Cashless childbirth, but at a cost: A grounded theory study on quality of intrapartum care in public health facilities in India

Abstract

Aimthis study aimed to explore and understand the perceptions and experiences of women regarding quality of care received during childbirth in public health facilities. Designqualitative in-depth interviews were conducted and analysed using the Grounded Theory approach. Participantsthirteen women who had given vaginal birth to a healthy newborn infant. Settingparticipants were interviewed in their homes in one district of Chhattisgarh, India. Data collectionthe interview followed a pre-tested guide comprising one key question: How did the women experience and perceive the care provided during labour and childbirth? Findings'cashless childbirth but at a cost: subordination during childbirth' was identified as the core category. Women chose a public health facility due to their socio-economic limitations, and to have a cashless and safe childbirth. Participants expressed a sense of trust in public health facilities, and verbalised that free food and ambulance services provided by the government were appreciated. Care during normal birth was medicalised, and women lacked control over the process of their labour. Often, the women experienced verbal and physical abuse, which led to passive acceptance of all the services provided to avoid confrontation with the providers. Conclusionsincreasingly higher numbers of women give birth in public health facilities in Chhattisgarh, India, and women who have no alternative place to have a safe and normal birth are the main beneficiaries. The labour rooms are functional, but there is a need for improvement of interpersonal processes, information-sharing, and sensitive treatment of women seeking childbirth services in public health facilities.