Quality of maternity care provided by private sector healthcare facilities in three states of India: a situational analysis

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Abstract

Background

Better quality of care around the time of childbirth can significantly improve maternal and newborn survival. In countries like India, where the private sector contributes to a considerable proportion of institutional deliveries, it is important to assess the quality of maternity care offered by private sector healthcare facilities. This study seeks to fill that information gap by analysing baseline assessments conducted for the Manyata program, which aims to improve the quality of maternity care at private facilities.

Methods

An observation checklist based on 16 clinical standards endorsed by the Federation of Obstetric and Gynaecological Societies of India (FOGSI) was used to assess 201 private sector healthcare facilities in Maharashtra, Jharkhand, and Uttar Pradesh. Data on facility characteristics came from profiles completed when facilities enrolled in Manyata. Differences in the mean number of standards met were analysed by facility characteristics and the availability of essential supplies.

Results

Around half (47.1%) of all nursing staff engaged in maternity care services at these private healthcare facilities were under qualified. The mean number of clinical standards met by facilities was 3.2 (SD 2.4). Facilities with a monthly delivery load between 20 and 50 met a significantly higher number of standards, as did facilities that had more than 70% of essential supplies available. Both these factors were also significant in a multiple linear regression analysis.

Conclusions

The overall quality of maternity care in private healthcare facilities is poor in all three states, especially for clinical standards related to management of complications.

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Most cited references 15

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Beyond too little, too late and too much, too soon: a pathway towards evidence-based, respectful maternity care worldwide.

Suellen Miller, Edgardo Abalos, Monica Chamillard … (2016)

On the continuum of maternal health care, two extreme situations exist: too little, too late (TLTL) and too much, too soon (TMTS). TLTL describes care with inadequate resources, below evidence-based standards, or care withheld or unavailable until too late to help. TLTL is an underlying problem associated with high maternal mortality and morbidity. TMTS describes the routine over-medicalisation of normal pregnancy and birth. TMTS includes unnecessary use of non-evidence-based interventions, as well as use of interventions that can be life saving when used appropriately, but harmful when applied routinely or overused. As facility births increase, so does the recognition that TMTS causes harm and increases health costs, and often concentrates disrespect and abuse. Although TMTS is typically ascribed to high-income countries and TLTL to low-income and middle-income ones, social and health inequities mean these extremes coexist in many countries. A global approach to quality and equitable maternal health, supporting the implementation of respectful, evidence-based care for all, is urgently needed. We present a systematic review of evidence-based clinical practice guidelines for routine antenatal, intrapartum, and postnatal care, categorising them as recommended, recommended only for clinical indications, and not recommended. We also present prevalence data from middle-income countries for specific clinical practices, which demonstrate TLTL and increasing TMTS. Health-care providers and health systems need to ensure that all women receive high-quality, evidence-based, equitable and respectful care. The right amount of care needs to be offered at the right time, and delivered in a manner that respects, protects, and promotes human rights.

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Disrespect and abuse of women during childbirth in Nigeria: A systematic review

Foluso Ishola, Onikepe Owolabi, Veronique Filippi (2017)

Background Promoting respectful care at childbirth is important to improve quality of care and encourage women to utilize skilled delivery services. However, there has been a relative lack of public health research on this topic in Nigeria. A systematic review was conducted to synthesize current evidence on disrespect and abuse of women during childbirth in Nigeria in order to understand its nature and extent, contributing factors and consequences, and propose solutions. Methods Five electronic databases were searched for relevant published studies, and five data sources for additional grey literature. A qualitative synthesis was conducted using the Bowser and Hill landscape analytical framework on disrespect and abuse of women during childbirth. Results Fourteen studies were included in this review. Of these studies, eleven were cross sectional studies, one was a qualitative study and two used a mixed method approach. The type of abuse most frequently reported was non-dignified care in form of negative, poor and unfriendly provider attitude and the least frequent were physical abuse and detention in facilities. These behaviors were influenced by low socioeconomic status, lack of education and empowerment of women, poor provider training and supervision, weak health systems, lack of accountability and legal redress mechanisms. Overall, disrespectful and abusive behavior undermined the utilization of health facilities for delivery and created psychological distance between women and health providers. Conclusion This systematic review documented a broad range of disrespectful and abusive behavior experienced by women during childbirth in Nigeria, their contributing factors and consequences. The nature of the factors influencing disrespectful and abusive behavior suggests that educating women on their rights, strengthening health systems to respond to specific needs of women at childbirth, improving providers training to encompass interpersonal aspects of care, and implementing and enforcing policies on respectful maternity care are important. This review has also shown that more robust research is needed to explore disrespect and abuse of women during childbirth in Nigeria and propose compelling interventions.

