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Brief Communication
3 (
1
); 56-58
doi:
10.25259/WJWCH_17_2024

Assessment of health facilities of Pune city, India, for delivering respectful maternity care

Symbiosis Institute of Health Sciences, Symbiosis International (Deemed University), Lavale, Pune, Maharashtra, India
Corresponding author: Rajiv Yeravdekar, Symbiosis Institute of Health Sciences, Symbiosis International (Deemed University), Lavale, Pune, Maharashtra, India. provostfohs@siu.edu.in
Licence
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Ansari H, Yeravdekar R. Assessment of health facilities of Pune city, India, for delivering respectful maternity care. Wadia J Women Child Health. 2024;3(1):56-8. doi: 10.25259/WJWCH_17_2024

INTRODUCTION

Ill-treatment, disrespect, and abuse are prevalent globally. A systematic review from India showed that the prevalence of ill-treatment at health facilities was 65.38% and at community settings, was 77.32%.[1] Various factors play a role in delivering respectful maternity care (RMC), including stakeholders involved, facilities, types of facilities, infrastructural issues, etc. Even though stakeholders want to provide RMC, there are factors at facilities that hinder the delivery of RMC. Only when these factors are identified and addressed, will it be possible to deliver RMC.[1]

Therefore, the objective of the study was to assess the health facilities in the city of Pune for selected characteristics and, thereby calculate the RMC index.

METHODOLOGY

The study was conducted in Pune, India, from January to August 2021. A total of twenty-four hospitals were approached for the study, of which ten declined to be a part, and four were made COVID centers due to the pandemic. Therefore, a total of ten hospitals were selected for the study, including six private and four government hospitals. The hospitals were selected after obtaining the consent from the respective hospitals’ authorities. The study was approved by the Independent Ethics Committee of the University.

The hospitals were assessed for selected characteristics based on a checklist given by the International Childbirth Initiative.[2] The assessment was done by direct observation of the facilities. Further, the RMC index was computed. The RMC index was calculated based on the three components, including policy, facility, and experience.[3] Policy includes allowing a birth companion of choice, choosing a birthing position, and allowing women to walk around during labor. Facility includes curtains for maintaining privacy, waiting areas, and toilets for women and their families. Experience includes not sharing a bed with others, not sleeping or not delivering on the floor. A health facility is said to have an RMC index if all these three components are present.

RESULTS

The hospitals selected for the study purpose were assessed using a checklist. Table 1 shows that only seven hospitals had a feedback mechanism through which patients could give their suggestions or file a complaint. Six hospitals had a grievance cell. None of the hospitals displayed an RMC charter. Information on reporting bribes, poster was not displayed in any of the hospitals included in the study. Only one hospital had a poster on birth positions and a poster showing birth companions are allowed. Posters displaying mothers eating, drinking, and walking during labor were not there in any of the hospitals. Chairs, mattresses, curtains, and walls for privacy were there in all hospitals. Tools such as wall ladders and balls were only there in one hospital. Pre- and post-natal education posters and charts were displayed only in half of the hospitals. Emergency care or transport facilities were available at all hospitals. Combined care for mother and child was there in nine of the ten hospitals. Eight hospitals had space according to the guidelines. None of the hospitals displayed posters on infant formula. However, only six hospitals had posters in the local language on skin-to-skin contact, breastfeeding, and their benefits. All hospitals had consents in the local language. A safe childbirth checklist in the labor room was there in nine hospitals, and a surgical checklist in the operation theater was there in eight of the ten hospitals. An audit was conducted in all hospitals. A poster on handwashing was there in nine hospitals.

Table 1: Characteristics of health facilities.
Characteristics n(%) n(%)
Yes No
Feedback mechanisms/Suggestions/Complaint box 7 (70) 3 (30)
Grievance cells 6 (60) 4 (40)
Display of RMC charter 0 10 (100)
Informational posters on costs as well as reporting of bribes 0 10 (100)
Posters showing birth companion is allowed 1 (10) 9 (90)
Posters showing birth position 1 (10) 9 (90)
Posters displaying mother eating, drinking, walking during labor 0 10 (100)
Tools such as chairs, mattress are available 10 (100) 0
Tools such as balls, wall ladder 1 (10) 9 (90)
Curtains/walls for privacy 10 (100) 0
Display of pre- and post-natal education posters/charts 5 (50) 5 (50)
Emergency care (drugs, devices, equipments)/treatment triage and transport available 10 (100) 0
Combined care for mother and child 9 (90) 1 (10)
Sufficient space as per guidelines 8 (80) 2 (20)
Any posters on infant formula 0 10 (100)
Posters in local language on skin-to-skin contact, breastfeeding, their benefits, culturally appropriate 6 (60) 4 (40)
Personalized consents for each condition in local language 10 (100) 0
Safe childbirth checklist in labor room 9 (90) 1 (10)
Surgical check list in operation theater 8 (80) 2 (20)
Episiotomies and Cesarean audit 10 (100) 0
Posters on hand washing 9 (90) 1 (10)

RMC: Respectful maternity care

The RMC index[3] comprising of the three components, including policy, facility, and experience in the various health facility is shown in Table 2. None of the selected facilities had the sub categories of policy. Only six health facilities provided curtains for maintaining privacy, waiting areas, and toilets for women and their families. Eight facilities had provision related to experience including not sharing bed with others and not sleeping or delivering on the floor.

Table 2: Respectful maternity care index of health facilities
Facilities n(%)
RMC Index
  Yes 0
  No 10 (100)
Policy
  Yes 0
  No 10 (100)
Facility
  Yes 6 (60)
  No 4 (40)
Experience
  Yes 8 (80)
  No 2 (20)

RMC: Respectful maternity care

Thus, none of the selected facilities met the criteria of having an RMC Index as one or more of the components were lacking in all facilities.

DISCUSSION

A study done in Ethiopia showed that 29.9% of hospitals and 27.8% of health centers met the criteria of an RMC index.[3] None of the facilities included in this study met the criteria of having an RMC index. To our knowledge, this is one of the few studies to assess the characteristics of health facilities and also assess the RMC Index in India. A limited number of facilities were selected for the study. Facilities from rural areas were not included. The government should work in this direction by providing funding, allocation of budgets, and setting standard norms and guidelines so that the facilities can provide RMC.

CONCLUSION

It is essential to improve the facilities provided by the hospitals to meet the criteria of having and delivering RMC services.

Acknowledgment

The authors gratefully acknowledge the funding support received from the Department of Science and Technology, Government of India, for the first author.

Ethical approval

The research/study approved by the Institutional Review Board at Symbiosis International (Deeemed University), number SIU/IEC/168, dated August 27, 2020.

Declaration of patient consent

Patient’s consent not required as there are no patients in this study.

Conflicts of interest

There are no conflicts of interest.

Use of artificial intelligence (AI)-assisted technology for manuscript preparation

The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.

Financial support and sponsorship

Funding support to the first author by Department of Science and Technology, Government of India.

References

  1. , . Respectful maternity care during childbirth in India: A systematic review and meta-analysis. J Postgrad Med. 2020;66:133-40.
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  2. International Childbirth Initiative (ICI) 12 steps to safe and respectful mother baby family maternity care. Available from: https://www.icichildbirth.org
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  3. , , , , , , et al. Status of institutional-level respectful maternity care: Results from the national Ethiopia EmONC assessment. Int J Gynecol Obstet. 2021;153:260-7.
    [CrossRef] [PubMed] [Google Scholar]
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