|Year : 2023 | Volume
| Issue : 1 | Page : 26-30
Perception of beneficiaries regarding quality of care and respectful maternity care being provided in delivery room using LaQshya guidelines
Chandra Gopal Dogne1, Jitendra Dudi1, Nalini Dogne2, Sana Afrin1, Abhay Singh3, Deepa Raghunath1, Salil Sakalle1, Vinoth Gnana Chellaiyan4
1 Department of Community Medicine, MGM Medical College, Indore, Madhya Pradesh, India
2 Department of Obstetrics and Gynaecology, Gandhi Medical College, Bhopal, Madhya Pradesh, India
3 Department of Community and Family Medicine, AIIMS, Raebareli, Uttar Pradesh, India
4 Department of Community Medicine, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Chennai, Tamil Nadu, India
|Date of Submission||02-Sep-2022|
|Date of Decision||26-Oct-2022|
|Date of Acceptance||30-Oct-2022|
|Date of Web Publication||09-Feb-2023|
Dr. Sana Afrin
Department of Community Medicine, MGM Medical College, Indore, Madhya Pradesh
Source of Support: None, Conflict of Interest: None
Introduction: Quality of care in labor room and maternity operation theatre is crucial so that every pregnant woman receives the most appropriate care with dignity and respect, which is her fundamental right. The present study was attempted to assess the satisfaction of beneficiaries of both rural and urban areas visiting the public health facilities with regard to the quality of care and Respectful Maternal Care (RMC). Methodology: The present study was carried out in the Department of Community Medicine, MGM Medical College Indore to assess the satisfaction of beneficiaries of both rural and urban areas visiting the public health facilities with regard to the quality of care and Respectful Maternity Care (RMC) for 1 year from June 2020 to June 2021. A scoring system was used and based on the perception of the beneficiaries on different parameters on the scale of 1–5 where 1 – poor, 2 – satisfactory, 3 – good, 4 – very good, and 5 was considered excellent. Results: The majority of beneficiaries were in the age group of 21–30 years. Statistically significant difference between rural and urban areas in parameters of beneficiaries with regards to various aspects of post-natal care, in parameter of explanation of treatment procedure, maintenance of privacy efforts put to not allow to feel lonely and treatment with dignity and respect between rural and urban areas. Conclusion: When all the parameters and subparameters of the perception of beneficiaries of quality of care and respectful maternity care (RMC) were analyzed in both rural and urban areas, statistically significant difference was observed.
Keywords: Beneficiary perception, LaQshya guidelines, respectful maternity care
|How to cite this article:|
Dogne CG, Dudi J, Dogne N, Afrin S, Singh A, Raghunath D, Sakalle S, Chellaiyan VG. Perception of beneficiaries regarding quality of care and respectful maternity care being provided in delivery room using LaQshya guidelines. Indian J Med Spec 2023;14:26-30
|How to cite this URL:|
Dogne CG, Dudi J, Dogne N, Afrin S, Singh A, Raghunath D, Sakalle S, Chellaiyan VG. Perception of beneficiaries regarding quality of care and respectful maternity care being provided in delivery room using LaQshya guidelines. Indian J Med Spec [serial online] 2023 [cited 2023 Jun 9];14:26-30. Available from: http://www.ijms.in/text.asp?2023/14/1/26/369382
| Introduction|| |
The Government of India launched LaQshya program in 2017 by the Ministry of Health and Family Welfare (Mohfw, India) which aims at improving quality of care in labor room and maternity operation theater (OT) so that every pregnant woman receives the most appropriate care with dignity and respect, which is her fundamental right. LaQshya is a focused and targeted approach for improving intrapartum and immediate postpartum care beginning with high case load higher level facilities.
According to a policy statement from the World Health Organization (WHO) promoting respectful maternity care (RMC), "every woman has the right to the highest attainable standard of health, which includes the right to dignified, respectful health care." The WHO's vision for better maternal and newborn care, which emphasizes three areas that affect positive women's experiences: respect and dignity, effective communication, and emotional support, reflects this as well. More recently, the WHO published a thorough set of evidence-based recommendations with the goal of encouraging a positive user experience of intrapartum care. According to these recommendations, RMC is a concept that combines supportive and respectful care. This states that "the care organised for and provided to all women in a manner that maintains their dignity, privacy, and confidentiality, ensures freedom from harm and mistreatment, and enables informed choice and continuous support during labor and childbirth."
