An Investigation into Quality of Care at the Time of Birth at Public and Private Sector Maternity Facilities in Uttar Pradesh, India

Background: Ensuring high quality care during labour and childbirth is important to eliminate preventable maternal deaths, neonatal deaths and intrapartum stillbirths. My PhD investigates quality of care (QoC) during normal labour and childbirth, and examines whether QoC is influenced by management practices at 26 public and private sector maternity facilities in Uttar Pradesh, India. Methods: First, I conducted clinical observations of labour and childbirth. I used descriptive statistics and multivariate analysis techniques to describe and compare differences in overall QoC, and quality for obstetric and neonatal care. Second, I used quantitative and qualitative methods to describe existing patterns of mistreatment encountered by women. Third, I described existing management practices using a separate survey dataset and linked both QoC and management datasets to examine the relationship between management practices and QoC. Results: QoC was found to be poor at both public and private sector facilities. The private sector outperformed public sector facilities for overall essential care at birth, and for both obstetric and newborn care. All women encountered at least one indicator of mistreatment. There were no significant differences between qualified and unqualified personnel for QoC and mistreatment levels. Qualitative results suggest that informal payments are widespread, maternity care pathways are non-functional, and there are poor hygiene standards. Lastly, I found that maternity facilities scored poorly on management best practices. Overall, I found no association between total management scores and QoC. Conclusions: The results of my PhD study indicate that in 2015, in maternity facilities of Uttar Pradesh, unqualified personnel provided the bulk of maternity care, adherence to evidencebased obstetric and neonatal care protocols was generally poor and all women encountered at least one practice of mistreatment. These results suggest the need to comprehensively measure and urgently improve QoC at the time of birth in Uttar Pradesh, India.