Health Care Providers In India Research Articles

Knowledge and attitude on childhood cancer survivorship among healthcare trainees: a multicentre study from India

BackgroundThe proportion of childhood cancer survivors (CCS) in low/middle-income countries (LMICs) is rising. CCS often develop several physical and psycho-social long-term adverse effects, with unique healthcare needs. Primary healthcare providers...

Promotion and strategies of menstrual cup use among healthcare providers: A primer towards a sustainable solution for menstrual health and hygiene management in India

Menstrual cups are considered a sustainable solution for menstrual health and hygiene management, as they are cost-effective, environment-friendly, reusable and offer health benefits over traditional menstrual hygiene products such as pads and tampons. However, in lower middle income countries (LMICs), menstrual cup use is limited. Recently, India's current menstrual hygiene program has included menstrual cups as an option for menstrual health and hygiene management. However, the menstrual cup has not been promoted widely in the Indian context. Even if the use of menstrual cups among female healthcare providers in India is minimal, the manuscript identified the crucial challenges in menstrual health and hygiene management, the role of menstrual cups as a solution and the essential strategies to increase menstrual cup use. Programmatic success requires endorsement from healthcare providers as they are trusted sources of information related to healthcare. Good experiences and leading examples from healthcare providers about using menstrual cups is a welcoming step in the path of the dream of a "pad-free country" for India.

A Knowledge, Attitude, and Practice Survey on Oncology Healthcare Professionals’ Awareness of Cancer Cachexia Diagnosis and its Management: A Cross-sectional Study

Introduction: As per the new classification of Cancer Cachexia (CC), the clear distinct precachexia stage can be identified, enabling early interventional strategies to retard the progression of CC. Given its recent classification and potential to prevent the onset of CC, it is imperative to study its awareness among Oncology Health Care Providers in India. Aim: To assess the Knowledge, Attitude, and Practices (KAP) of diagnosing and managing CC in a group of oncologists and Onco-physiotherapists in India. Materials and Methods: This was a survey-based crosssectional study. The surveys were disseminated through various Indian Oncology professional organisation bodies in the country via emails from May 2020 to April 2021. Two survey questionnaires were formulated and validated based on a literature review and input from experts in the field. A total of 64 oncologists with an average of 11.96±8.49 years of experience and 53 physiotherapists with an average of 3.86±4.89 years of experience participated in the survey. Data was analysed using descriptive statistics. Results: In the knowledge domain, oncologists considered muscle wasting (37, 58%), weight loss (36, 57%), and loss of appetite (18, 14%) as the most accurate determinants of CC, and Onco-physiotherapists considered weight loss (18, 34%), muscle wasting (16, 30%), and loss of appetite (11, 21%) as the most accurate determinants. In the attitude domain of both surveys, nutritional therapy was considered an extremely important treatment. In the practice domain, the results showed that the majority of Oncologists (25, 39%) would initiate treatment at a weight loss of >5% when the stage of cachexia or refractory cachexia may have set in, while Oncophysiotherapists (23, 43%) would do so at 5%. Conclusion: These surveys suggest a knowledge-to-action gap and highlight the need for increased awareness about CC among cancer healthcare providers for optimal patient care.

Is the quality of public health facilities always worse compared to private health facilities: Association between birthplace on neonatal deaths in the Indian states.

