Institutionalizing Respectful Maternity Care as a Standard of Care: A Case Study from Maharashtra in India.

Background: There is a need to institutionalize respectful maternity care (RMC) as a standard of care in public health systems.

Aim and objectives: This study demonstrates the development, implementation, and impact of an intervention package for providing RMC to women availing antenatal, natal, and postnatal services.

Methodology: An intervention package was developed in consultation with healthcare providers incorporating, (a) capacity-building workshops to empower healthcare staff, (b) mentoring support for developing action plans, and (c) development of behavior change communication material. Key practices such as allowing birth companions and the development of consent forms for different procedures were institutionalized. Baseline (January 2018) and endline (March 2020) evaluations were conducted using mixed methods in the department of obstetrics and gynecology at a medical college in Maharashtra, India. Exit interviews with 100 antenatal women, in-depth interviews (IDIs) with postnatal women (19 in baseline and 8 in endline), and 16-h of labor room observations were conducted.

Results: Of the 35 types of disrespect and abuse (D and A) instances, 20 were reported by atleast two methods (any two out of exit interviews/IDIs/labor room observations) - hence considered "definite." A significant improvement was observed in nine types of D and A. However, 11 types of D and A such as issues in providing verbal comfort, using curtains and drapes for examination, provision of changing rooms, taking informed consents for the procedures, and attending to women at her call were still reported/observed at the endline. The interventions led to improved service delivery.

Conclusions: Written policies and procedures, regular training, focused interventions, and using behavior change communication materials have the potential to enhance RMC. However, despite the interventions, many instances of D and A persisted indicating it to be a systemic problem.