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ORIGINAL ARTICLE
Year : 2023 | Volume
: 14
| 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
Correspondence Address:
Dr. Sana Afrin
Department of Community Medicine, MGM Medical College, Indore, Madhya Pradesh
India
Source of Support: None, Conflict of Interest: None
DOI: 10.4103/injms.injms_108_22
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
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.[1]
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."[2] 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.[2] More recently, the WHO published a thorough set of evidence-based recommendations with the goal of encouraging a positive user experience of intrapartum care.[3] 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."[3]
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.[4],[5],[6],[7],[8],[9],[10] This is true despite the growing recognition that the mistreatment of women during childbirth is a violation of their human rights.[4] Mistreatment can have both immediate and long-term negative effects, including pain and suffering, unpleasant birthing experiences, labor anxiety, and a sense of dehumanization.[7],[11] Such appalling events might discourage facility-based births.[12],[13] Given that women are frequently mistreated while giving birth, research has largely (and understandably) focused on women's perspectives on care.[8],[9],[10],[14] Less research has been done, however, to examine service providers' perspectives on the matter.[15],[16],[17] Some of these investigations centered on how service providers felt about abuse[18] and its potential effects on pregnant women's well-being;[17] 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).
MethodologyThe 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.
ResultsForty-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 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.[19]
Bohren et al.[6] 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).[20]
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.[21],[22],[23],[24] Thus, before the present study, to the best of the knowledge of authors, there were very few studies[25],[26] 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.
ConclusionWhen 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
None.
Conflicts of interest
There are no conflicts of interest.
References
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