The role of place of delivery on the neonatal health outcomes are very crucial. Although the quality of care is being improved, there is no consensus about who is the better healthcare provider in low and middle-income countries (LMICs), public or private facilities. The aim of this study is to assess the differentials in neonatal mortality by the type of healthcare providers in India and its states. We used the data from the fourth wave of the National Family Health Survey 2015-16 (NFHS-4). Information on 259,627 live births to women within the five years preceding the survey was examined. Neonatal mortality rates for state and national levels were calculated using DHS methodology. Multi-variate logistics regression was performed to find the effect of birthplace on neonatal deaths. Propensity score matching (PSM) was used to evaluate the relationship between place of delivery and neonatal deaths to account for the bias attributable to observable covariates. The rise in parity of the women and purchasing power influences the choice of healthcare providers. Increased neonatal mortality was found in private hospital delivery compared to public hospitals in Punjab, Rajasthan, Chhattisgarh, Madhya Pradesh, Bihar, Jharkhand, Odisha, Goa, Maharashtra, Andhra Pradesh and Karnataka states using propensity score matching analysis. However, analysis on the standard of pre-natal and post-natal care indicates that private hospitals generally outperformed public hospitals. The study observed a significant variation in neonatal mortality among public and private health care systems in India. Findings of the study urges that more attention be paid to the improve care at the place of delivery to improve neonatal health. There is a need of strengthened national health policy and public-private partnerships in order to improve maternal and child health care in both private and public health facilities.

Perspectives of Pregnant Women on Maternal Health and Pregnancy Experiences in Urban Areas | A Qualitative Analysis of Maternal Health in Tamil Nadu

"Maternal health and pregnancy experiences are critical issues for women in India. Despite recent efforts to improve maternal health outcomes, there is still much work to be done. This research project aims to explore the current state of maternity health in India and investigate the pregnancy experiences of pregnant women. Using a mixed-methods approach that combines qualitative interviews with quantitative data analysis, this study will examine factors that contribute to maternal mortality and morbidity, including access to health care, socioeconomic status, and cultural norms. Additionally, this research will explore the experiences of pregnant women in India, including the challenges they face during pregnancy and childbirth. By examining these issues, this study aims to provide recommendations for improving maternal health outcomes and promoting positive pregnancy experiences for women in India." The study will examine several factors that affect maternity health in India, including access to healthcare services, socioeconomic status, and cultural norms. By exploring these factors, the research project aims to develop recommendations for improving maternal health outcomes and promoting positive pregnancy experiences. The research project will provide valuable insights into the experiences of pregnant women in India, including the challenges they face during pregnancy and childbirth. It will also identify areas where improvements are needed to enhance maternal health outcomes in the country. By disseminating the findings of the study, the hope is to create a greater awareness of the issues surrounding maternity health and to provide useful guidance for policymakers and healthcare providers in India.

Knowledge, attitudes, and behaviors of Indian medical students and health-care providers on COVID-19: An Online Cross-Sectional Survey

Background: COVID-19 has created fear, misconception, and apprehensions among not just the public but also the present and future health-care providers. The COVID-19 pandemic has passed two waves, and currently, the third wave is waning. Aim: This study aimed to evaluate the knowledge, attitude, and practice toward COVID-19 among the health-care providers and medical students of India. Materials and Methods: This was a cross-sectional, observational study conducted with medical students, practicing doctors, nurses, ward attendants, and other health-care workers working all over India. The questionnaire used for the study was developed using the three-step modified Delphi method. It was prevalidated and standardized by conducting a pilot study. Then, the survey questionnaire was circulated via Google Forms. The collected responses were tested statistically by Kolmogorov–Smirnov test, Chi-square, and Spearman's rank correlation. Results: A total of 2211 (1137 medical students, 840 doctors, 126 nurses, 12 ward attendants, and 96 other health-care workers) respondents participated in the study. The mean score for knowledge was 5.93 ± 1.21, for attitude was 5.20 ± 0.84, and for practice was 2·38 ± 0·896. We found a significant positive correlation between knowledge and attitude, knowledge and practices, and attitude and practices. Conclusion: There is an average to a good level of knowledge, attitude, and practice toward COVID-19 among the medical students and health-care providers in India in the third wave of the COVID-19 pandemic. The positive correlation affirms that better knowledge can lead to a positive attitude. This ultimately helps build appropriate behavior.

