INTRODUCTION:

Respectful maternity care (RMC) is a rightful expectation of women. In India, pregnancy and childbirth are blessings in women's lives and their families. Every woman who is giving birth to a child has the right to respectful maternity care¹. It respects dignity, empathy, privacy, secrecy, emotions, choices, and preferences, as is companionship during maternity care and continued care during labour and birth. During pregnancy and childbirth, a connection with maternity care professionals and maternity care hospitals is critical. All child-bearing women need fair treatment as well as the safety of their independence and right to self-determination; this comprises extra care for mother-baby pairs and women who are marginalized or in danger. As a result, healthcare practitioners should focus more on women during childbirth.

The White Ribbon Alliance (For Safe Motherhood):

The White Ribbon Alliance is a global group with a shared goal: to make all women and infants in every nation safer during pregnancy and delivery. The White Ribbon Alliance is an advocate leader who provides a chance for new collaborations to improve safe pregnancy and infant health throughout the world. In addition, the idea of "safe motherhood" is typically limited to physical safety, but childbirth is also a significant rite of passage for a woman and her family, with profound personal and cultural importance². The concept of safe motherhood must be broadened to include respect for women's fundamental human rights in addition to the prevention of illness and mortality.

Universal rights for childbearing women (WHO):

Human rights are essential rights of all people that are acknowledged by societies and governments and are codified in global treaties and declarations. Every pregnant woman has the right to respectable obstetric care in every health organization around the world. Women's interactions with caregivers can either distress or either soothe them in the long run³. Hence, it is critical to educate women about their rights to respectful maternity care in order to protect them against abuse. Following are the women’s rights-

· Every woman has the right to be free from harm and ill-treatment.

· Every woman has the right to secrecy and privacy.

· Every woman has the right to knowledge, informed consent, and refusal, as well as Respect for her choices and preferences throughout maternity care.

· Every woman has the right to be respected and treated with decency.

· Every woman has the right to equality, non-discrimination, and fair treatment.

· Every woman has a legal right to healthcare and the best possible health.

· Every woman is entitled to freedom, independence, self-rule, and the absence of compulsion.

· Everyone has the right to enough food and safe drinking water.

It has been found that Women’s experiences with caregivers may either distress and ease them or cause them to endure emotional distress. The pleasant and bad memories a woman has of her childbearing experiences linger with her for the rest of her life. According to studies, infringing on women's rights during childbirth makes them distrust healthcare providers and institutions. As a result, the present paper's goal was to conduct a systematic review and identify different forms of abuse, analyse abusive maternity care, and explore areas of improvement for respectful maternity care in India.

Respectful Maternity Care:

RMC is an essential indicator of the overall excellence of care provided to females during pregnancy and childbirth. The health of a woman and her baby are intertwined, and both might be overlooked after childbirth and the months that follow. This is required to concentrate on reducing maternal and neonatal morbidity and death. Motherhood care is an important human right that includes respect for women's beliefs, freedoms, feelings, dignity and preferences, such as the ability to have a partner or perform cultural rituals⁴. In recent years RMC has been highlighted because of the importance of the moral, emotional, community and cultural features of childbirth in various cultures. In addition, a woman's autonomy, as well as her sensitive happiness, choices and favourites, as well as the right to have a partner of her choice during childbirth, must be acknowledged and respected. The mother, and their family should be helped to care for and make the best choices for their baby, especially when it comes to choosing health care providers. A woman's association with motherhood care providers and the care system is vital during the prenatal period, delivery, and the postnatal period.

Literature Reviews:

Choudhary et al.,⁵ suggest that India is one of the world's most risky places to give birth, considering for about 11% of all maternal deaths wide-reaching. Despite the fact that over 80% of women deliver in health facilities, more than 34,000 women die in the country each year from maternal reasons. Almost all of these fatalities might have been avoided, suggesting that the quality of treatment requires attention on several levels. Further, WRA India is employed with communities to call their rights to honourable maternity care and to ensure that healthcare providers are offered as standard practice to avoid deaths during pregnancy and childbirth. Health systems ready to assist professionals.

Christe DM, Padmanaban S,⁶ reports that Respect and dignity are essential indicators of maternal health care and are a fundamental component of delivering excellent care during facility-based delivery. Healthcare practitioners must have specific skills and attitudes in order to provide excellent care as their position is crucial to maximising treatments in maternity settings. Respectful Maternity Care encompasses safeguarding against verbal and physical abuse, as well as disrespect and prejudice, while in the care of the mother. In addition, the birthing and post-natal care process should be a combined effort between women and healthcare providers, with mutual emotional and medical support. Consequently, every female has the right to obtain RMC.

As per the views of Dasari P, Thulasingam M.⁷, expert assistance throughout pregnancy and delivery is one of the most effective therapies for lessening maternal morbidity and mortality. It is because many women suffer disrespectful and abusive treatment in institutions during labour and delivery, according to research, which is a significant obstacle to increasing skilled care usage and maternal health outcomes. Further, it has been found that if the quality of care given, particularly components of respectful care, does not improve. Efforts to increase the use of facility-based motherhood care in developed nations like India are doubtful to yield the anticipated results.

