Women's narratives of disrespect and abuse during facility-based childbirth in Kolkata, India.

Abstract

Quality of care during childbirth is crucial to maternal health outcomes. Studies from India that report on women's experiences of disrespect and abuse by healthcare providers during facility-based childbirth are limited to high-fertility states and predominantly focus on public hospitals. However, the quality of maternal care in states with low fertility rates like West Bengal needs further examination. This study aimed to understand women's experiences of disrespect and abuse and their perceptions of facility-based childbirth. The study focused on public, private, and charitable hospitals in Kolkata district of West Bengal that presents a higher institutional birth rate than the national average. The findings derive from a qualitative study using in-depth interviews with 17 postpartum women who had facility-based births within one year before data collection in May 2019. Grounded theory approach was used to iteratively code the interview transcripts, identify reappearing categories, and generate themes through abstraction. The participants' narratives revealed experiences of verbal abuse, neglect and abandonment, poor rapport between providers and women, improper conduct of procedures, health facility conditions and constraints, and instances of overlapping forms of disrespect and abuse. The findings demonstrate the nature of disrespect and abuse across different hospital types in a major metropolis of India. Normalisation of poor-quality care manifested in women's lack of expectations of patient education and attention from providers. Health system conditions and constraints can impact the quality of care that problematise the push for institutional deliveries as a panacea for poor maternal health outcomes. The findings add to long-standing calls for improving maternal experiences of birth with an emphasis on promoting autonomy. National and state guidelines related to maternal health need to be aligned with accepted standards of care. West Bengal must establish ways to assess the implementation of such guidelines on the ground.