Associations between sociodemographic factors and receiving "ask and advise" services from healthcare providers in India: analysis of the national GATS-2 dataset

BackgroundIndia is home to about 12% of the world's tobacco users, with about 1.35 million tobacco-related deaths each year. The morbidity and mortality rates are socially patterned based on gender, rural vs. urban residence, education, and other factors. Following the World Health Organization's guidance, it is critical to offer tobacco users support for cessation as a complement to policy and environmental changes. Such guidance is typically unavailable in low-resource systems, despite the potential for population-level impact. Additionally, service delivery for tobacco control tends to be patterned by sociodemographic factors. To understand current activity in this area, we assessed the percentage of daily tobacco users being asked about tobacco use and advised to quit by a healthcare provider. We also examined social patterning of receipt of services (related to by rural vs. urban residence, age, gender, education, caste, and wealth).MethodsWe analyzed cross-sectional data from India's 2016-2017 Global Adult Tobacco Survey (GATS-2), a nationally representative survey. Among 74,037 respondents, about 25% were daily users of smoked and/or smokeless tobacco. We examined rates of being asked and advised about tobacco use overall and based on rural vs. urban residence, age, gender, education, caste, and wealth. We also conducted multivariate logistic regression to assess the association of demographic and socioeconomic conditions with participants' receipt of “ask and advise” services.ResultsNationally, among daily tobacco users, we found low rates of individuals reporting being asked about tobacco use or advised to quit by a healthcare provider (22% and 19%, respectively). Being asked and advised about tobacco use was patterned by age, gender, education, caste, and wealth in our final regression model.ConclusionsThis study offers a helpful starting point in identifying opportunities to address a critical service delivery gap in India. Given the existing burden on the public health and health systems, scale-up will require innovative, resource-appropriate solutions. The findings also point to the need to center equity in the design and scale-up of tobacco cessation supports so that marginalized and underserved groups will have equitable access to these critical services.

“DISCLOSURE OF DIAGNOSIS IN PATIENTS WITH HAEMATOLOGICAL CANCERSEXPERIENCE FROM A TERTIARY CENTRE IN INDIA”

Disclosure of diagnosis is a challenge for health care providers in India. (1) There is preference towards a family centred decision making in favour of a patient-centred process. Various socio-cultural factors are then at play in a doctor-patient interaction in India. With family playing a significant role in healthcare decisions, there is often collusion between the doctor and the family to withhold information from the patient.(2)

CML-489 Anxiety and Depression Rates in Patients With Hematologic Malignancies Among Patients in Southern India

Patients in India often find it taboo to report mental health symptoms such as depression and anxiety. The authors set out with the aim to check for the prevalence of anxiety and depression in patients with hematological malignancies to see how underreported it is. The authors conducted a cross-sectional study of 358 patients who were currently undergoing treatment for various hematologic malignancies with the goal of detecting anxiety or depression in a hospital in Andhra Pradesh, India. Patients who had previously been diagnosed with depression or anxiety were excluded. Patients were assessed for depression with the patient health questionnaire 9 (PHQ-9) and anxiety with the general anxiety disorder assessment 7 (GAD-7). The patients were interviewed without the presence of their other family members in order to prevent skewing of results. Among the 358 patients who were surveyed with the PHQ-9 scale, there were 112 (31.2%) patients who had a score greater than 4. 11 (9.8%) patients had a score greater than 20 indicating severe depression. Of the 11 patients, 1 patient admitted they were actively suicidal and was ashamed to tell their family. 43 (38.3%) patients had a score between 15-19, 47 (41.9%) patients had a score between 10-14, and 11 (9.8%) patients had a score between 5-9. 198 (55.3%) patients scored greater than 10 after being surveyed with the GAD-7, indicating that further intervention was required. There were 79 (22%) patients who had an overlap of PHQ-9 greater than 4 and a GAD-7 greater than 10. According to our data, there seems to be a large number of patients who do not report their mental health symptoms. We urge health care providers in India to screen for depression and anxiety, as early intervention with counseling and medications may promote better health for patients suffering from hematologic malignancies.