A study was carried out to assess the expectations of women during the process of childbirth. The study results showed that all the women (100%) were expecting their child to be physically and mentally healthy. The study also focused on the need of safe social and environmental factors to be one of the important component at the time of delivery

of child birth.⁸

In a non- experimental research design conducted to assess the factors associated with the labour outcomes in primigravid women, the labour pain was found to be one of the major fear making the women not to adopt normal vaginal delivery. The study concluded the need for respectful and compassionate care to alleviate the fear of women in labour⁹

The Hindu. 2021¹⁰ suggests that Respectful Maternity Care has been identified as a critical technique for increasing maternity care quality and use. During various stages of childbirth, such as labour, delivery, and postpartum, RMC makes an effort on improving interpersonal connections between a woman and health care professionals. In order to guarantee a woman's happiness throughout her birthing experience, RMC focuses on reducing poor and abusive behaviour by health care professionals and related staff, as well as establishing a caring and supportive working environment. Obviously, RMC is a human right that has the potential to enhance mother and newborn outcomes. An essential method for improving maternal health is to improve respectful maternity care and eliminate maltreatment of women during childbirth.

Deferential maternity care alludes to think about and gave to all ladies in a way that keeps up their respect, protection and classification, guarantees opportunity from damage and abuse, and empowers educated decision and persistent help during work and childbirth. In any event, when administrations are accessible, care might be undermined by abuse during labor, including harsh, careless, or discourteous consideration. . RMC can be characterized as a way to deal with care that accentuates the crucial privileges of ladies, babies, and families, and that elevates evenhanded access to prove based consideration while perceiving the interesting needs and inclinations of the two ladies and newborns. The White Ribbon Alliance has characterized seven spaces of RMC utilizing a rights based methodology; nonetheless, what establishes RMC operationally (as far as explicit practices', practices, or guidelines in research and program execution is regularly factor. As far as anyone is concerned, no endeavors have yet been made to utilize a proof based way to deal with figure out what comprises RMC during labor in wellbeing offices.¹¹

Dignity and respect 95%, Communication and autonomy 92%, Supportive care 93%, Privacy and Confidentiality 96% and Facility and environment 95%. Conclusion: Based on the results of this study, direct relationship was observed between respectful maternity care and positive childbirth experience¹² In addition, to maintain respectful maternity care, health sectors should provide safe working conditions and reasonable working hours to health professionals. They should allow Companions present in postnatal wards to give additional support and encouragement, such as spouses, mothers, sisters, and others.

Research Gap:

This article aims to bridge the knowledge gap by examining baseline assessment for optimal maternity care during pregnancy across India with the goal of enhancing the quality of maternity care in facilities. Improved mother and infant survival can be achieved by providing better care around the time of labour¹³. Evaluation of the superiority of motherhood care provided by private sector health facilities is essential in countries such as India, where the number of institutional births in the private sector is high.

Childbirth is supposed to be the most beautiful moment a woman can feel. Respectful maternity care programmes must consider and address the systems, structures, attitudes, and behaviours that lead to disrespect and abuse in a particular environment¹⁴. A multi-sectoral strategy is required to combat disrespect and abuse. Women and their partner should demand RMC as a fundamental right to overcome the generalization of disrespect and violence. The paper's significance is to break the veil of silence around disrespectful and rude maternity care by empowering health care workers, women, and communities to identify RMC as a fundamental human right. Further, access to public health care for pregnant women and their families is hampered by disrespectful treatment. However, abuse of women during childbirth in hospitals is becoming more widely recognised as a severe problem across the world

Figure 1: MMR between 2016 to 2018 of India

(Source: The Hindu. 2021)

Despite the government's instruction, the majority of Indian women continue to give birth alone, which is a tragedy. In addition, the maltreatment of women in health facilities during childbirth is a rising topic of research and public concern. During hospital-based labour and delivery, many women face indifferent and abusive treatment from health care personnel. There are many cases where Women have reported healthcare professionals' attitudes as "unfriendly" and "bad" as obstacles to maternity care. It is the responsibility of health practitioners to ensure safe delivery and to encourage respectful maternity care¹⁵. However, in unsupportive and poor health system contexts, sometimes contrary to established professional standards, increasing the potential for abuse. Evidence suggests that the variables that contribute to mistreatment in institutions are multifaceted, ranging from individual caregivers to organisational and systemic issues. Further, weak health systems exacerbate the harmful impacts of disrespect and maltreatment during delivery, resulting in poor access and utilisation of maternal health treatments.

In India, there have been several cases of misconduct in both public and private hospitals. For example, Long lines of pregnant women to come for health check-ups outside the hospitals for example, are not unusual, with security agents brandishing sticks telling them to wait. This rigorous therapy begins during pregnancy and continues during labour¹⁶.

