19% rural UP women taking maternal care 'shouted upon, insulted, threatened': Survey

By Rajiv Shah 

A study funded, among others, by the Bill & Melinda Gates Foundation, seeking to analyse what it calls person-centred maternity care or PCMC, has found that 57% of the 1,475 women surveyed taking maternity care in India reported that health service providers, including hospital managers, doctors and nurses, “never asked permission before performing medical procedures”, while 69% of women “reported that providers did not explain the purpose of examinations or procedures”.
Regretting that 58% of the women reported that they did not receive explanations on medications they were given, the study, published in the prestigious health journal “Lancet”, and carried out by Patience A Afulani, Beth Phillips, Raymond A Aborigo and Cheryl A Moyer, further found that in 18% of cases of doctors, nurses, or other health-care providers generally “shouted, scolded, insulted, threatened, or talked rudely” on women who had come for maternity care.
Carried out among women in Ghana, Kenya and India, the survey involved women in the age group 15–49 (average age 25) in 20 “predominantly rural” districts or Uttar Pradesh, with the University of California and the Community Empowerment Lab (India) working as collaborative partners. The “cross-sectional study” was carried out to find out the quality of maternity care in rural Uttar Pradesh.
The study revealed that in 23% of cases doctors, nurses, or other staff did not generally treat women for with respect, and in about 19% of cases they were shouted upon, scolded, insulted, or threatened. However, in 97% of cases, the women agreed, they were not “treated roughly” – by being pushed, beaten, slapped, pinched, physically restrained, or gagged.
The survey found that during examinations in the labour room, 32% of those surveyed complained they were “not covered up”; 38% said they felt that their “health information was or will be kept confidential”; and in 98% of cases the healthcare providers never introduced themselves when they first came to see the women.
Further, in 50% of cases the healthcare providers didn’t call the women by their name; and in 71% cases doctors, nurses or other staff at the facility did not involve women in the decisions about their care. Further, during delivery, in 87% of cases, the doctors, nurses, or other staff at the facility did not seek permission or consent before doing procedures on women. 

According to the survey, in 69% of cases the doctors and nurses never explained why they were doing examinations or procedures; in 78% of cases most of the time the health service providers did not explain what medicines were being given; in 35% of cases they generally did not feel like any questions which they had; in 78% of cases the doctors and nurses did not talk to them about how they were feeling; and in 55% of cases they did not try to understand the women’s anxieties.
Coming to infrastructure of the health facilities, the survey found that 39% of those surveyed felt that the labour and postnatal wards were crowded; 37% said the wards, washrooms, and the general environment of the health facility were dirty or very dirty; and 15% said most of the time there was no water facility.
Pointing out that in a scale in which 0 is the worst score and 90 is the best, the healthcare facilities in India had PCMC score of 40, the study, however, said, “In India, employed and wealthier women reported a higher PCMC score than did unemployed and poorer women, as did women who delivered in the health centres when compared with those who delivered in hospitals.”