COVID-19 Courtesy Stigma among Healthcare Providers in India: A Study of Stigma Management Communication and its Impact

ABSTRACT In early 2020, the first wave of the COVID-19 pandemic hit India, generating one of the highest rates of infection and death in the world. Meanwhile, healthcare workers experienced stigma and discrimination due to their association with COVID-19 patients. This study analyzed healthcare workers’ experience of courtesy stigma in India, the communication strategies they used to manage stigma, and the impact on their mental health. A cross-sectional survey of 150 healthcare workers in India showed that almost 50% experienced discrimination due to their association with COVID-19 patients. Using Confirmatory Factor Analysis and Structural Equation Modeling, this study found that experience of discrimination was associated with perceived courtesy stigma. Two stigma management strategies (reducing offensiveness and passive acceptance) mediated the relationship between perceived courtesy stigma and perceived stress and depression. Participants also reported engaging in stigma management strategies of bonding with other healthcare professionals and passive acceptance of the stigma more than reducing stigma and displaying/disclosing stigma. We conclude that perhaps due to depletion of cognitive and emotional resources, healthcare workers engaged more in social support (bonding) and passive stigma acceptance strategies to alleviate the stress associated with providing COVID-19 patient care. Practical and theoretical implications are further discussed.

Management of Hypertension in Patients with Diabetes: A Comprehensive Review of the Perceptions and Practices of Health Care Providers in India.

This study evaluated the perception and practices of health care providers (physicians, diabetologists, and endocrinologists) regarding the treatment of hypertension in patients with diabetes in India. Health care providers throughout India who treated patients with diabetes and hypertension were invited to participate in an online survey and periodic 21 virtual meetings. They were questioned about their perception and practices in managing these patients, and strategies to improve blood pressure (BP). The online survey was completed by 2,513 health care providers, and 344 participated in virtual meetings. More than 50% reported that 31-50% of their patients with diabetes also had hypertension. Home BP monitoring was recommended by 88%, and lifestyle modifications were consistently recommended. Choice of antihypertensive treatment varied based on comorbidities, and a renin-angiotensin system blocker plus a calcium channel blocker (CCB) was the most common combination for dual antihypertensive therapy. Suggested strategies to improve BP control included patient awareness/education, lifestyle modifications, better follow-up/monitoring, and optimization of therapy. Indian health care providers were aware of clinical recommendations and practices regarding treatment of patients with diabetes and hypertension, and generally make clinical decisions consistent with current guidelines. Optimization of care for these patients is essential to reduce cardiovascular disease risk and improve patient outcomes.

Is Profit Motive Infecting Indian Private Health Care Sector? An Analysis of Unincorporated Healthcare Providers

Indian healthcare system is dominated by private sector; its importance is growing with implementation of ‘Ayushman Bharat’, flagship programme of Indian government. Though 62% and 75% of inpatient and outpatient cases in India are treated in private sector, the information about the economy of private healthcare providers is very limited. To the author’s best knowledge, this is the first attempt to address the issue with empirical evidence for the private healthcare providers from a nationally representative survey data for India. Private healthcare sector is estimated to provide employment to 2.34 million persons annually and generate gross value added (GVA) of ₹473.3 billion. Treatment cost on an average is much high in private sector as compared to the public sector. But supply-side data show that average annual receipt per annum is six times higher than average operating cost per annum for unincorporated private healthcare providers in India, indicating underlying profit motive. Analysis of factor payments shows that 55% of GVA of unincorporated private hospitals is gross operating surplus (or profit), followed by emoluments paid to employees and workers (42%). These factors potentially cause over-charging in private sector. Context-specific and appropriate regulatory mechanisms are very much needed to ensure quality of services and control medical inflation.

Acceptance of covid-19 vaccine among the healthcare providers in India.