The degrading intrapartum care that occurs in hospitals around the world, particularly in low-and middle-income countries, is clearly demonstrated by research conducted over the past decades.,,,,,, This is true despite the growing recognition that the mistreatment of women during childbirth is a violation of their human rights. Mistreatment can have both immediate and long-term negative effects, including pain and suffering, unpleasant birthing experiences, labor anxiety, and a sense of dehumanization., Such appalling events might discourage facility-based births., Given that women are frequently mistreated while giving birth, research has largely (and understandably) focused on women's perspectives on care.,,, Less research has been done, however, to examine service providers' perspectives on the matter.,, Some of these investigations centered on how service providers felt about abuse and its potential effects on pregnant women's well-being; The present study attempted to assess the satisfaction of beneficiaries of both rural and urban areas visiting the public health facilities with regard to the quality of care and respectful maternity care (RMC).
| Methodology|| |
The present study was carried out in the Department of Community Medicine, MGM Medical College, Indore, to assess the satisfaction of beneficiaries of both rural and urban areas visiting the public health facilities with regard to the quality of care and Respectful Maternity Care (RMC). The study was conducted 1 year from the date of approval from the institutional ethics committee for 1 year from June 2020 to June 2021. Beneficiaries in the puerperal period who availed the services of labor room and delivery room/maternity OT room at the study site were included in the study, selected after sequential sampling, and gave consent for the study. Predesigned semi-structure questionnaire made on Google forms for assessment of beneficiary satisfaction with regards to the quality of service during intra and immediate postpartum period and respectful maternity care. These services will be provided by primary health center workers, which are medical officer – 2, staff nurse – 2, auxiliary nurse midwife – 3, laboratory technician – 1, and social workers – 2. Totally, the number of service providers was 10 for each primary health center, covering the population of fifty thousand. Moreover, these health-care providers were well-trained in maternal and child health. No freshers were included in this study. We followed interviewer method to acquire data; we explained the need and questionnaire in their own regional language to collect the necessary data. A self-devised scoring system was used to assess the perception of the beneficiaries on different parameters on the scale of 1–5 where 1 – poor, 2 – satisfactory, 3 – good, 4 – very good, and 5 was considered excellent. Sample size estimation – assuming the expected prevalence of 50% satisfaction among beneficiaries, the sample size is calculated as follows:
With the formula, n = z2PQ/d2. An expected prevalence is taken as 50% and margin of error (d) as 8%, the total sample arrived is 156. In this study, a total of 160 participants were included.
For beneficiaries in urban areas – out of 4 CHCS of Indore – Malharganj, Sanyogitaganj, Hukumchand, and Nanda Nagar and District Hospital Ujjain, 16 beneficiaries from each health unit were selected, thus total beneficiaries from urban areas selected were 16 × 5 = 80 beneficiaries from urban areas. For selecting beneficiaries in rural areas, out of a total 4 CHCs, 2 were selected from Indore (CHC Manpur and CHC Hatod), 2 were selected from Ujjan (CHC Ghatia and CHC Ingnoria). Out of these 4 CHCs, 4 PHCs were selected from each CHC. Thus, a total of 20 health centers were selected from rural areas (1 CHC and 4 PHCs), and 4 beneficiaries were selected from each health center. Since Hatod is both CHC and PHC total of 8 beneficiaries were included thus total beneficiaries from rural areas selected were 20 × 4 = 80 beneficiaries from health centers of rural areas. Thus, a total of 160 (80 from rural and 80 from urban areas are selected) ethical clearance of the study was done by the Ethical Committee of MGM Medical College Indore. Before data collection proper, we conducted a pilot study among 30 participants with our pro forma which is not included for analysis.
| Results|| |
Forty-five percent of beneficiaries in rural area and 38.125% in urban area of the total of 160 beneficiaries found no privacy in delivery room [Table 1]. Since the private room was not functional in rural CHCs hence 0%. Among the total 160 beneficiaries, only 3.75% of beneficiaries in urban CHC and 1.87% of beneficiaries in rural area found visual and auditory privacy in nonprivate room. Based on the perception of beneficiaries, there is statistically no significant difference in cleanliness conditions in delivery room in rural and urban areas; 9.376% and 15.625% of beneficiaries found that there is cleanliness in rural setup and urban setup, respectively [Table 2]. In both rural and urban areas, the major supply of water availability as per beneficiaries was through piped water supply to the delivery room [Table 3].
|Table 2: Scores of perception of beneficiaries on the facilities and infrastructure|
Click here to view
| Discussion|| |
Majority of beneficiaries of both rural and urban areas visiting the public health facilities were in the age group of 21–30 years. As far as the parity of beneficiaries is concerned, 63.1% of study subjects from both rural and urban areas visiting the public health facilities were Multiparous.
The parameters assessed were related to quality of service during intra and immediate postpartum period and respectful maternity care such as clean health institution along with cleanliness and accessibility of toilet, promptness & free-of-cost service, provision of essential medicine and a working phone-radio system. Interpersonal aspects such as welcoming on admission, maintaining of privacy, emotional support, not leaving the patient alone, treating with dignity, respect and politeness. In addition, decision-making support, explanation of the treatment procedure, information on postnatal care,nutrition-balanced diet, breastfeeding, postnatal follow-up, danger signs recognition and child immunization.The scores for these parameters were obtained from both urban and rural areas.