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Development of a tool to measure women’s perception of respectful maternity care in public health facilities

Ephrem D. Sheferaw, Teka Mengesha, Solomon Wase (2016)

Background Maternal mortality continues to be the biggest challenge facing Ethiopia and other developing countries. Although progress has been made in making maternity services available closer to the community, the rate of deliveries attended by skilled birth attendants has remained very low. Absence of respectful maternity care (RMC) is believed to have contributed to low utilization of facility delivery services. This study outlines steps undertaken to construct and validate a scale that measures women’s perception of respectful maternity care provided in health facilities. Methods An inductive item generation process that included a literature review and in-depth interviews with labor and delivery clients, followed by an expert review, assured face validity and content validity of the tool. A draft RMC scale with 37 items and two additional measures of global satisfaction items, measured on a five-point Likert scale, were administered to a developmental sample of 509 postnatal care clients visiting facilities immediately after childbirth to 7 weeks postpartum. IBM SPSS 20 was used to perform exploratory factor analysis (EFA) using principal component analysis (PCA) with oblique rotation method. Results The final RMC scale with 15 items was loaded on four components. The extracted components were labeled as friendly care, abuse-free care, timely care, and discrimination-free care. The final RMC scale correlated strongly with the global satisfaction measures, indicating criterion-related validity of the scale. Content-related validity was assured by the process of item generation. Construct validity of the RMC scale was confirmed by high average factor loading of the four components ranging from 0.76 to 0.82 and low correlation between the components. Stability of the scale was confirmed by running PCA in a randomly selected split sample of 320 samples from the validation sample. The final 15-item scale showed an adequate reliability with α = 0.845. Conclusion The 15-item RMC scale is a valid and reliable measure of women’s perception of RMC received in health facilities. We recommend that health facilities use the RMC scale in urban public health facilities and that other researchers conduct further exploratory and confirmatory factor analysis in different geographic areas.

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Author and article information

Contributors

Sanjay Tripathi: Sanjay.Tripathi@Jhpiego.org

Ashish Srivastava:

ORCID: http://orcid.org/0000-0003-3100-3581

asheishsrivastava@gmail.com , Ashish.Srivastava1@Jhpiego.org

Parvez Memon: Parvez.Memon@Jhpiego.org

Tapas Sadasivan Nair: Tapas.Nair@Jhpiego.org

Parag Bhamare: paragbhamare@hotmail.com

Dinesh Singh: Dinesh.Singh@Jhpiego.org

Vineet Srivastava: Vineet.Srivastava@Jhpiego.org

Journal

Journal ID (nlm-ta): BMC Health Serv Res

Journal ID (iso-abbrev): BMC Health Serv Res

Title: BMC Health Services Research

Publisher: BioMed Central (London )

ISSN (Electronic): 1472-6963

Publication date (Electronic): 16 December 2019

Publication date PMC-release: 16 December 2019

Publication date Collection: 2019

Volume: 19

Electronic Location Identifier: 971

Affiliations

[1 ]Jhpiego an affiliate of Johns Hopkins University, Lucknow, Uttar Pradesh India

[2 ]Jhpiego - an affiliate of Johns Hopkins University, Jhpiego, 29, Okhla Phase 3, New Delhi, India

[3 ]Jhpiego - an affiliate of Johns Hopkins University, Mumbai, Maharashtra India

[4 ]Jhpiego - an affiliate of Johns Hopkins University, Ranchi, Jharkhand India

Author information

Ashish Srivastava http://orcid.org/0000-0003-3100-3581

Article

Publisher ID: 4782

DOI: 10.1186/s12913-019-4782-x

PMC ID: 6915998

PubMed ID: 31842926

SO-VID: 3be19b16-e82b-40b1-9178-6ce18d25b005

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 25 June 2019

Date accepted : 26 November 2019

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100009947, Merck Sharp and Dohme;

Award ID: MFM-150929-014691 TO1

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ScienceOpen disciplines: Health & Social care

Keywords: quality of care,facility preparedness,private sector,intrapartum care,postpartum care,maternal health,quality improvement

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ScienceOpen disciplines: Health & Social care

Keywords: quality of care, facility preparedness, private sector, intrapartum care, postpartum care, maternal health, quality improvement

Quality of maternity care provided by private sector healthcare facilities in three states of India: a situational analysis

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Most cited references 15

Beyond too little, too late and too much, too soon: a pathway towards evidence-based, respectful maternity care worldwide.

Disrespect and abuse of women during childbirth in Nigeria: A systematic review

Development of a tool to measure women’s perception of respectful maternity care in public health facilities

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