By increasing immunity, the corona virus disease-19 (COVID-19) vaccine is expected to reduce the rate of infection and severity of infection, as well as the rate of hospitalisation. Healthcare providers (HCPs) can provide a good example when it comes to their health habits. HCPs are believed to have the best vaccine acceptance rates because they are open-minded and informed. By concentrating on COVID-19 vaccine attitudes among HCPs in India, the current study gives a clear picture of vaccine acceptability. A cross-sectional observational study approach was used. Participants in the study gave their informed permission. Snowball sampling was employed to spread the survey around social media platforms (mostly WhatsApp groups and email IDs). The survey was open from April 1 through April 30, 2021, and a total of 316 responses were received. SPSS software, version 25, was used for statistical analysis (SPSS, Inc., Chicago, IL, USA). The participants' average age was 32.8 ± 9.7, with 57% of them being male. 16.5% of the 316 individuals had a history of chronic illness. 40.5% had ever experienced COVID-19 symptoms, and 24.1% had been diagnosed with COVID-19 while on duty. Only 16.5% strongly agreed that they could get COVID-19 in the near future, and 48.1% disputed that obtaining COVID-19 infection would make them very unwell. Only 40.5% of participants were concerned about the possible side effects of the vaccine, while 63.2% were not concerned about the possible side effects of the vaccine. Only 39.2% were concerned about the affordability (high price) of vaccines. The majority (95%) of participants agreed to be vaccinated when sufficient information was provided, and only 31.7% agreed to be vaccinated if they were vaccinated free of charge. Due to the high level of current willingness among healthcare professionals to accept COVID-19 vaccines, these data may not be available to the general public. Understanding the complex and interrelated factors that influence vaccination decisions and the determinants of vaccine hesitancy in a particular population is essential to inform interventions to improve immunization coverage.

A Modern Perspective on Vaccinating Healthcare Service Providers in India: A Narrative Review.

Healthcare providers (HCPs) are at increased risk of acquisition and transmission of infectious disease. Vaccinating HCPs is an essential preventive measure to protect them and their patients against communicable diseases, while positively and directly impacting the functioning of the healthcare system. In India, healthcare represents one of the largest employment sectors with 3.8 million HCPs; however, there is limited awareness of national immunisation guidelines for the Indian HCP population. Data from communicable disease outbreaks across India suggest inadequate vaccination rates amongst HCPs; studies have reported influenza and varicella vaccination rates as low as 4.4% and 16%, respectively. In this review, we discuss data highlighting the impact of insufficient vaccination coverage, barriers to vaccination, and the lack of immunisation guidelines amongst HCPs in India. COVID-19 vaccination programmes for HCPs have been critical in slowing the pandemic in India. This provides an opportunity to raise awareness about the importance of vaccines amongst HCPs in India.

Prevalence and severity of secondary traumatic stress and optimism in Indian health care professionals during COVID-19 lockdown.

The COVID-19 pandemic has brought to light the lacunae in the preparedness of healthcare systems across the globe. This preparedness also includes the safety of healthcare providers (HCPs) at various levels. Sudden spread of COVID-19 infection has created threatening and vulnerable conditions for the HCPs. The current pandemic situation has not only affected physical health of HCPs but also their mental health. This study aims to understand the prevalence and severity of secondary traumatic stress, optimism parameters, along with states of mood experienced by the HCPs, viz., doctors, nurses and allied healthcare professionals (including Physiotherapist, Lab technicians, Phlebotomist, dieticians, administrative staff and clinical pharmacist), during the COVID-19 lockdown in India. The assessment of level of secondary traumatic stress (STS), optimism/pessimism (via Life Orientation Test-Revised) and current mood states experienced by Indian HCPs in the present COVID-19 pandemic situation was done using a primary data of 2,008 HCPs from India during the first lockdown during April-May 2020. Data was collected through snow-ball sampling technique, reaching out to various medical health care professionals through social media platforms. Amongst the study sample 88.2% of doctors, 79.2 of nurses and 58.6% of allied HCPs were found to have STS in varying severity. There was a female preponderance in the category of Severe STS. Higher optimism on the LOTR scale was observed among doctors at 39.3% followed by nurses at 26.7% and allied health care professionals 22.8%. The mood visual analogue scale which measures the "mood" during the survey indicated moderate mood states without any gender bias in the study sample. The current investigation sheds light on the magnitude of the STSS experienced by the HCPs in the Indian Subcontinent during the pandemic. This hitherto undiagnosed and unaddressed issue, calls for a dire need of creating better and accessible mental health programmes and facilities for the health care providers in India.