When all these parameters and subparameters of perception of beneficiaries were analyzed in both rural and urban areas statistically significant difference observed in infrastructure-related parameters included cleanliness-health institution (<0.0001), working phone/radio system (0.025), and maintenance of privacy (<0.0001). Similarly, with respect to respectful maternal care (RMC), the statistically significant difference was observed in the following parameters – treatment with dignity and respect (0.008), not allowed to feel lonely (0.007), and explaining treatment procedure (0.041). The parameters of warm welcome on admission, polite helpful staff, not allowed to feel lonely, and emotional support provided showed better scores in rural areas as compared to urban areas whereas the parameters of privacy maintained and treated with dignity and respect showed better scores in urban areas as compared to rural areas. Ansari and Yeravdekar while doing an extensive meta-analysis of respectful maternity care during childbirth in India found the overall pooled prevalence of disrespectful maternity care was 71.31% (95% confidence interval 39.84–102.78). The highest reported form of ill-treatment was nonconsent (49.84%), verbal abuse (25.75%) followed by threats (23.25%), physical abuse (16.96%), and discrimination (14.79%). Besides, other factors identified included lack of dignity, delivery by unqualified personnel, lack of privacy, demand for informal payments, and lack of basic infrastructure, hygiene, and sanitation. They have concluded that the high prevalence of disrespectful maternity care indicates an urgent need to improve maternity care in India by making it more respectful, dignified, and women centered.
Bohren et al. in 2015 in one of the extensive systematic reviews on the mistreatment of women during childbirth in health facilities globally concluded that women's experiences of childbirth worldwide are marred by mistreatment and although the mistreatment of women during delivery in health facilities often occurs at the level of the interaction between women and health-care providers, systemic failures at the levels of the health facility and the health system also contribute to its occurrence.
With respect to informative aspects of PNC care, statistically significant difference was observed in the provision of information on breastfeeding (<0.0001) and information on child immunization (<0.0001). Forty-five percent beneficiaries in rural area and 38.125% in urban area of the total 160 beneficiaries found no privacy in delivery room. In none of the rural CHCs private room was functional (0%). Only 3.75% of beneficiaries in urban CHCs and 1.875% of beneficiaries in rural CHCs of the total 160 beneficiaries found visual and auditory privacy in nonprivate room. These findings are similar to the ones presented by Sharma et al. when they found that in Uttar Pradesh, the public sector performed worse than the private sector for not ensuring privacy of the laboring women (P ≤ 0.001).
One of the key elements enquired in the present study is the perception of beneficiaries regarding the cleanliness of health institution and maternity wing and toilet. Although there has been a definite improvement in these aspects in the health facilities of both rural and urban areas, there is statistically no significant difference in cleanliness conditions in delivery room in rural and urban areas; 9.376% and 15.625% beneficiaries found that there is cleanliness in rural setup and urban set up, respectively. On comparing these parameters on scoring system between urban and rural health facilities, the health facilities of urban areas (3.53 ± 0.57) showed marginally better improvement as compared to their rural counterparts (3.18 ± 0.41).
In both rural and urban areas, the major supply of water availability as per beneficiaries was through piped water supply to delivery room. Qualitatively, however, there is a definite scope to improve the overall water, sanitation, and hygiene (WASH) services in the labor room. Many studies and authors in India have reiterated the need of improvisation in the coverage of WASH services for maternal and newborn care. For example, many authors have concluded that WASH services must be improved in labor room and maternity wing to reduce risks of maternal and newborn morbidity and mortality.,,, Thus, before the present study, to the best of the knowledge of authors, there were very few studies, associated with LaQshya guidelines and the present study is pioneer in highlighting the perception of beneficiaries and respectful mother care with respect to the LaQshya guidelines in the selected study sites.
| Conclusion|| |
When all the parameters and subparameters of perception of beneficiaries of quality of care and respectful maternity care (RMC) were analyzed in both rural and urban areas statistically significant difference observed in maintenance of privacy, treatment with dignity and respect, not allowed to feel lonely and explaining treatment procedure. With respect to informative aspects of PNC care, difference was observed in the provision of information on breastfeeding and information on child immunization. Nonprivacy in delivery room was one of the major issues found in the present study. One of the key elements enquired in the present study is the perception of beneficiaries regarding the cleanliness of health institution and maternity wing and toilet. There has been a definite improvement in these aspects in the health facilities of both rural and urban areas. On comparing these parameters on the scoring system between urban and rural health facilities, the health facilities of urban areas showed marginally better improvement as compared to their rural counterparts.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
World Health Organization. The Prevention and Elimination of Disrespect and Abuse during Facility-Based Childbirth. Geneva, Switzerland World Health Organization; 2014.
