Abstract
ObjectiveTo evaluate the quality of essential care during normal labour and childbirth in maternity facilities in Uttar Pradesh, India.MethodsBetween 26 May and 8 July 2015, we used clinical observations to assess care provision for 275 mother–neonate pairs at 26 hospitals. Data on 42 items of care were collected, summarized into 17 clinical practices and three aggregate scores and then weighted to obtain population-based estimates. We examined unadjusted differences in quality between the public and private facilities. Multilevel linear mixed-effects models were used to adjust for birth attendant, facility and maternal characteristics.FindingsThe quality of care we observed was generally poor in both private and public facilities; the mean percentage of essential clinical care practices completed for each woman was 35.7%. Weighted estimates indicate that unqualified personnel provided care for 73.0% and 27.0% of the mother–neonate pairs in public and private facilities, respectively. Obstetric, neonatal and overall care at birth appeared better in the private facilities than in the public ones. In the adjusted analysis, the score for overall quality of care in private facilities was found to be six percentage points higher than the corresponding score for public facilities.ConclusionIn 2015, the personnel providing labour and childbirth care in maternity facilities were often unqualified and adherence to care protocols was generally poor. Initiatives to measure and improve the quality of care during labour and childbirth need to be developed in the private and public facilities in Uttar Pradesh.
Highlights
IntroductionThe quality of care offered at maternity facilities affects pregnant women – both emotionally and physically – and has an impact on the long-term health and survival of mothers and neonates.[1,2] An increased focus on care during childbirth can lead to reductions in disability, maternal and neonatal mortality and stillbirths.[2,3]
The quality of care offered at maternity facilities affects pregnant women – both emotionally and physically – and has an impact on the long-term health and survival of mothers and neonates.[1,2] An increased focus on care during childbirth can lead to reductions in disability, maternal and neonatal mortality and stillbirths.[2,3]An estimated 72% of all deliveries – including 69% of those in South Asia – occur in health facilities.[4]
According to the weighted estimates, qualified personnel performed 73.0% of deliveries in the private sector but only 27.0% of those in the public sector (P = 0.01) and 99.5% of maternity cases seen in the private sector but only 93.1% of those seen in the public sector were admitted during daytime workhours (P = 0.003; Table 2)
Summary
The quality of care offered at maternity facilities affects pregnant women – both emotionally and physically – and has an impact on the long-term health and survival of mothers and neonates.[1,2] An increased focus on care during childbirth can lead to reductions in disability, maternal and neonatal mortality and stillbirths.[2,3]. An estimated 72% of all deliveries – including 69% of those in South Asia – occur in health facilities.[4] Even in health facilities, failures in the processes of care can result in bad obstetric and neonatal outcomes[5,6] and care of poor quality often leads to low demand for maternal health services.[7,8] Some routine interventions can be ineffective or even harmful.[9]. Despite substantial efforts to promote evidence-based obstetrics, the uptake of recommended interventions into clinical practice has been limited.[10,11,12] Clinical practices can be difficult to change because they are influenced by health worker and patient characteristics, the complexity of the tasks involved and the institutional and sociocultural environments.[13,14]
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