Abstract
ObjectivesTo investigate the nature and context of mistreatment during labour and childbirth at public and private sector maternity facilities in Uttar Pradesh, India.MethodsThis study analyses mixed-methods data obtained through systematic clinical observations and open-ended comments recorded by the observers to describe care provision for 275 mothers and their newborns at 26 hospitals in three districts of Uttar Pradesh from 26 May to 8 July 2015. We conducted a bivariate descriptive analysis of the quantitative data and used a thematic approach to analyse qualitative data.FindingsAll women in the study encountered at least one indicator of mistreatment. There was a high prevalence of not offering birthing position choice (92%) and routine manual exploration of the uterus (80%) in facilities in both sectors. Private sector facilities performed worse than the public sector for not allowing birth companions (p = 0.02) and for perineal shaving (p = < 0.001), whereas the public sector performed worse for not ensuring adequate privacy (p = < 0.001), not informing women prior to a vaginal examination (p = 0.01) and for physical violence (p = 0.04). Prepared comments by observers provide further contextual insights into the quantitative data, and additional themes of mistreatment, such as deficiencies in infection prevention, lack of analgesia for episiotomy, informal payments and poor hygiene standards at maternity facilities were identified.ConclusionsMistreatment of women frequently occurs in both private and public sector facilities. This paper contributes to the literature on mistreatment of women during labour and childbirth at maternity facilities in India by articulating new constructs of overtreatment and under-treatment. There are five key implications of this study. First, a systematic and context-specific effort to measure mistreatment in public and private sector facilities in high burden states in India is required. Second, a training initiative to orient all maternity care personnel to the principles of respectful maternity care would be useful. Third, innovative mechanisms to improve accountability towards respectful maternity care are required. Fourth, participatory community and health system interventions to support respectful maternity care would be useful. Lastly, we note that there needs to be a long-term, sustained investment in health systems so that supportive and enabling work-environments are available to front- line health workers.
Highlights
The number of maternal deaths remains large in India with 45,000 estimated deaths in 2013 [1]
This paper contributes to the literature on mistreatment of women during labour and childbirth at maternity facilities in India by articulating new constructs of overtreatment and under-treatment
We note that there needs to be a long-term, sustained investment in health systems so that supportive and enabling work-environments are available to front- line health workers
Summary
The number of maternal deaths remains large in India with 45,000 estimated deaths in 2013 [1]. Since 2006, the Government of India has promoted skilled attendance at birth and rapidly expanded the Janani Suraksha Yojana (JSY) programme that benefits approximately 40% of India’s birth cohort [2]. The JSY is a cash transfer programme that provides a monetary incentives to women attending institutions for birth [3]. Recent evidence from JSY has been cautionary and highlights the need to improve Quality of Care (QoC), concomitantly, with efforts to increase utilisation of institutional births [4]. Ensuring high QoC at the time of birth encompasses the application of evidence- based obstetric and neonatal care and efforts to ensure positive birth experiences for pregnant woman [5]. Dignity and emotional support, integral to ensuring positive birth experiences have been overlooked in research, policy, programmes and practice [6, 7]
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
