Patient-experience during delivery in public health facilities in Uttar Pradesh, India

Dominic Montagu, Amanda Landrian, Vishwajeet Kumar, Beth S Phillips, Shreya Singhal, Shambhavi Mishra, Shambhavi Singh, Sun Yu Cotter, Vinay Pratap Singh, Fnu Kajal, May Sudhinaraset, Dominic Montagu, Amanda Landrian, Vishwajeet Kumar, Beth S Phillips, Shreya Singhal, Shambhavi Mishra, Shambhavi Singh, Sun Yu Cotter, Vinay Pratap Singh, Fnu Kajal, May Sudhinaraset

Abstract

In India, most women now delivery in hospitals or other facilities, however, maternal and neonatal mortality remains stubbornly high. Studies have shown that mistreatment causes delays in care-seeking, early discharge and poor adherence to post-delivery guidance. This study seeks to understand the variation of women's experiences in different levels of government facilities. This information can help to guide improvement planning. We surveyed 2018 women who gave birth in a representative set of 40 government facilities from across Uttar Pradesh (UP) state in northern India. Women were asked about their experiences of care, using an established scale for person-centred care. We asked questions specific to treatment and clinical care, including whether tests such as blood pressure, contraction timing, newborn heartbeat or vaginal exams were conducted, and whether medical assessments for mothers or newborns were done prior to discharge. Women delivering in hospitals reported less attentive care than women in lower-level facilities, and were less trusting of their providers. After controlling for a range of demographic attributes, we found that better access, higher clinical quality, and lower facility-level, were all significantly predictive of patient-centred care. In UP, lower-level facilities are more accessible, women have greater trust for the providers and women report being better treated than in hospitals. For the vast majority of women who will have a safe and uncomplicated delivery, our findings suggest that the best option would be to invest in improvements mid-level facilities, with access to effective and efficient emergency referral and transportation systems should they be needed.

Keywords: Maternal health; global health; person-centred-care; quality.

© The Author(s) 2019. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

Figures

Figure 1
Figure 1
Map of study sites in Uttar Pradesh, India (n = 40).
Figure 2
Figure 2
Average patient-centred care score, by facility-level with linear trendline.
Figure 3
Figure 3
Patient reporting on (A) trusting their provider and (B) experiences with verbal abuse, by facility type.

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