Women giving birth in Uttar Pradesh, India, have worse experience at higher-level facilities

mother and baby
Over 90% of women in India will become mothers. Giving birth comes with risks, but those can be mitigated by factors like use of a skilled birth attendant and access to clinical services. These conditions are likely to be present at a health facility, so moving births from homes to facilities has been a top priority.

Some studies have shown that women delay seeking care at facilities because they fear mistreatment and poor quality of care from healthcare providers and staff. New Bixby research looked at women’s experiences of patient-centered care in different facility types across the state of Uttar Pradesh.

Lower-level facilities in India like primary health centers and community health centers have a limited capacity to manage complications but are more accessible. Referral systems can transfer people in need of emergency obstetric care to higher-level facilities. In interviews with more than 2000 women, researchers found that women had a worse patient experience at higher-level facilities like referral and specialty hospitals. Women delivering in hospitals were less likely to report trusting their provider and were more likely to report experiencing verbal abuse than those giving birth in lower-level facilities.

There has been a push to assure quality maternity care by focusing on a small number of advanced facilities rather than a large number of staffed clinics. Given the greater trust and better treatment women report at the lower-level facilities, these findings indicate that this kind of approach may not be appropriate for Uttar Pradesh. For the vast majority of women who have a safe and uncomplicated delivery, this study suggests that the best option would be to deliver in a lower-level center with access to efficient emergency referral. Quality improvement efforts in India should prioritize investment in CHCs as a way to build on better patient experiences and assure quality clinical care. Within hospitals, attention is needed to address poor person-centered care.

Person-centered care is a key component of overall maternal health quality. The experience women have during labor and delivery influences whether they follow medical advice after giving birth, their care-seeking after they are discharged, and the way they and their friends and family feel about future delivery and prenatal care services. Good clinical services must be paired with good person-centered care, and balancing attention to each aspect will be important for future quality improvement efforts in India.