaps by exploring midwives’ perspectives on maternal–foetal conflicts in a peri-urban district hospital in Ghana, thus contributing to a context-sensitive understanding of maternal health ethics. METHODOLOGY: The study used an exploratory qualitative approach with in-depth interviews and focus group discussions. It involved twelve health professionals: ten midwives, one gynaecologist, and one quality assurance officer from a healthcare facility. We purposively recruited midwives who encountered conflicts between mothers’ and babies’ needs in their practice to share their experiences. We analyzed the data thematically to identify the moral, legal, and social issues related to these conflicts in peri-urban healthcare facilities.

resultsThe analysis identified four themes. First, there were tensions between maternal autonomy and foetal protection, as some women refused medically indicated procedures for personal or religious reasons, creating ethical dilemmas for clinicians. Second, cultural and religious beliefs strongly shaped treatment decisions, with refusals of caesarean section, blood transfusion, and other interventions occurring even when clinical risks were understood. Third, socioeconomic barriers limited access to essential care, raising concerns about fairness and equity. Finally healthcare providers reported moral distress and uncertainty due to community expectations and the absence of structured ethical guidelines. In such contexts, clinicians relied primarily on available clinical protocols, resulting in maternal autonomy being upheld only when it aligned with clinical judgement and perceived safety. Across themes, low educational status, strong religious influence, and cultural norms were key factors shaping decision-making and limiting women’s understanding of medical risks, often prioritizing clinical judgement over expressed maternal preferences.

conclusionMaternal-foetal conflicts are real in maternal health, affecting both clinical decision-making and clinical outcomes of pregnancy. Clear ethical and legal guidance on the status of the foetus is essential for resolving maternal-foetal conflict. The use of medical protocols to guide decision-making during such conflicts reveals a significant gap in patient-centred care. The study emphasizes the need for a structured ethical framework at both the hospital (local) and national levels. Ethics committees, medical councils, and professional associations must lead this charge of establishing these guidelines. Developing case-specific consent processes and including sociocultural perspectives in clinical practice would lead to a more balanced and ethically sound approach to managing these conflicts.

trial registrationNot Applicable.