How just and fair are consent and debriefing for caesarean sections in Cameroon? An exploration of womens and providers perspectives

Women-centeredness and a positive experience of caesarean sections (CS) care is contingent upon just, equitable and fair treatment of women during informed consent and post-operative debriefing, yet evidence from low-resource settings remains scarce. This study explored how routine practices of informed consent and post-operative debriefing for CS in West Cameroon speak to justice and fairness. From March 2024 to August 2024, 69 purposively selected providers CS and 20 post-CS women were had face-to-face in-depth interviews. They were selected from the twenty hospitals in the West Region of Cameroon that recorded 100 or more CSs in 2022. Using an interpretivist paradigm, we generated codes inductively from verbatim transcripts and conducted thematic analysis. Our analysis drew on bioethical frameworks related to womens rights (Fouries feminist approach to bioethics), epistemic and structural (in)justice (Frickers conception of epistemic injustice and Powers and Fadens work on power, advantage and human rights), and power relations (Oderos work on patient - health provider power dynamics). Consent procedure for CS was mainly verbal and conducted without protocols thus causing an informational deficit accentuated by the concealment or downplaying of risks and disproportionate involvement of third parties. Consent is generally initiated by the antenatal care or labour room midwife, confirmed by the attending physician and completed by the surgical theatre team (scrub and anaesthetist nurses). We identified several manifestations of injustice and unfairness in consent interactions comprising: a profound informational inadequacy contravening national medico-legal provisions; culturally hostile, informational deficient and disrespectful emergency consent routines; and unfairness towards rural women of low educational background. Routine debriefing practices were unfair towards low-income and unassertive women, the default being the absence of debriefing that was only provided upon womans resolute request. Four key barriers underpin these inequities: fear of CS, cultural misalignment, hospital structural constraints, and pervasive corruption. Consent routines for both elective and emergency CSs in the West Region of Cameroon are characterised by several dimensions of injustice and unfairness that are not subsequently mitigated by post-operative debriefing which is by default absent. The underpinning of these are systemic drawbacks require redress to make consent, debriefing and CS at large more equitable, just and fair.