Associations Between Mistreatment by a Provider during Childbirth and Maternal Health Complications in Uttar Pradesh, India

Abstract

Objectives This study assesses associations between mistreatment by a provider during childbirth and maternal complications in Uttar Pradesh, India. Methods Cross-sectional survey data were collected from women (N = 2639) who had delivered at 68 public health facilities in Uttar Pradesh, participating in a quality of care study. Participants were recruited from April to July 2015 and surveyed on demographics, mistreatment during childbirth (measure developed for this study, Cronbach's alpha = 0.70), and maternal health complications. Regression models assessed associations between mistreatment during childbirth and maternal complications, at delivery and postpartum, adjusting for demographics and pregnancy complications. Results Participants were aged 17-48 years, and 30.3% were scheduled caste/scheduled tribe. One in five (20.9%) reported mistreatment by their provider during childbirth, including discrimination and abuse; complications during delivery (e.g., obstructed labor) and postpartum (e.g., excessive bleeding) were reported by 45.8 and 41.5% of women, respectively. Health providers at delivery included staff nurses (81.8%), midwives (14.0%), and physicians (2.2%); Chi square analyses indicate that women were significantly more likely to report mistreatment when their provider was a nurse rather than a physician or midwife. Women reporting mistreatment by a provider during childbirth had higher odds of complications at delivery (AOR = 1.32; 95% CI 1.05-1.67) and postpartum (AOR = 2.12; 95% CI 1.67-2.68). Conclusions for Practice Mistreatment of women by their provider during childbirth is a pervasive health and human rights violation, and is associated with increased risk for maternal health complications in Uttar Pradesh. Efforts to improve quality of maternal care should include greater training and monitoring of providers to ensure respectful treatment of patients.

Do women’s perspectives of quality of care during childbirth match with those of providers? A qualitative study in Uttar Pradesh, India

“…In this paper, we aim to examine pregnant women’s expectations of high quality care in public health facilities in Uttar Pradesh, India, and to contrast this with provider’s perceptions of the same, as well as the barriers that limit their ability to provide high-quality care. Uttar Pradesh (UP), the most populous state in India, accounts for more than 20% of overall maternal deaths in India [12]. Normalisation of mistreatment in the facility context may lead to low expectations among women to receive high quality care [6].…”

Mothers’ reproductive and medical history misinformation practices as strategies against healthcare providers’ domination and humiliation in maternal care decision-making interactions: an ethnographic study in Southern Ghana

“…Additionally, pregnant women desire to receive medical treatment and have access to medical resources like medications, which healthcare providers control [ 19 , 29 , 58 ]. Relatively lower educational and social status of many pregnant women [ 19 , 21 , 25 , 59 , 60 ] have also been stated as factors influencing pregnant women’s decision to use covert ‘resistance’ strategies to confront healthcare providers, when dissatisfied with their – healthcare providers’ - behaviours and practices of power.…”

“…Despite this, empirical studies and qualitative synthesis suggest that the problem remains widespread globally, but more prevalent in low and middle-income countries including Ghana, the setting of the current study [ 8 , 14 – 21 ]. Some consequences of disrespectful treatment of pregnant women include dissatisfaction, increased risk of experiencing obstetric complications and poor utilisation of reproductive and maternal healthcare services in subsequent pregnancies and deliveries [ 16 , 22 – 25 ].…”

Birth place, practices - a research agenda

“…Additionally, researchers have reported the provision of women-centered, respectful maternity care practices in just 4% of deliveries. 17 In the study by Raj et al 18 mistreatment of women by their providers during childbirth was a pervasive health and human rights violation, and was associated with increased risk for maternal health complications in Uttar Pradesh. While increase in the number of women delivering in health facilities was rapid, the quality of obstetric and neonatal care continued to be poor in India, contributing to high maternal and neonatal mortality.…”