Birthing women require support, particularly emotional support, during the process of labour and delivery. Traditionally, across cultures, this support was made available by the continuous presence of a companion during labour, childbirth and the immediate post-partum period. However, this practice is not universal, especially in health facilities in low- and middle-income countries. This cross-sectional study was conducted in 18 tertiary health care facilities of India using a mixed-method approach. The quantitative data were collected to document the number of birthing women, birth companions and healthcare providers in the labour rooms, and the typology of disrespect and abuse (D&A) faced by women. This was followed by in-depth interviews with 55 providers to understand their perspective on the various dimensions of D&A and the challenges they face to provide respectful care. This article explores the status of birth companionship in India and its plausible associations with D&A faced by birthing women in public facilities. Our study reveals that birth companionship is still not a common practice in Indian public hospitals. Birth companions were present during less than half of the observational period, also less than half of the birthing women were accompanied by a birth companion. Lack of hospital policy, space constraints, overcrowding and privacy concerns for other patients were cited as reasons for not allowing birth companions in the labour rooms, whose supportive roles, both for women and providers, were otherwise widely acknowledged during the qualitative interviews. Also, the presence of birth companions was found to be critically negatively associated with occurrences of D&A of birthing women. We contend that owing to the high pressure on the public hospitals in India, birth companions can be a low-cost intervention model for promoting respectful maternity care. However, adequate infrastructure is a critical aspect to be taken care of.
A relatively large proportion of India's underweight children belong to groups facing multiple disadvantages. Addressing child malnutrition among these communities is critical if India is to eliminate undernutrition and achieve the MDG goals. This article draws evidence from the Integrated Nutrition and Health Project II (INHP-II), a USAID funded project, implemented by CARE in India, to show how, by ensuring universal service coverage, a programme can enhance equity and inclusion. INHP-approaches such as: Nutrition and health days (NHD); prioritising home contacts; system strengthening; community participation; tracking left-out children; enhancing convergence and coverage of nutritional and health services, all help to improve nutritional outcomes among all sections of society, particularly socially excluded groups.
Adolescence is a critical developmental period that has the power to shape an individual’s dreams and future. Young people have been severely impacted by the COVID-19 pandemic. Closure of schools and non-formal education deprived them of learning opportunities and also of social engagement with their peers and educators. Prolonged lockdowns/closures and movement restrictions led to additional emotional and mental unrest and anxiety. Adolescents and youth, especially adolescent girls and young women, experienced higher levels of violence due to quarantine and isolation. The authors discuss the effects of these ground realities on access to health services and education during the COVID-19 lockdowns. They highlight important issues and make recommendations for policy dialogue and advocacy around critical areas like vulnerability to COVID-19 infection, physical abuse, limited access to mobile phones, disruption of supply chains, adolescent-friendly counseling, dealing with violence, early marriage, school drop-outs, and trafficking. Recommendations are made to decision-makers and program implementers for addressing barriers to access timely and appropriate care.
Background: Maternal mortality perdures to be a major challenge for India like in other developing countries. Though the efforts to increase the institutional deliveries have resulted in appreciable results, it has not translated to the corresponding decline in maternal mortality rates. Dearth in quality of care especially concerning respectful maternity care in health facilities is considered as a major reason for this phenomenon. This work describes the development process of the study tool to assess respectful maternity care in the health facilities of India. Methods: A collaborative approach was employed for the development of a comprehensive tool to be used to assess respectful maternity care in the Indian setting. The tool development process comprised of four steps: 1) literature review and meeting with Technical Advisory Group; 2) the National Stakeholders workshop and development of the initial tool; 3) feedback on the tool from twenty tertiary care public health facilities from various regions of India; 4) the final tool and its validity approval by Technical Advisory Group. Results: A comprehensive tool was made comprising of indicators for assessing deficits in respectful maternity care, and for assessing contextual data of the health care facility. The initial tool was tested at twenty facilities. The changes suggested and observed were adapted, and the final tool was prepared. The Technical Advisory Group approved the content validity of the tool.Conclusions: A comprehensive tool was made to assess various aspects of respectful maternity care provided in tertiary Indian institutional settings aiding in in a deeper understanding of the phenomenon. This tool is recommended, especially to health care providers of India, for assessing the status of maternity care in health facilities and bringing the required interventions in the health care facilities.
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