ABSTRACT OF PLAN OF THESIS

TITLE A study to assess the women’s perception of respectful

maternity care among postnatal mother admitted in
selected hospital of Punjab.
FOR THE DEGREE Master of Science in Nursing (Obstetrics and
Gynecology)
NAME OF CANDIDATE Ms. Sapna Pathania
GUIDE

CO – GUIDE

INSTITUTE Saraswati Nursing Institute, Village Dhianpura, Kurali,

Distt. Ropar, Punjab.
UNIVERSITY Baba Farid University of Health Sciences, Faridkot,
Punjab.

Every woman e in the world has a right to accept respectful maternity care. Respectful maternity
care (RMC) is not only a great important part of quality of care it is a human right .The concept
of “respectful maternity care” has progress and enlarge over the past few years.The main aim of
this study to assess the women’s perception of respectful maternity care. A Descriptive design
will be used to assess the women’s perception of respectful maternity care. The sample will be
selected by using purposive sampling technique. Analysis and interpretation of data will be based
on objective and will be done by using descriptive and interential statistics.
 SYNOPSIS

TITLE A study to assess the women’s perception of respectful maternity care

among postnatal mother admitted in selected hospital of Punjab.
GUIDE

CO-GUIDE

SUBMITTED BY Ms. Sapna Pathania

MSc. Nursing 1st Year
Obstetrics and Gynecology
UNIVERSITY Baba Farid University of Health Sciences, Faridkot, Punjab.
 Approval Performa by Research and Ethical committee
SARASWATI NURSING INSTITUTE, DHIANPURA
Name of the candidate Sapna Pathania

Topic of Thesis A study to assess the women’s perception of

respectful maternity care in selected hospital
Punjab.

Date of enrolment
Name of the guide

Name of the co-guide

Signature of member of research committee Signature of ethical committer

1. Dr.(Mrs.)Raman Kalia 1. Dr.(Mrs.)Raman Kalia

Principal Principal
Charperson Charperson
2. Mr Natrrajan Kaushal
Advocate
Legal Ethical Consultant

2. Dr.Bharat Pareek 3. Ms Shevata Sharma

Vice Principal Associate Professor
Research Coordinator Member

4. Ms.Kamlesh 5. Ms. Harpreet Sharma

Associate Professor Associate Professor
Member Member

5. Ms Jasmeet Kaur
6. Ms. Manpreet Kaur Associate Professor
Assistant Professor Member
Member
7. Ms Amiteshwar Kaur 6. Ms Sabina
Assistant Professor Assistant Professor
Member Member

Approved: Yes/No Approved: Yes/No

Dr. (Mrs.) Raman Kalia, Principal Dr. (Mrs.) Raman Kalia, Principal
Saraswati Nursing Institute, Saraswati Nursing Institute,
Vill. Dhianpura, Kurali Vill. Dhianpura, Kurali
Chair person Chair person
INTROUCTION

BACKGROUND OF THE STUDY

‘No matter where you are, pregnancy and labour can be trying. The least women deserve
is dignity through the process.’

Women are not dying because of untreatable diseases. They are dying because societies
have yet to make the decision that their lives are worth saving. We have not yet valued
women’s lives and health highly enough.

Childbirth is an event in a woman’s life when her womanhood is celebrated. It is often a life
changing event because during this time, the mother goes through a lot of biological, social
and emotional transitions.1 A satisfactory childbirth can profoundly affect the future well being
of the mother, and her relationship with the baby and Family.2

Respectful maternity care which refers to the care organized for and provided to all women in
that manner to maintains their privacy, dignity and confidentiality, and also ensures that freedom
from harm and mistreatment, and there should be continuous support during labour and
childbirth. Globally, approximately there are 140 million births are occurring every year. The
majority of the vaginal births among pregnant women have no risk factors for complications,
either for their babies and themselves also, at the onset of the labour. However, in some
situations complications arise during the labour, the risk of serious morbidity and death increases
for both the woman as well as baby. Nowadays women have been encouraged to give birth in
health care facilities so it helps to reduce the mortality rate of woman and baby. However,
conduct labour and childbirth care in health care facilities may not guarantee a good quality of
care. Disrespectful and undignified care is very much prevalent in many health care facility
settings and it is particularly for needful populations, and this not only brutal their human rights
but also barrier to accessing intra-partum care services. 2

During intra-partum period in many segment of the world, health care providers may exposed
evidently healthy Gravid women for unnecessary medical involvement that interfere the
physiological process of child-birth. Every woman everywhere in the world has a right to accept
respectful maternity care. The concept of “respectful maternity care” has progress and enlarge
over the past few years. In November 2000, the International Conference on the Humanization of
Childbirth was held in Brazil, largely as a response to the trend of medical zed birth, exemplified
by the global caesarean section epidemic, as well as growing concerns over obstetric violence.
Advocates emphasized the need to humanize birth, taking a woman- cantered approach.3

