Does Quality of Delivery Care Differ Between Public and Private Facilities in Madhya Pradesh, India?: An Exit Interview Study of Routine Delivery Care Practices

Session: Quality in Context: How Can Facility-Based Maternal Newborn Care Be Improved?

Presenter: Bharat Randive, Umea University, Sweden
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Background:   Routine delivery care practices at facilities are indicators of quality of care. India has promoted facility births through the Janani Suraksha Yojana (JSY) cash transfer program. In Madhya Pradesh (MP) state, where over two thirds of births occur at facilities, the JSY is implemented through the public health system that is the major provider of obstetric care. We compare routine delivery practices at public and private facilities in MP.

Methods: We selected facilities conducting at least 10 deliveries a month in three districts of MP. We conducted exit interviews with women who delivered in these facilities. The questionnaire was based on standard recommendations in the WHO guide for delivery care practices. Comparisons were made using proportions; non-overlapping 95% Confidence Intervals were considered significant.

Results: We interviewed 997 women who delivered at 96 facilities- 881 women at 73public facilities and 116 women at 23 private facilities. Practices that should be promoted were generally more prevalent in public facilities than private facilities: companionship in labour (78% vs6%), mobility during labour (59% vs 35%), early mother-baby rooming-in (46% vs 34%) and early initiation of breast feeding (29% vs 17%). Practices that should be discouraged as routine were more prevalent in private facilities than public facilities: intravenous fluids (93% vs 33%), pubic shaving (98% vs 42%), episiotomy (78% vs 16%), and enema (50% 21%). Three practices did not significantly differ between public and private facilities- delivering in the supine position (98%at public and 96% at private),abuse during delivery (16% vs 14%), as also the potentially harmful practice of fundal pressure in the second stage of labour (36% vs 37%).

Conclusion: Routinely encouraged practices are generally more prevalent at public facilities while those routinely discouraged are more prevalent at private facilities indicating relatively better quality of care at facilities in the JSY cash transfer program in MP.