Women’s experience of post-natal care: A study from Uttarakhand, India

ABSTRACT

Although significant strides have been made in improving maternal and child health outcomes following the millennium development goals, India's progress has been slow, as reflected by its relatively high maternal and child mortality rates. This calls for investigation into the quality of care (QOC) offered to women during pregnancy and childbirth. This study uses primary data to evaluate women's experience of the postnatal care they receive in order to understand maternal perceptions about QOC in Uttarakhand, India. Specifically, we try to measure women's satisfaction with postnatal care and construct a maternal satisfaction index. We also attempt to understand the demographic, socio-economic and obstetric factors that affect them. Results show that a sufficient number of postnatal checks for both the mother and baby were done, while they felt the length of stay in health facilities had been adequate and they had adequate privacy during these processes. These emerged as the most important components of maternal satisfaction. Factors such as women's working status, place of residence, number of children born, pregnancy and delivery related complications, and planned place of delivery were important for their satisfaction. This study may have policy implications to help bridge the supply-demand gaps in the QOC framework.

ABSTRACT IN HINDI

यद्यपि सहस्राब्दी विकास लक्ष्यों की स्थापना के बाद मातृ और बाल स्वास्थ्य परिणामों में सुधार के लिए भारत ने महत्वपूर्ण प्रगति हासिल की है, उसकी गति धीमी रही है, जैसा कि अपेक्षाकृत उच्च मातृ और बाल मृत्यु दर में परिलक्षित होता है। इसके लिए गर्भावस्था और प्रसव के विभिन्न चरणों के दौरान महिलाओं को दी जाने वाली देखभाल की गुणवत्ता की जांच की आवश्यकता करना ज़रूरी है। इस संदर्भ में, यह अध्ययन भारत के उत्तराखंड राज्य में देखभाल की गुणवत्ता की मातृ धारणा को समझने का प्रयास करता है। हम प्रसवोत्तर देखभाल को माओं की संतुष्टि के माध्यम से मापते है। हम माओं की संतुष्टि से सम्बन्धित जनसांख्यिकी, सामाजिक-आर्थिक और प्रसूति संबंधी कारकों को भी समझने का प्रयास करते हैं। परिणाम बताते हैं कि मां और बच्चे दोनों के लिए प्रसवोत्तर जांच की पर्याप्तता, स्वास्थ्य सुविधाओं में प्रसव के बाद की अवधि की पर्याप्तता आदि, मातृ संतुष्टि के महत्वपूर्ण घटक के रूप में उभरे हैं। महिलाओं की कामकाजी स्थिति, निवास स्थान, जन्म क्रम, आदि, संतुष्टि को प्रभावित करने में महत्वपूर्ण हैं। इस अध्ययन के नीतिगत निहितार्थ हो सकते हैं जो देखभाल की गुणवत्ता के ढांचे में आपूर्ति-मांग के अंतर को कम करने में मदद कर सकते हैं।

KEYWORDS:

• Maternal and child health
• quality of care
• postnatal care
• maternal satisfaction
• Uttarakhand

KEYWORDS:

• मातृ एवं शिशु स्वास्थ्य
• देखभाल की गुणवत्ता
• प्रसवोत्तर देखभाल
• मातृ संतुष्टि
• उत्तराखंड

Acknowledgements

We thank the organizers and participants of the conference on “Reproduction, Demography and Cultural Anxieties in India and China in the twenty-first century” held in New Delhi in February 2020. We are also grateful to Reetika Khera and Diane Coffey for their valuable feedback on this article. Also, we would like to thank all the healthcare providers in the two districts of Uttarakhand, particularly the ASHA workers and ANMs, who provided useful assistance and information during fieldwork for this study. Finally, we are grateful to all the women who agreed to participate and without whom this study would not have been possible.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1 There are some exceptions to this and in some cases, evaluating users’ perspective may prove to be more harmful than beneficial. For example, a study conducted in the United States of America found that while evaluating the performance of health providers and hospitals via public disclosure by patients regarding health outcomes (so called healthcare report cards) may improve quality of care, they can also be detrimental in terms of societal benefit and create perverse disincentives for health-care providers who may deny treatment to patients with complicated ailments and thereby reduce patient and social welfare (Dranove et al., 2003). Another study from Uganda found that making health providers accountable to communities by involving them in monitoring public service delivery may not improve the quality of services. This is because these communities are plagued by problems of income inequality and ethnic division that seriously impact any collective action (Björkman & Svensson, 2010).

2 EAG states were those that lagged behind other states in service delivery in certain demographic, and reproductive and maternal health related areas.

3 As of 2019, there were five hospitals operating in the PPP mode in Uttarakhand, including the district hospital at Tehri and four CHCs in Dehradun, Devprayag, Doiwala and Tehri. The district hospital and the CHC in Tehri, in particular, have been handed over to the Swami Ram Himalayan Trust Hospital (SRHTH) in Jollygrant in Dehradun district. Other PPP projects in the pipeline include the district hospital at Pauri and CHCs in Ramnagar, Nainital, Bhikiyasain and Almora. The objectives of these partnerships is to plug the acute shortage of doctors that plagues the state due to their unwillingness to serve in rural areas. However, they have merely become referral centers for the parent private hospitals (Shekhawat, 2019).

4 Authors’ calculation from NFHS data 2015–2016.

5 Authors’ calculation from NFHS data 2015–2016.

6 We also calculated the fully standardised co-efficients (βeta Co-efficients) for all the predictor variables, in order to enable comparison to check for the relative importance of the predictors. However, since all these variables are binary and scale free, we use the raw regression co-efficients as weights.

7 Using the global measure, we found that 33% of the women were not satisfied with the PNC they received.

Additional information

Notes on contributors

Asmita Verma

Asmita VERMA is a post-doctoral fellow at the Centre for Society and Policy, IISc, Bengaluru. Her research interests include health economics, public health, demography, development economics, econometrics and data economics. Her recent research involves understanding healthcare service delivery in India and its implications for maternal and child health, and demographic outcomes in the country.

Sourabh B. Paul

Sourabh PAUL is an assistant professor of economics at the department of humanities and social sciences, IIT Delhi. His work broadly focuses on how some recent changes in the Indian economy have affected the most vulnerable sections of Indian society. His research encompasses issues such as castes and labor mobility, distributional aspects of trade policy, preferences, nutrition, gender, and violence, among others.