Respectful maternity care (RMC) is not only a great important part of quality of care it is
a human right. In 2014, WHO released a statement calling for the inhibition and elimination of
disregard and a mistreat during childbirth, stating that “every woman has the right to the highest
accessible standard of health, that including the right to dignified, respectful care during
pregnancy and also during childbirth. Disrespect and abuse of women by providers had been
found to be a strong disincentive for accessing skilled care by women during child-birth . In
2016, WHO again published new guidelines for the improving quality of care for mothers and
new- born during pregnancy and child-birth in health facilities, which included an enlarge
attention on respect and maintain the dignity.4

Disrespect and abuse during childbirth can include physical abuse, non-consented care, poor
communication between women and health care providers, stigma and unfairness during child-
birth and pregnancy. However, “the lack of Disrespect and abuse is not the same as RMC…it
would be possible to abstain from disrespectful and offensive treatment and still not be
particularly kind and humble.5

The White Ribbon Alliance also promotes universally Respectful Maternity Care as a human
right in worldwide. Research has also shown that small and affordable measures can significantly
reduce the health risks that women face when they become pregnant. Most maternal deaths could
be prevented if women had access to appropriate healthcare during pregnancy, childbirth, and
immediately afterwards. Respectful Maternity Care ensures quality care and preserves women’s
autonomy, dignity, feelings, choices, and preferences during childbirth. Maternity caregivers can
empower and comfort pregnant women, or inflict lasting damage and emotional trauma.
Evidence suggests that in countries with a high maternal mortality like India, the fear of
disrespect and abuse that women often encounter in facility-based maternity care is a more
powerful deterrent to use of skilled care than commonly recognized barriers such as cost or
distance.6

Mistreatment of women during labour and delivery is a global challenge, because it negatively
influences women’s decisions to seek future obstetric care at health facilities and violates
women’s rights despite nearly two decades of growing concern about poor provider attitudes and
women experiencing mistreatment in health facilities few maternal health service interventions
have a central objective focusing on these issues.7

The seven articles of the Charter are closely aligned to the seven domains of D&A (see 'Seven
rights')

Article 1. Every woman has the right to be free from harm and ill treatment.

Article 2. Every woman has the right to information, informed consent and refusal, and respect
for her choices and preferences, including companionship during maternity care.

Article 3. Every woman has the right to privacy and confidentiality.

Article 4. Every woman has the right to be treated with dignity and respect.

Article 5. Every woman has the right to equality, freedom from discrimination, and equitable
care.
Article 6. Every woman has the right to healthcare and to the highest attainable level of health.

Article 7. Every woman has the right to liberty, autonomy, self-determination, and freedom from
coercion.8
NEED OF STUDY

Respectful maternity care is an integral element of comprehensive, high-quality health services.

Many women around the world experience disrespectful, abusive, and harmful treatment
throughout pregnancy and childbirth. Labour and childbirth can be complicated and painful.
Health providers ignore a woman’s questions, preferences, and distress. Physical violence   such as
a provider hitting a labouring mother to quiet her is not uncommon.6

When the word midwife was first used, it meant, literally, “with woman.” Midwives, together
with nurses and doctors, are on the front lines of ensuring that women receive the respectful
maternity care they are entitled to. Advancing respectful, dignified care must be a priority for
countries, with clear measurements and goals. Let’s make sure every woman, everywhere, can
attain it.4

In 2014, the WHO published a statement calling for the elimination of disrespect and abuse
during facility based childbirth. As a consequence of this focus, in 2016 the WHO prioritized a
question for its 2018 intra partum care guideline on the effects of polices to increase RMC.1

In India every year 45,000 women die during pregnancy and childbirth. When we eliminate
disrespect and abuse during maternity care it remarkably reduce the health risks that pregnant
women face.Every year on April 11, India distinguish National Safe Motherhood Day so that all
native, association and shareholders create focus on the maternal health situation and pay
attentions on what actions are working and further what more actions is needed to be done. 4
REVIEW OF LITERATURE

Every woman has the right to be treated with dignity and respect by facility staff
regardless of background, health or social status, this includes, but is not limited to, women
who are single, poor, and uneducated, or a minority in her community.

