Background: Mistreatment during childbirth undermines women's dignity, autonomy, satisfaction with maternity services and confidence in facility-based care. This study examined mistreatment during facility-based childbirth and its implications for maternal satisfaction and future facility use among women in selected communities of Ebonyi State, Nigeria.

Methods: A community-based cross-sectional mixed-methods design was adopted. The quantitative component involved 300 women who had delivered in a health facility within the preceding 12 months in selected communities of Abakaliki, Afikpo and Izzi Local Government Areas. Childbirth experiences in primary healthcare centres, general hospitals and private facilities were assessed. The study was conceptually informed by Bohren et al.'s typology of mistreatment and respectful maternity-care principles. Quantitative variables included physical abuse, non-consented care, non-dignified care, abandonment or neglect, detention, discrimination, facility type, birth companionship, out-of-pocket payment, knowledge of respectful maternity-care rights, maternal satisfaction and future facility-birth intention.

Results: Overall, 205 of 300 women (68.3%) experienced at least one measured form of mistreatment. Non-dignified care was most prevalent (68.3%), followed by abandonment or neglect (36.3%), non-consented care (28.0%), discrimination (16.3%), physical abuse (14.0%) and detention (14.0%). Mistreatment was significantly associated with facility type, birth companionship, out-of-pocket payment, educational status and knowledge of respectful maternity-care rights. Women who experienced mistreatment reported substantially lower satisfaction (mean 2.25 ± 0.78) than women without mistreatment (4.82 ± 0.39, p < .001). Only 49.8% of mistreated women intended to use a health facility for future childbirth, compared with 100% of women who reported no mistreatment.

Conclusion: Mistreatment during facility-based childbirth was common and was strongly associated with poorer maternal satisfaction and reduced intention for future facility delivery. Strengthening respectful maternity-care standards, birth companionship, informed consent, financial protection, provider communication, accountability and women's knowledge of maternity-care rights is essential. Several complete or near-complete associations in the dataset require verification against original field records before final multivariable modelling.