Awareness, Attitude, and Current Practices Toward Influenza Vaccination Among Physicians in India: A Multicenter, Cross-Sectional Study.

Background: Although annual influenza vaccination is recommended for healthcare providers (HCPs), vaccination rate among HCPs in India is generally low. This cross-sectional survey was conducted to evaluate physicians' awareness, attitude, and current practices toward influenza vaccination in high-risk groups in India.Methods: The survey was performed in June–July 2020, wherein consulting physicians, pulmonologists, diabetologists, obstetricians/gynecologists, or cardiologists across 14 cities completed a 39-item questionnaire consisting of 3 sections, one each on awareness, attitude, and practice patterns. Descriptive statistics were used to summarize the study results. Statistical analysis was performed for comparison of subgroups by physician specialty, city of practice (metro/non-metro), and zone of practice (north/south/east/west). Level of statistical significance was set at p < 0.05.Results: In all, 780 physicians completed the survey. Of these, 3.97, 53.08, and 42.95% had high, medium, and low level of awareness about influenza/influenza vaccination, respectively. Statistically significant (p < 0.05) between-group differences were found by physician specialty and zone of practice. In terms of attitude toward vaccination of high-risk group subjects, only 0.9% physicians were “extremely concerned,” while the majority (92.56%) were “quite concerned” and 6.54% were a “little concerned,” with no reported significant differences between different subgroups. With regard to practice patterns, 82.82% of physicians offered influenza vaccines to their patients, 32.69% vaccinated 10–25% of patients per month, and 38.85% required and offered the vaccine to their office staff. Physicians' reasons for not prescribing influenza vaccines to patients included fear of side effects (16.54%), cost (15.64%), lack of awareness about availability (15.38%), absence of belief that it is beneficial (14.36%), history of side effects (13.46%), and patients' fear of needles (11.28%).Conclusion: These findings suggest the need to implement educational strategies among physicians to enhance their awareness about influenza vaccination and improve their attitudes and current practices toward influenza vaccination especially in high-risk groups in India.

Age and reasons for first dental visit in a tertiary care hospital in South India

Background: Early visit to the dentist with an aim of prevention has been advocated universally, but the timing for seeking dental treatment differs among different countries. Aim: This study aimed to determine the timing and reasons for the first dental visit among children attending the dental clinic in a tertiary care hospital in Tamil Nadu, South India. Methods: This hospital-based study reviewed the dental records of children who had visited the dental clinic from January 1, 2019 to December 31, 2019. All those between 0 and 10 years of age and visiting a dentist for the first time were included in the study. The continuous variables were analyzed using mean and standard deviation. The categorical variables were calculated using Chi-square, Fisher's exact test, and two-proportion test. Results: We reviewed the dental records of 1005 children (60% boys and 40% girls). The most frequent age for the first dental visit was between 5 and 6 years. The most common reasons for visits to the dental clinic were pain (23.8%) and dental caries (16.6%). Only 3.8% of children had their first dental visit by 1 year of age and primarily for therapeutic purposes. Dental caries and traumatic injuries were more frequent in children below the age of 3 years. Conclusion: The present study found pain as the most frequent reason for the visit, but there was a delay in first dental visits among children. This study suggests effective oral health policies for children and a need to change the perception and practices among the dental professionals in the region. Timing of the first dental visit of a child can help us to determine the quality of dental care a child receives. Delayed dental visit among children in this study indicates the ineffective oral health policies and the gap that exists between the pediatric health-care providers in India.

