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Cashless childbirth, but at a cost: A grounded theory study on quality of intrapartum care in public health facilities in India
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
Karolinska Inst, Dept Womens & Childrens Hlth, S-10401 Stockholm, Sweden..
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
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2016 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 39, p. 78-86Article in journal (Refereed) Published
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Abstract [en]

Aim: this study aimed to explore and understand the perceptions and experiences of women regarding quality of care received during childbirth in public health facilities. Design: qualitative in-depth interviews were conducted and analysed using the Grounded Theory approach. Participants: thirteen women who had given vaginal birth to a healthy newborn infant. Setting: participants were interviewed in their homes in one district of Chhattisgarh, India. Data collection: the interview followed a pre-tested guide comprising one key question: How did the women experience and perceive the care provided during labour and childbirth? Findings: 'cashless childbirth but at a cost: subordination during childbirth' was identified as the core category. Women chose a public health facility due to their socio-economic limitations, and to have a cashless and safe childbirth. Participants expressed a sense of trust in public health facilities, and verbalised that free food and ambulance services provided by the government were appreciated. Care during normal birth was medicalised, and women lacked control over the process of their labour. Often, the women experienced verbal and physical abuse, which led to passive acceptance of all the services provided to avoid confrontation with the providers. Conclusions: increasingly higher numbers of women give birth in public health facilities in Chhattisgarh, India, and women who have no alternative place to have a safe and normal birth are the main beneficiaries. The labour rooms are functional, but there is a need for improvement of interpersonal processes, information-sharing, and sensitive treatment of women seeking childbirth services in public health facilities.

Place, publisher, year, edition, pages
2016. Vol. 39, p. 78-86
Keywords [en]
Birth experience, Institutional delivery, Abuse, Communication, Care providers, Grounded theory
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
URN: urn:nbn:se:uu:diva-299546DOI: 10.1016/j.midw.2016.04.012ISI: 000377935800011PubMedID: 27321724OAI: oai:DiVA.org:uu-299546DiVA, id: diva2:949811
Funder
Sida - Swedish International Development Cooperation AgencyAvailable from: 2016-07-25 Created: 2016-07-22 Last updated: 2017-11-28Bibliographically approved
In thesis
1. ‘Two Sides of a Coin’: Quality of Childbirth Services in Indian Public Health Facilities, from the Perspectives of Women and their Care Providers
Open this publication in new window or tab >>‘Two Sides of a Coin’: Quality of Childbirth Services in Indian Public Health Facilities, from the Perspectives of Women and their Care Providers
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Skilled birth attendance, usually available by promoting childbirth at health care institutions in low-resource settings, is known to prevent maternal and neonatal morbidity and mortality. While institutional childbirths in India have increased at an exponential rate, the infrastructure, material and manpower resources to support this practice are lagging, raising concerns about the quality of childbirth services.

Methodology: A mixed-method approach was used in this project: in-depth interviews with women (n= 13); and focus-group-discussions with the care providers (n=27) were conducted and analysed using Grounded Theory. A cross-sectional survey (n= 1004) assessed prevalence of Fear of Birth (FoB) and postnatal depressive symptoms (PND), along with satisfaction with childbirth services among women in the immediate postpartum period.

Results: The system of cashless childbirth provided at the public health facilities, in the women’s experiences, came at the hidden cost of them having to make themselves subordinate to the offered services. The prevalence of FoB and PND was 13.1% and 17.1%, respectively, and these were significantly associated (p < 0.001). Among women with vaginal births (VB), 41.2% had experienced a perineal wound and 59% of them underwent repair without local anaesthesia. While the majority of the women were satisfied (VB 68.7%; Caesarean births 79.2%) with the services; women having VBs at Community Health Centres (nearly 81%) were more commonly satisfied compared to those at the District Hospitals (nearly 60%) (p < 0.001). From the care providers’ perspective, maintaining quality of childbirth services was like a balancing act between the realities of low-resource settings with stakeholders’ expectations. While the providers remained proud and committed; the challenges often left them fatigued, disillusioned, irritable and sceptical.

Conclusion: There is a need to improve the sensitivity with which childbirth services are being delivered to women coming to public health facilities; as well as towards improving the care providers’ work conditions. Suboptimal birth experiences are associated with the women’s perinatal mental health and satisfaction, while perpetual work challenges may make the care providers frustrated and/or apathetic. Improving manpower resources could reduce work-stress in care providers and thereby improve childbirth processes.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2017. p. 82
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1384
Keywords
Fear of Birth, Postnatal Depressive Symptoms, Hindi WDEQ, Hindi SMMS, Institutional Childbirth
National Category
Medical and Health Sciences
Research subject
Health Care Research
Identifiers
urn:nbn:se:uu:diva-331673 (URN)978-91-513-0110-5 (ISBN)
Public defence
2017-12-13, Auditorium Minus, Gustavianum, Akademigatan 3, Uppsala, 13:00 (English)
Opponent
Supervisors
Available from: 2017-11-22 Created: 2017-10-16 Last updated: 2018-03-07

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Jha, ParidhiSvanberg, Agneta SkoogLarsson, Margareta

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