Disrespectful intrapartum care during facility-based delivery in sub-Saharan Africa: A qualitative systematic review and thematic synthesis of women’s perceptions and experience – http://www.sciencedirect.com/science/article/pii/S0277953616305469

This article in the sub Saharan African context analyses the model of maternity care that is increasingly institution centred rather than women centred. Women’s experiences at institutions indicate that institutions and care providers tend to maintain power and control by situating birth as a medical event by focusing on the technical elements of care, including controlling bodies and knowledge. Global policies are pushing for facility based care, putting service providers and women between medical based care as compared to the traditional psycho emotional care provided by mid-wives.

The study though based in Africa is indicative of the issues in Indian context too, especially with the push from the NRHM (National Rural Health Mission) /NHM (National Health Mission) for institutional delivery. Field work in Jharkhand, done as a part of a fellowship on maternal health by the team at Development solutions also indicates that the push for institutional delivery, often dehumanizes women. The study in Jharkhand analysing the factors that influence access to care during pregnancy and child birth, reveals that given a choice, most women would prefer not to access Government facilities. Women are often treated with disrespect and lack the care and emotional support needed during delivery; and available in traditional home based delivery and care systems. While the need for a safe delivery and the merit in institution based care, is understood; the lack of adequate interpersonal care and support is a deterrent. The main reason why women accessed the Government facilities was owing to the Janani Suraksha Yojna (JSY) incentive. Those who could afford to, accessed good private hospitals, where they felt the quality of care is much better; else they preferred to call qualified doctors and nurses at home for delivery.