Exploring quality of life among head-and-neck cancer patients in Western India using European organization for research and treatment of cancer questionnaires.

Head-and-neck cancers (HNCs) are one of the major public health problems for both patients and the health-care providers in India. The clinical manifestations of HNC and its treatment can lead to negative effects on the quality of life (QoL) of the patient. The study is aimed to explore the QoL using the European Organization for Research and Treatment of Cancer (EORTC) QoL questionnaires among HNC patients in Western part of India. A cross-sectional prospective study was conducted among 400 HNC patients attending the tertiary cancer center. The QoL was assessed by using the EORTC core questionnaire (EORTC QLQ-C30) and EORTC head- and neck-specific questionnaire (EORTC QLQ-H and N35). The data were explored using means, standard deviation, medians, ranges, and proportions. All the 400 patients had completed the questionnaire having a compliance rate of 100%. There was no missing data at the item level for the EORTC QLQ-C30 questionnaire. While the missing items for EORTC QLQ-H and N35 were: problems while swallowing food, problems with teeth, and sexuality. The mean functional score ranged from 74.22 to 93.49 for EORTC QLQ-C30. The mean symptoms score was found in the range from 3.25 to 81.50 for EORTC QLQ-H and N35. Both questionnaires were comprehensive and well accepted by the patients. These questionnaires provided the information-related disease-specific QoL data, which otherwise is often missed. Health-care providers should not only focus on the clinical effects of treatment but also on QoL issues because it will improve overall patient care and survival.

Why do some health care providers disrespect and abuse women during childbirth in India?

BackgroundDisrespect and abuse during childbirth can result in fear of childbirth. Consequently, women may be discouraged to seek care, increasing the likelihood for women to choose elective cesarean section in order to avoid humiliation, postnatal depression and even maternal mortality. This study investigates the causes underlying mistreatment of women during childbirth by health care providers in India, where evidence of disrespect and abuse has been reported. MethodsQualitative research was undertaken involving 34 in-depth interviews with midwifery and nursing leaders from India who represent administration, advocacy, education, regulation, research and service provision at state and national levels. Data are analysed thematically with NVivo12. The analysis added value by bringing an international perspective from interviews with midwifery leaders from Switzerland and the United Kingdom. FindingsThe factors leading to disrespect and abuse of women relate to characteristics of both women and their midwives. Relevant woman-related attributes include her age, gender, physical appearance and education, extending to the social environment including her social status, family support, culture of abuse, myths around childbirth and sex-based discrimination. Midwife-related factors include gender, workload, medical hierarchy, bullying and powerlessness. DiscussionThe intersectionality of factors associated with mistreatment during childbirth operate at individual, infrastructural, social and policy levels for both the women and nurse-midwives, and these factors could exacerbate existing gender-based inequalities. Maternal health policies should address the complex interplay of these factors to ensure a positive birthing experience for women in India. ConclusionMaternal health interventions could improve by integrating women-centred protocols and monitoring measures to ensure respectful and dignified care during childbirth.

Peripartum Safety: Time to Act

Peripartum safety refers to the safe care of women throughout the antenatal, intranatal, and postnatal periods.Approximately 15% of all childbearing women are likely to develop life-threatening complications. Indiaand Nigeria accounted for one-third of global maternal deaths at the country level. Recognizing the need,the United States has initiated a Maternal safety Bundle. On a par with, The Government of India introducedvarious programs to reduce maternal deaths. Though the country made most of its progress, MMR stateperformances are varied in their extremes and failed to achieve the targeted goal. High maternal mortalityis associated with medical, socio-economic, and health care system problems are evidenced. The shortfallof skilled health care providers in India hampers progress towards achieving universal health coverage. Thecurrent situation calls for more sensitization and sustainable efforts for integration and institutionalizationof health system monitoring to achieve the target of Sustainable Developmental Goals. Studies need togerminate to tackle the health care insufficiencies of pregnant women and enhance the quality of care.