Background Poor patient experiences during delivery in Uttar Pradesh, India is a common problem. It delays presentation at facilities after the onset of labor and contributes to poor maternal health outcomes. Patient-centered maternity care (PCMC) is recognized by the World Health Organization as critical to overall quality. Changing PCMC requires changing the process of care, and is therefore especially challenging. Methods We used a matched case-control design to evaluate a quality improvement process directed at PCMC and based on widely established team-based methods used in many OECD countries. The intervention was introduced into three government facilities and teams supported to brainstorm and test improvements over 12 months. Progress was measured through pre-post interviews with new mothers, scored using a validated PCMC scale. Analysis included chi-squared and difference-in-difference tests. Findings On a scale to 100, the PCMC score of the intervention group increased 22.9 points compared to controls. Deliveries attended by midwives, dais, ASHAs or non-skilled providers resulted in significantly higher PCMC scores than those attended to by nurses or doctors. The intervention was associated with one additional visit from a doctor and over two additional visits from nurses per day, compared to the control group. Interpretation This study has demonstrated the effectiveness of a team-based quality improvement intervention to ameliorate women’s childbirth experiences. These improvements were locally designed and led, and offer a model for potential replication.

Green (2021) Can changes to improve person-centred maternity care be spread across public health facilities in

Background: Person-centered quality for family planning has been gaining increased attention, yet few interventions have focused on this, or measured associations between person-centered quality for family planning and family planning outcomes (uptake, continuation, etc.). In India, the first point of contact for family planning is often the community health care worker, in this case, Accredited Social Health Activists (ASHAs). Methods: In this study, we evaluate a training on person-centered family planning as an add-on to a training on family planning provision for urban ASHAs in Varanasi, India in 2019 using mixed methods. We first validate a scale to measure person-centered family planning in a community health worker population and find it to be valid. Higher person-centered family planning scores are associated with family planning uptake. Results: Comparing women who saw intervention compared to control ASHAs, we find that the intervention had no impact on overall person-centered family planning scores. Women in the intervention arm were more likely to report that their ASHA had a strong preference about what method they choose, suggesting that the training increased provider pressure. However, qualitative interviews with ASHAs suggest that they value person-centered care for their interactions and absorbed the messages from the intervention.Conclusions: More research is needed on how to intervene to change behaviors related to person-centered family planning. This study received IRB approval from the University of California, San Francisco (IRB # 15-25950) and was retrospectively registered at clinicaltrials.gov (NCT04206527)

Background Person-centered quality for family planning has been gaining increased attention, yet few interventions have focused on this, or measured associations between person-centered quality for family planning and family planning outcomes (uptake, continuation, etc.). In India, the first point of contact for family planning is often the community health care worker, in this case, Accredited Social Health Activists (ASHAs). Methods In this study, we evaluate a training on person-centered family planning as an add-on to a training on family planning provision for urban ASHAs in Varanasi, India in 2019 using mixed methods. We first validate a scale to measure person-centered family planning in a community health worker population and find it to be valid. Higher person-centered family planning scores are associated with family planning uptake. Results Comparing women who saw intervention compared to control ASHAs, we find that the intervention had no impact on overall person-centered family planning scores. Women in the intervention arm were more likely to report that their ASHA had a strong preference about what method they choose, suggesting that the training increased provider pressure. However, qualitative interviews with ASHAs suggest that they value person-centered care for their interactions and absorbed the messages from the intervention. Conclusions More research is needed on how to intervene to change behaviors related to person-centered family planning. Trial registration This study received IRB approval from the University of California, San Francisco (IRB # 15–25,950) and was retrospectively registered at clinicaltrials.gov (NCT04206527).

Background: Medical certification of cause of death (MCCD) scheme is imperative tool to obtain scientific and reliable information in terms causes of mortality. The office of the registrar general of India (ORGI) initiated the scheme on MCCD under civil registration system (CRS), during the third five year plan. Methods: This paper analyzes the data for the last 16 years for MCCD in Rajasthan from 1999 to 2015. The findings are based on more than half a million deaths, for which cause of death data is reported. The per cent of cause of deaths have been computed and the curve estimation method has been used to project the cause of death due to circulatory diseases. Results: The data reveals that the percentage of medically certified deaths hovers around 10 to 13 percent during 1999 to 2015 of the total deaths registered under the civil registration system, which is about 5 million deaths. The highest percentage of deaths that has been medically certified is due to circulatory diseases as seen for the combined period of sixteen years (1999-2015) (21 percent) followed by deaths due to certain infectious and parasitic diseases (16 percent). This has increased from 13.8 per cent in 1999 to 20.2 per cent in 2015. This proportion has been projected upto 2030, the target year of achievement of Sustainable Development Goals (SDGs). Conclusions: Addressing this cause, could help in the achievement of indicator of 3.4.1, mortality rate attributed to cardiovascular disease, cancer, diabetes or chronic respiratory disease under the target of reducing by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being by 2030 subsumed under the SDG 3 of ensuring healthy lives and promote well-being for all at all ages.