Disrespect during childbirth leaves a lasting memory on women. These recollections cause anxiety and distrust in the healthcare system. According to data from countries with the highest maternal mortality rates, humble care during labour and birth is a major determinant of whether pregnant women seek expert help or even expecting future pregnancies¹⁷. Consequently, maternal health care professionals' unfavourable attitudes and behaviours jeopardise wellbeing and health outcomes. Hence, these findings indicate that many women do not receive such treatment. In such settings, mothers are more likely to be abused and treated rudely by tired and overworked healthcare personnel. In order to satisfy the rising demand for institutional births, the government needs to increase trained human resources in labour rooms¹⁸. Moreover, there are a number of social and environmental factors of physical concern such as a lack of basic infrastructure, sanitation, hygiene, and congestion are to blame for disrespectful maternity care Staffing, equipment, and shortages—trained healthcare personnel.

Figure 2: Dealing with disrespect and abuse: Seven rights of women of childbearing age

(Source: WHO.int. 2021)

While seeing the abuse during pregnancy, there are many areas of improvement for respectful maternity care. Midwifery is an essential strategy for providing superior, humble care during pregnancy and delivery. Midwives play a vital role for many nations, helping to humanise the delivery process for females. However, In India, there is no institutional assembly for educating and integrating them into the healthcare organisation. Midwifery is a vast prospect for India, and should be dedicated to additional development in this field. Further, RMC will be established as a standard if young minds are taught the importance of humanised birth. Respectful Maternity Care must become a critical component of birthing in this nation, according to the obstetric community ¹⁹. Compliant maternity providers must all endeavour to create a society where everyone involved in a woman's path to parenthood is taught to treat women in labour with Respect and compassion.

Studies have also shown that when the woman receives quality care, the delivery result improves. It is critical to raise awareness among moms about the need for respectful maternity care. For example, in the delivery room, having a birth partner reduces the chance of disrespect and abuse. To ensure that women have access to high-quality treatment, variables such as provider workload and hospital infrastructure must be addressed. Hence, it needs to educate nurses, midwives, and other clinical personnel about the significance of respectful maternity care. Better maternal and newborn care could save 1.48 million maternal and neonatal deaths and miscarriages every year, according to global research, and considerably enhance maternal and neonatal survival ²⁰.

METHODOLOGY:

For this study a new dataset was created by merging baseline assessment data with facility attribute data. The data was examined and double-checked for accuracy. The findings show there is a link between RMC and a pleasant childbirth experience. According to research on disrepute and abuse, poor treatment of women during delivery may be prevalent, posing a barrier to better maternal health outcomes and sustained involvement with the health system. The findings demonstrate that a variety of variables, including sociocultural factors and environmental ones, are to blame for disrespectful maternity care, including physical issues such as a lack of basic infrastructure, sanitation, cleanliness, and congestion. Healthcare shortages, such as staffing, equipment, and trained employees, have been recorded. It has been found that improving care quality is critical for ensuring patient safety and accelerating mortality and morbidity reductions. Every pregnant lady and newborn requires professional heed at the time of delivery, with evidence-based clinical and non-clinical treatments delivered in a caring and supportive setting to reduce unnecessary maternal and neonatal deaths.

CONCLUSION:

Women have a right to demand respectful maternity care. Disrespectful maternity care, on the other hand, is standard in a variety of contexts. In order to learn about different types of mistreatments, their causes, and the overall incidence of abuse maternity care in India, a methodical review and meta-analysis were undertaken. In India, maternal health and human rights groups have lately agreed on the need for humble and non-abusive delivery care for all females. The aim of this study was to see how women are treated with Respect during delivery, which is the most vulnerable time in a female's life. The goal of the study is to find indication of any unequal or rude treatment in facility-based delivery, as well as to emphasise the components of care that women value most during delivery. The findings suggest that this is critical in order to get support for current well-being strategies and initiatives that push for more official births with the long-term goal of reducing maternal mortality in India.

Any rude or harsh treatment during childbirth will have a negative impact on her physical and mental wellbeing. It may deter women from seeking delivery care at a health facility, resulting in missed chances to detect pregnancy and childbirth-related morbidities early. With increased disease and fatalities in India, the disparity may expand much further. Women in India may use more important maternity care if timely and courteous maternity care is provided, particularly at public health facilities. In addition, a collection of rules outlining the steps that public health institutions should take to guarantee that maternity care is of high quality and respectful, resulting in a pleasant childbirth experience. Small, cost-effective measures have been demonstrated in studies to dramatically minimise the health risks that women experience when they get pregnant. The majority of maternal fatalities might be avoided if women had access to adequate healthcare during pregnancy, delivery, and the early postpartum period.

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Received on 19.08.2023 Modified on 26.08.2023

Asian J. Nursing Education and Research. 2023; 13(4):296-300.

DOI: 10.52711/2349-2996.2023.00061