Determinants of respectful maternity care in India: A cross-sectional study

Abstract

Background: Respectful maternity care (RMC) is a basic right of all pregnant women. The study identifies the sociodemographic and economic factors influencing disrespect and abuse (D&A) faced by women during pregnancy, childbirth, and immediate postpartum period in India.

Methodology: A cross-sectional study was conducted across six health facilities in three states of India from June 2019 to June 2020 among 401 women aged 18 years or more who had a live birth within the past 2 months of data collection. A validated structured interview schedule was used to capture data on sociodemographic and economic characteristics; antenatal, intranatal, and postnatal history; and incidences of D&A based on Bowser's seven domains of RMC. Ordered logistic regression was done to identify the determinant of high D&A.

Results: The composite score of D&A ranged from 0 to 48 with a median interquartile range of 13 (9-17). All women faced one or the other kind of D&A. Women with the lowest food security (odds ratio [OR] = 3.3; 95% confidence interval: 1.6-6.7), who did not avail any antenatal care from the facility (OR = 1.9 [1.1-3.2]), and in the lowest wealth index (OR = 2.2 [1.3-3.7]) faced more D&A than those with high food security, more than two ANC services from same health facility, and in the high wealth index, respectively. Women who had low mobility score experienced lower D&A (OR = 0.5 [0.3-0.8]) as compared to the women with a high mobility score. Nonconsented care, nonconfidential care, and physical discomfort were the most common types of D&A.

Conclusions: RMC is directly associated with socioeconomic status of women. Policy and program interventions are needed to address the inequity in health service care provision and expanding the social security net for women.

Keywords: Disrespect and abuse; respectful maternity care; socioeconomic determinants.