Evaluate The Effectiveness Of Implementation Of Respectful Maternity Care Assignment

Assignment Task

Introduction

Every childbearing woman in every health system around the world has the right to respectful maternity care. Women's interactions with maternity caregivers can either empower and comfort them, or cause long-term harm and mental distress. In any case, memories of childbirth events stick with women for the rest of their lives. While numerous interventions try to enhance access to expert birth care, the quality of interactions with caregivers throughout maternity care has received less attention. Evidence suggests, however, that fear of the disrespect and abuse that woman all too often experience in facility-based maternity care is a stronger deterrent to using competent care in countries with a high maternal death rate than well recognised barriers like cost or distance. The International Initiative on 'Maternal Mortality and Human Rights' (IIMMHR) has also emphasised and recognised the necessity of integrating human rights principles into maternal mortality and injury prevention efforts. 

Respectful maternity care (RMC) is defined by the World Health Organization as ‘care organized for and provided to all women in a manner that maintains their dignity, privacy and confidentiality, ensures freedom from harm and mistreatment, and enables informed choice and continuous support during labour and childbirth. Respectful maternity care (RMC) has emerged as a new terminology in recent years in the field of midwifery and obstetrics. RMC emphasizes the importance of ethical, psychological, social, and cultural aspects of childbirth among different populations. The term is often used synonymously with friendly and woman-centered care. ² Disrespect and abuse of women during childbirth has become a major cause of concern globally. Disrespectful and abusive treatment during childbirth includes outright physical abuse, profound humiliation, verbal abuse, unconsented medical procedures, lack of confidentiality, failure to get informed consent, and refusal to give pain medications. Gross violations of privacy, refusal of admission to health facilities, neglecting women during childbirth leading to life-threatening complications that are avoidable, and detention of women and their newborns in facilities due to an inability to pay also amount to disrespect and abuse. Lack of respect for women in childbirth facilities can be a significant deterrent to utilizing maternity care services. 

As highlighted in the World Health Organization (WHO) framework for improving quality of care for pregnant women during childbirth, experience of care is as important as clinical care provision in achieving the desired person-centred outcomes. This up-to-date, comprehensive and consolidated guideline on intrapartum care for healthy pregnant women and their babies brings together new and existing WHO recommendations that, when delivered as a package of care, will ensure good quality and evidence-based care in all country settings. In addition to establishing essential clinical and non-clinical practices that support a positive childbirth experience, the guideline highlights unnecessary, non-evidence-based and potentially harmful intrapartum care practices that weaken women‟s innate childbirth capabilities, waste resources and reduce equity. The percentage of institutional birth in India has doubled from 38.7% to 78.9% in the decade 2015-16, according to the National Family 5 Health Survey (NFHS-4). ⁴

However, this increase in coverage has not translated in commensurate reduction of maternal and newborn mortality and stillbirths. One of the major factors being inadequacies in the quality of care provided in health facilities. The current figures of maternal mortality ratio of 130 and neonatal mortality rate of 24 suggest that though there has been tremendous improvement in maternal newborn healthcare indicators, there still exists a vast scope to achieve the targets set for our country. It is estimated that approximately 46% maternal deaths, over 40% stillbirths and 25% of under-5 deaths take place on the day of the delivery. Half of the maternal death each year can be prevented if we provide higher quality health care. ⁵ Quality of care is increasingly recognized as a critical aspect of the unfinished maternal and newborn health agenda, mainly with respect to care around labour and delivery and in the immediate postnatal period. Education and training programme of the Nurse Midwifery Practitioners would be conducted at the National and Regional Midwifery Training Institutes identified by the NMTF. The NMTI would fundamentally focus on a three-month training of midwifery educators. Midwifery educators in turn would then be engaged for the 18-month training of NPMs at the Regional Midwifery Training Institutes (RMTIs). In this respect, Ministry of Health and Family Welfare has launched program „LaQshya‟- quality improvement initiative in labour room & maternity OT, aimed at improving quality of care for mothers and newborn during intrapartum and immediate post-partum period. 

RMC must be exercised as a right and not an option. Every childbearing woman owns the right of herself and baby to be treated with care, dignity, free from harm, and to maintain absolute liberty in choice of care. Respectful maternity care (RMC) is a marker of quality maternity care. A safe and respectful delivery environment ensures the protection of basic human rights of every child-bearing woman. India still needs to go a long way in maximising the quality of midwifery care although a lot of initiatives by the government is in the pipeline. 

The change in policies and curriculum has helped shift long-entrenched barriers to women receiving quality care and dignified, respectful treatment during labor. Healthcare providers are now sensitized to the need and importance of listening to women and providing care with respect and dignity. Women are increasingly asked what they want and need, are provided key information on the care they receive, and are treated with dignity. Ministry of Health and Family Welfare, Government of India, launched the ‘LaQshya’ initiative in 2017, which is intended to improve the quality of care in labour rooms and maternity operation theatres. Under this, states are urged to undertake concerted efforts to ensure that respectful and high-quality maternal care is provided to each woman during delivery and immediate postpartum. Since then, the field of respectful maternity care has continued to grow with increased focus.

To tackle mistreatment during childbirth, health systems must be held accountable, and sufficient resources must be in place to provide quality, accessible maternal health care and clear policies on women’s rights. Healthcare providers also require support and training to ensure that women are treated with compassion and dignity. This is a very low researched area, hence requiring further study to explore the lacunae and improve the quality of maternity care in the country as well as globally. 

Statement of the Problem & Objectives

A Mixed Method Study To Evaluate The Effectiveness Of Implementation Of Respectful Maternity Care Guidelines On The Status Of Respectful Maternity Care And Satisfaction Level Of Postnatal Mothers In Selected Tertiary Care Hospitals Of Maharashtra.

Objectives

• To assess and compare the status of RMC among postnatal mothers in experimental and comparison group.
• To explore the perception of mothers regarding RMC.
• To assess and compare the level of satisfaction before and after implementation of RMC guidelines among postnatal mothers in experimental and comparison group.
• To find out the association between status of RMC among postnatal mothers with selected demographic variables.

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