Maternal Care

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Women’s perspectives on quality of maternal health care services in Jaipur

Maternal care covers all aspects of the mother’s caretaking activity from her child’s birth until it reaches the age of twelve to fifteen months, or, the age of three years. Primarily, it is the quality of the relationship established by the mother with her infant and maintained throughout this period. While “the mother” usually means the woman who has carried the child to term and looks after it after birth, in the present context it may also denote any person who fulfills the maternal role in a continuous fashion from birth on (mother substitute).

The concept of maternal care is essentially post-Freudian. Freud assigned the mother no primary structuring role in the mental development of the child, nor did he view the loss of the mother as a traumatic event of particular import when it occurred in the child’s earliest years.

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High quality care should be

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Safe—delivering health care which minimizes risks and harm to service users, including avoiding preventable injuries and reducing medical errors
Effective—providing services based on scientific knowledge and evidence-based guidelines
Timely—reducing delays in providing and receiving health care
Efficient—delivering health care in a manner that maximizes resource use and avoids waste
Equitable—delivering health care that does not vary in quality because of personal characteristics such as gender, race, ethnicity, geographical location or socioeconomic status
People-centered—providing care which takes into account the preferences and aspirations of individual service users and the cultures of their communities
Measuring quality is one of the first steps towards improving it, but measurement can be challenging given the complex and interconnected aspects of women’s experiences with the maternal health care system. The availability of infrastructure and supplies, the health care workers’ level of training, provider-patient relationships and many other factors affect the quality of care a woman receives, and some of these elements are easier to measure than others. Researchers and practitioners have proposed different ways of capturing quality of antenatal, intrapartum and postpartum care. However, many indicators that researchers currently use to measure quality have not been validated in various global settings, begging the question: How much do we really know about the quality of maternal health care around the world?

Survey-based studies have demonstrated wide variation in health facilities’ capacity to deliver basic maternity services and manage obstetric complications: In sub-Saharan Africa, only one out of every ten health facilities providing maternity care is able to perform cesarean sections, and often times those facilities operate without essential infrastructure such as a safe water source or electricity. Other studies have illustrated the high prevalence of disrespect and abuse during facility-based childbirth, including instances of women being scolded, abandoned and even physically beaten by health care staff, promoted efforts to measure and improve the quality of antenatal and postnatal care and created novel measures to track autonomy and respect along the continuum of care. Numerous papers have discussed, measured and analyzed skilled birth attendance as an indicator of quality, contributing to an ongoing dialogue about who is capable of providing high quality maternity care and where those deliveries should take place.

Designing interventions to improve quality of care is a critical component of ending preventable maternal mortality and requires a better assessment of the factors that matter most to women. Addressing the challenges faced by frontline providers, health policy makers and program implementers trying to improve maternal health is also key. Continuing the global dialogue on quality of maternal health care is crucial for answering some of the most pressing questions:

What are the best strategies for accurately measuring quality of maternal health care?
In what ways might high quality care look different across diverse sociocultural settings?
How does the WHO definition of quality of care compare to the real-life experiences of women receiving maternity care services?
What kind of programs, policy changes and other interventions are most effective for addressing issues of quality?
The Maternal Health Task Force (MHTF) strives to ensure that the global maternal health community is well-informed and equipped to tackle these difficult questions and work together to improve the health and wellbeing of women, mothers and newborns around the globe.