Quality of routine labor and delivery care in Uttar Pradesh, India: Are private facilities better?

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In India, the percentage of women who delivered in a health facility increased from roughly 35% in 2000 to 79% in 2014 (https://data.unicef.org/topic/maternal-health/delivery-care/). Despite this progress, given India's massive population, 15% of global maternal deaths took place in India in 2015 (http://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2015/en/), suggesting substantial gaps in quality of care at the time of birth. Researchers have noted that women in India tend to associate private facilities with higher quality of care (https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-8-29) compared to public facilities. While studies of public facilities in India have indicated generally poor quality Of care (http://journals.plos.org/plosone/article?id=10.1371/joumal.pone.oo67452), evidence from private facilities--particularly for normal labor and delivery--is scarce.

Measuring quality of care in public and private facilities

In an effort to address this evidence gap, a recent article from the Bulletin of the World Health Organization (http://www.who.int/bulletin/volumes/95/6/16-179291/en/) assessed the quality of essential obstetric and newborn care during routine labor and delivery in Uttar Pradesh, India. The authors from the London School of Hygiene & Tropical Medicine and Sambodhi Research and Communications conducted clinical observations of 275 mother-newborn pairs at 18 public facilities and eight private facilities in Uttar Pradesh. For each clinical observation, the authors assessed 42 items related to quality of care and, using a comprehensive framework, mapped their observations onto 17 essential obstetric and neonatal care practices:

The researchers found poor quality of care in both public and private facilities. Unqualified personnel were found to provide institutional maternity care in up to 59% of all deliveries, and a number of life-saving clinical practices such as partograph use for monitoring labor, screening for pre-eclampsia/eclampsia and active management of the third stage of labor were rarely observed. Additionally, researchers noted the provision of women-centered, respectful maternity care (https://www.mhtf.org/topics/respectful-maternity-care/) practices in just 4% of deliveries.

Overall, 45% of recommended practices were completed for women giving birth in the private sector compared to 33% in the public sector. For obstetric care, private sector clients received...

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