Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, WC 1E 7HT, UK.
Deputy Manager-Research, Sambodhi Research and Communications, O-2, Lajpat Nagar-II, New Delhi, 110024, India.
Reprod Health. 2019 Jan 23;16(1):7. doi: 10.1186/s12978-019-0668-y.
To investigate the nature and context of mistreatment during labour and childbirth at public and private sector maternity facilities in Uttar Pradesh, India.
This study analyses mixed-methods data obtained through systematic clinical observations and open-ended comments recorded by the observers to describe care provision for 275 mothers and their newborns at 26 hospitals in three districts of Uttar Pradesh from 26 May to 8 July 2015. We conducted a bivariate descriptive analysis of the quantitative data and used a thematic approach to analyse qualitative data.
All women in the study encountered at least one indicator of mistreatment. There was a high prevalence of not offering birthing position choice (92%) and routine manual exploration of the uterus (80%) in facilities in both sectors. Private sector facilities performed worse than the public sector for not allowing birth companions (p = 0.02) and for perineal shaving (p = < 0.001), whereas the public sector performed worse for not ensuring adequate privacy (p = < 0.001), not informing women prior to a vaginal examination (p = 0.01) and for physical violence (p = 0.04). Prepared comments by observers provide further contextual insights into the quantitative data, and additional themes of mistreatment, such as deficiencies in infection prevention, lack of analgesia for episiotomy, informal payments and poor hygiene standards at maternity facilities were identified.
Mistreatment of women frequently occurs in both private and public sector facilities. This paper contributes to the literature on mistreatment of women during labour and childbirth at maternity facilities in India by articulating new constructs of overtreatment and under-treatment. There are five key implications of this study. First, a systematic and context-specific effort to measure mistreatment in public and private sector facilities in high burden states in India is required. Second, a training initiative to orient all maternity care personnel to the principles of respectful maternity care would be useful. Third, innovative mechanisms to improve accountability towards respectful maternity care are required. Fourth, participatory community and health system interventions to support respectful maternity care would be useful. Lastly, we note that there needs to be a long-term, sustained investment in health systems so that supportive and enabling work-environments are available to front- line health workers.
调查印度北方邦公立和私立产科医疗机构中分娩和产后虐待的性质和背景。
本研究通过系统的临床观察和观察员记录的开放式评论来分析混合方法数据，以描述 2015 年 5 月 26 日至 7 月 8 日在北方邦三个地区的 26 家医院对 275 名母亲及其新生儿的护理情况。我们对定量数据进行了双变量描述性分析，并使用主题方法对定性数据进行了分析。
研究中的所有妇女都至少遇到了一种虐待的迹象。在两个部门的设施中，都有很高的选择分娩体位（92%）和常规手动探查子宫（80%）的情况。私营部门设施在不允许陪产（p=0.02）和会阴剃毛（p<0.001）方面的表现不如公立部门，而公立部门在确保充分隐私（p<0.001）、阴道检查前不告知妇女（p=0.01）和身体暴力（p=0.04）方面的表现更差。观察员的准备性评论进一步深入了解了定量数据，还确定了其他虐待主题，如感染预防措施不足、会阴切开术缺乏镇痛、非正式付款和产科设施卫生标准差。
妇女在私营和公共部门设施中经常受到虐待。本文通过阐明过度治疗和治疗不足的新概念，为印度产科设施中妇女分娩和产后虐待的文献做出了贡献。这项研究有五个主要意义。首先，需要在印度高负担州的公立和私立部门设施中进行系统和具体情况的测量虐待。其次，向所有产科护理人员提供尊重产妇护理原则的培训倡议将是有用的。第三，需要创新机制来提高对尊重产妇护理的问责制。第四，支持尊重产妇护理的参与式社区和卫生系统干预措施将是有用的。最后，我们注意到需要对卫生系统进行长期、持续的投资，以便为一线卫生工作者提供支持和有利的工作环境。