Tunçalp Ӧ, Were WM, MacLennan C, Oladapo OT, Gülmezoglu AM, Bahl R, et al.
Quality of care for pregnant women and newborns-the WHO vision. BJOG 2015;122:1045-9.
World Health Organization. WHO Recommendations: Intrapartum Care for a Positive Childbirth Experience. Geneva, Switzerland World Health Organization; 2018.
Khosla R, Zampas C, Vogel JP, Bohren MA, Roseman M, Erdman JN. International human rights and the mistreatment of women during childbirth. Health Hum Rights 2016;18:131-43.
Bohren MA, Vogel JP, Hunter EC, Lutsiv O, Makh SK, Souza JP, et al.
The mistreatment of women during childbirth in health facilities globally: A mixed-methods systematic review. PLoS Med 2015;12:e1001847.
Hameed W, Avan BI. Women's experiences of mistreatment during childbirth: A comparative view of home- and facility-based births in Pakistan. PLoS One 2018;13:e0194601.
Ukke GG, Gurara MK, Boynito WG. Disrespect and abuse of women during childbirth in public health facilities in Arba Minch town, south Ethiopia – A cross-sectional study. PLoS One 2019;14:e0205545.
Bhattacharya S, Sundari Ravindran TK. Silent voices: Institutional disrespect and abuse during delivery among women of Varanasi district, northern India. BMC Pregnancy Childbirth 2018;18:338.
Okafor II, Ugwu EO, Obi SN. Disrespect and abuse during facility-based childbirth in a low-income country. Int J Gynaecol Obstet 2015;128:110-3.
Schroll AM, Kjærgaard H, Midtgaard J. Encountering abuse in health care; lifetime experiences in postnatal women – A qualitative study. BMC Pregnancy Childbirth 2013;13:74.
Bowser D, Hill K. Exploring Evidence for Disrespect and Abuse in Facility-Based Childbirth: Report of a Landscape Analysis; 2010.
Kane S, Rial M, Kok M, Matere A, Dieleman M, Broerse JE. Too afraid to go: Fears of dignity violations as reasons for non-use of maternal health services in South Sudan. Reprod Health 2018;15:51.
Hameed W, Uddin M, Avan BI. Are underprivileged and less empowered women deprived of respectful maternity care: Inequities in childbirth experiences in public health facilities in Pakistan. PLoS One 2021;16:e0249874.
Asefa A, Bekele D, Morgan A, Kermode M. Service providers' experiences of disrespectful and abusive behavior towards women during facility based childbirth in Addis Ababa, Ethiopia. Reprod Health 2018;15:4.
Afulani PA, Kelly AM, Buback L, Asunka J, Kirumbi L, Lyndon A. Providers' perceptions of disrespect and abuse during childbirth: A mixed-methods study in Kenya. Health Policy Plan 2020;35:577-86.
Orpin J, Puthussery S, Burden B. Healthcare providers' perspectives of disrespect and abuse in maternity care facilities in Nigeria: A qualitative study. Int J Public Health 2019;64:1291-9.
Moridi M, Pazandeh F, Hajian S, Potrata B. Midwives' perspectives of respectful maternity care during childbirth: A qualitative study. PLoS One 2020;15:e0229941.
Ansari H, Yeravdekar R. Respectful maternity care during childbirth in India: A systematic review and meta-analysis. J Postgrad Med 2020;66:133-40.
] [Full text]
Sharma G, Penn-Kekana L, Halder K, Filippi V. An investigation into mistreatment of women during labour and childbirth in maternity care facilities in Uttar Pradesh, India: A mixed methods study. Reprod Health 2019;16:7.
Mannava P, Murray JC, Kim R, Sobel HL. Status of water, sanitation and hygiene services for childbirth and newborn care in eight countries in East Asia and the Pacific. J Glob Health 2019;9:020430.
Cross S, Afsana K, Banu M, Mavalankar D, Morrison E, Rahman A, et al.
Hygiene on maternity units: Lessons from a needs assessment in Bangladesh and India. Glob Health Action 2016;9:32541.
Bouzid M, Cumming O, Hunter PR. What is the impact of water sanitation and hygiene in healthcare facilities on care seeking behaviour and patient satisfaction? A systematic review of the evidence from low-income and middle-income countries. BMJ Glob Health 2018;3:e000648.
Arowosegbe AO, Ojo DA, Shittu OB, Iwaloye O, Ekpo UF. Water, sanitation, and hygiene (WASH) facilities and infection control/prevention practices in traditional birth homes in Southwest Nigeria. BMC Health Serv Res 2021;21:912.
Mankar DD. A study of maternal and newborn healthcare services at district hospital Sitamarhi, Bihar. J Res Med Dent Sci 2020;8:134-8.
[Table 1], [Table 2], [Table 3]