Encouraging dignified maternal care

The White Ribbon Alliance for Safe Motherhood, India, is advocating proper and basic quality care at health centre facilities for women, writes Sneha Bhattacharjee

Much is made of the joys of motherhood and the process of giving birth. Actually, it is not as romantic as it sounds. Nor is the enabling environment particularly nurturing. Cases of abuse and chiding from doctors, unhygienic conditions in the hospital, unavailability of medicines and free ambulance services etc are some of the issues plaguing maternal care in India despite the government flagship programmes like Janani Suraksha Yojana (JSY), Janani Shishu Suraksha Karyakram (JSSK).

Take the case of 23-year- old Munni Kumari, who was “screamed at by a nurse” during her labour. “None of the prescribed medicines were available at the health centre”, says 35-year-old Sunita Devi questioning, “why am I being denied entitlements?”. These are not stray cases. There have been instances of bribery when a child is born. For women who have no money to spend on their care, to give their hard-earned money to please the ‘seeking’ nurses and doctors at the health centre, can be hard.

“It is taken for granted that quality of care includes only clinical aspects”, says Aparajita Gogoi, national coordinator, White Ribbon Alliance for Safe Motherhood (WRAI), India. WRAI is an alliance of maternal health advocates committed to reducing maternal mortality and morbidity in India. “We asked 150,000 women across India about their most important quality of care indicator. And almost one out of two said that respectful care, (being treated well and not being discriminated against) is what they seek most. This shows the need to incorporate respectful care as part of all quality improvement efforts,” she adds.

With the objective of amplifying women’s voices, their needs and priorities, the WRAI initiated a campaign ‘ Hamara Swasthya, Hamari Awaz’ (‘Our Health, Our Voices’). This campaign reached out to women directly to understand what they seek as quality maternal healthcare in India and engaged with women directly to put forward their one ‘ask’ to improve reproductive and maternal health in the country. Over the past six months from October 2016 to March 2017, WRAI members have spoken to 1,43,556 women across 24 states and union territories directly about their expectations on quality. The findings indicate that a sizeable 36 per cent of the women seek access to maternal health entitlements, services and supplies, followed by 23 per cent women who want services provided with dignity and respectful care.

According to Gogoi, it is very important to talk about maternal care especially when there are policies such as JSY and JSSK that ensure women have such facilities around them. “Only if a woman has a good experience at a health centre facility will she ask others in her family and among her friends to opt for it,” she says. Women play an important role in country’s economy and her health therefore becomes “imperative for long term sustainable economic growth and development” she adds. Further, it’s unacceptable that a woman should die of preventable deaths in the prime of their life while bringing another life into this world, Gogoi says.

Despite the initiatives propounded by the government, India needs to focus on improving the quality of care. Gogoi says, patientcentered care that has respect, empathy, and compassion from health care providers is the order of the day. “There needs to be equitable delivery of care. For instance, mothers with lower income and literacy, and from tribal groups, scheduled castes, and rural areas must receive the same care as their counterparts at other socioeconomic levels,” she adds.

The World Health Organisation (WHO) defines quality of care as “the extent to which health care services provided to individuals and patient populations improve desired health outcomes. In order to achieve this, health care must be safe, effective, timely, efficient, equitable and people- centered.” Although the WHO framework for quality of care for mothers and newborns focuses on the care provided in facilities, it also accounts for the critical role of communities and service users in identifying their needs and preferences and in managing their own health. The WRAI’s advocacy for quality, equity and dignity is intended to link with the roll out of the WHO quality of care framework, and the effort takes forward the implementation of the “Every Newborn Action Plan” and strategies towards “Ending Preventable Maternal Mortality” to achieve the goals.

In Gogoi’s words, “It’s time to focus on providing respectful maternal care. There must be zero tolerance for disrespect and abuse in child birth”.