Quality of care in maternity services : childbirth among the urban poor of Mumbai, India

Abstract

The framework draws together experience and evidence from the extensive medical, health policy and social science literature on all aspects of quality in maternity care to create a flexible quality assessment framework specifically for use at the institutional level in developing countries.  It divides quality into two elements:  firstly into the provision of quality of care, and second into elements relating to users’ experience of that care.  These two important aspects of quality of care in pregnancy and childbirth are intrinsic components of a basic reproductive rights approach.  The framework is then applied to practice to evaluate the quality of the provision of care and the quality of the experience of care at maternity institutions in a slum area of the eastern suburbs of Mumbai, India’s most populous city.  The city has one of the highest institutional delivery rates for the country as a whole with 82% of women living in slums delivering in an institution.

The findings provide evidence that quality is far from optimal in both municipal and private facilitates.  Within elements of the quality of the provision of care issues ranged from lack of essential drugs to the use of inappropriate procedures that are not evidence-based.  Within elements of the quality of the experience of care issues ranged from users being left unsupported, evidence of physical and verbal abuse and institutional delivery which does not guarantee attendance by a health professional let alone skilled attendance.  There is no substantive difference in the quality of care (beyond the quality of the provision of human and physical resources) that women receive and experience at private providers, indeed they are at greater risk of unnecessary interventions.  Findings do show, however, that the quality of experience of care varies significantly by background characteristics of the woman and her family.

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