Abstract
ABSTRACTBackground: Persistently high maternal mortality levels are a concern in developing countries. In India, monetary incentive schemes have increased institutional delivery rates appreciably, but have not been equally successful in reducing maternal mortality. Maternal outcomes are affected by quality of obstetric care and socio-cultural norms. In this light there is need to examine the quality of care provided to women delivering in institutions.Objective: This study aimed to examine pregnant women’s expectations of high-quality care in public health facilities in Uttar Pradesh, India, and to contrast this with provider’s perceptions of the same, as well as the barriers that limit their ability to provide high-quality care.Methods: A qualitative descriptive analysis was conducted on data from two studies – focus group discussions with rural women in their last trimester of pregnancy (conducted in 2014) to understand women’s experience and satisfaction with maternal care services, and in-depth interviews with care providers (conducted in 2016–17) to understand provision of person-centred care. Provider perspectives were matched with themes of women’s perspectives on quality of childbirth care in facilities.Results: Major themes of care prioritised by women included availability of doctors at the facility; availability of medicines; food; ambulance services; maintenance of cleanliness and hygiene; privacy; good and safe delivery with no complications; client-provider interaction; financial cost of care. Many women also voiced no expectation of care, indicating disillusionment from the existing system. Providers concurred with women on all themes of care except availability of doctors, as they felt that trained nurses were proficient in conducting deliveries.Conclusions: This study shows that women have clear expectations of quality care from facilities where they go to deliver. Understanding their expectations and matching them with providers’ perspectives of care is critical for efforts to improve the quality of care and thereby impact maternal outcomes.
Highlights
High maternal mortality levels are a concern in developing countries
Janani Suraksha Yojana (JSY) has been successful in facilitating a marked increase in institutional delivery, this increase has not been associated with a reduction in maternal mortality ratio (MMR) as initially anticipated [3]
Results are arranged by the themes of expectation of care prioritised by women during childbirth in health facilities
Summary
High maternal mortality levels are a concern in developing countries. In India, monetary incentive schemes have increased institutional delivery rates appreciably, but have not been successful in reducing maternal mortality. Maternal outcomes are affected by quality of obstetric care and socio-cultural norms In this light there is need to examine the quality of care provided to women delivering in institutions. In 2005, the Indian National Government launched the NRHM to improve access to health services for rural populations of India, and to reduce maternal and infant mortality rates [2]. JSY has been successful in facilitating a marked increase in institutional delivery, this increase has not been associated with a reduction in MMR as initially anticipated [3] This could be attributed to gaps in the quality of care received by women at the facilities
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