As part of safe motherhood commitments, many governments aim to raise the proportion of births occurring in health facilities. But do these places always provide the best care? Research by Options Consultancy Services, London, and the University of Southampton, UK, finds gaps in quality of care at maternity facilities in an Indian urban slum.

Poor quality care and dissatisfaction with the quality of care contribute to delayed access and non-use of maternal health services. Across India, only 7 to 34 percent of women give birth in a health facility. By contrast, 86 percent of births in the study area take place either in one of 4 public hospitals or a number of private facilities. How good is the care these women receive?

The researchers collected data from the hospitals via observation, exit interviews, provider interviews, review of hospital records, the mystery client approach and a household survey of 650 women living nearby. They analysed these data using a framework that divides quality into two parts: the quality of users’ experience of care, and the quality of the provision of care. Elements included: provision of and experience of human and physical resources; women’s access to clear information about their care; respect, dignity and equity; emotional support; referral; maternity management information systems; use of appropriate technologies and internationally recognised good practice; and management of emergencies.

The study found evidence that the quality of the care experienced varies depending on the socio-economic status of the woman and her family. Other problems with service quality included:

• lack of essential drugs
• use of inappropriate procedures that are not evidence-based
• women left unsupported
• evidence of physical and verbal abuse
• births occurring in hospitals without a health professional in attendance

The results highlight the dangers of policies which aim to increase hospital births without addressing service quality. The researchers point to many potential benefits of improving quality of care:

• increase in timely and effective use of services
• improved psycho-social and health outcomes
• improved efficiently through more appropriate use of limited resources
• optimal use of existing inputs
• closer adherence to correct procedures

They conclude that discharging a live mother and baby after childbirth should not be the only goal for providers. Offering care that follows international good practice, avoiding the use of inappropriate technologies and providing services that are humane, respectful, equitable and evidence-based are goals that need to be included when scaling up institutional births.

Source(s):
‘Applying a Framework for Assessing the Quality of Maternal Health Services in Urban India’, Social Science and Medicine 64, pages 2083-2095, by Louise Hulton, Zoe Matthews and Robert Stone, 2007 Full document.

Funded by: The Wellcome Trust

id21 Research Highlight: 10 May 2008

Further Information:
Louise Hulton
Options Consultancy Services Ltd.
Cap House
9–12 Long Lane
EC1A 9HA
London

Tel: +44 (0)20 7776 3900
Fax: +44 (0)20 7776 3978
Contact the contributor: l.hulton@options.co.uk

Options Consultancy Services Ltd., London, UK

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