Rosen E H, Lyman F P et (2015) conducted a study on Direct observation of respectful

maternity care in five countries: a cross sectional study of health facilities in East and Southern
Africa. A total of 2164 labour and delivery observation were conducted at hospital and health
centres. Women overall were treated with dignity and supportive manner by provider and were
not well informed about their care. Both verbal and physical abuse were observed during the
studzy.7

Vedam S, Stoll K, Rubashkin N et all (2017) conducted a study on The Mothers on Respect
(MOR) index: measuring quality, safety, and human rights in childbirth. A cross-sectional survey
was completed by women of childbearing age from diverse communities across British
Columbia. To demonstrate replicability, they report psychometric results separately for three
samples of women (S1 and S2) (n=2271), (S3, n=1613). The MOR index is a reliable, patient-
informed quality and safety indicator that can be applied across jurisdictions to assess the nature
of provider-patient relationships, and access to person-cantered maternity care. 8

Nyirenda1 H T, Mulenga1 D, Nyirenda T et all (2018) conducted a study on Status of

Respectful Maternal Care in Ndola and Kitwe Districts of Zambia. A cross-sectional study
design and captured quantitative data on self-reporting of experiences of respectful maternal care
during child birth among women. The sample size was 471 resident women of the selected 18
high volume health facilities. Cluster sampling technique was used and structured interview
questionnaire was used to conduct household interviews. The findings show that on average,
18% of the women had experienced physical abuse by a service provider during child birth.
Prominent issues that led to ill-treatment included 43% of the women not provided comfort/pain-
relief. On average 41% of the women received non-consented care from the service provider. 9

Nyirenda1 H T, Mulenga1 D, Nyirenda T et all (2018) conducted a study on Status of

Respectful Maternal Care in Ndola and Kitwe Districts of Zambia. A cross-sectional study
design and captured quantitative data on self-reporting of experiences of respectful maternal care
during child birth among women. The sample size was 471 resident women of the selected 18
high volume health facilities. Cluster sampling technique was used and structured interview
questionnaire was used to conduct household interviews. The findings show that on average,
18% of the women had experienced physical abuse by a service provider during child birth.
Prominent issues that led to ill-treatment included 43% of the women not provided comfort/pain-
relief. On average 41% of the women received non-consented care from the service provider. 10

Webber G , Chirangi B and Magatti N (2018) Conducted a study on Promoting respectful

maternity care in rural Tanzania: nurses’ experiences of the “Health Workers for Change”
program. A series of workshops were held for 60 maternal health care nurses who are working at
the hospitals, health care centres and dispensaries in the district. The participators appreciated the
training and reflected on that they were providing poor quality of health care services recognize
that attitudes towards maternal patients were problematic.11

Downe S, Lawrie A, T Finlayson K et all (2018) conducted a study on Effectiveness of

respectful care policies for women using routine intrapartum services: a systematic
review.Randamized and non randomized controlled studies was used for evaluating the effect
of introducing RMC policies into health care facilities.In this study 8000 women were
included. Moderate certainty evidence suggested that RMC intervention increases women’s
experiences of respectful care.

Mousa O, TuringanM O (2019) conducted a study on Quality of care in the delivery room:
Focusing on respectful maternal care practices. This study provided a descriptive overview of
the care provided in the delivery room. A cross-sectional retrospective study was conducted at
the postpartum department in Minia University Maternity and Child Health Hospital in Minia,
Egypt. Purposive sampling technique was used. The 15-item Respectful Maternal Care (RMC)
Scale was used for this study. A total of 580 questionnaires were distributed to the postpartum
women in the hospital and 501 were completed and collected giving a retrieval rate of 86.4%.
Generally, the postpartum mothers felt that they received a high degree of discrimination free
care during childbirth. 13
PROBLEM STATEMENT

A descriptive study to assess the women’s perception of respectful maternity care among
postnatal mother admitted in selected hospital of Punjab.

AIM

A study to assess the women’s perception of respectful maternity care in selected hospital
Punjab.

OBJECTIVES

 To assess the women’s perception of respectful maternity care among postnatal mother.

OPERATIONAL DEFINTION

Respectful maternity care:- is a universal human right due to every childbearing woman in
every health system around the world .Women’s experiences with maternity care giver can
empower and comfort or inflict lasting damage and emotional trauma.

Women Perception :-Women perception is ability to become aware of something through

senses in labor room.

MATERIAL AND METHODS

Research approach: - Non Experimental

Research design: - Descriptive

Study setting:- Study will be conducted in GMSH-16 Chandigarh .

Sample Size:- 200 postnatal mothers.

POPULATION:- Postnatal women’s before 4 weeks

SAMPLE TECHNIQUE: -Purposive sampling technique

SAMPLING CRITERIA

Inclusion Criteria: -

All mothers who give birth in before 4 weeks.

Women who were resident of the area since the past six months.

Exclusion criteria: -

Mothers who were critically ill and unable to communicate at the time of data collection.

VALIDITY:- It will be determined by expert’s opinion.

RELABILITY:-The reliability of tool will be assessed by testing for stability (test-retest method
) and internal consistency.

PILOT STUDY:-It will be conducted on 10% total sample size to determione feasibility of
study.

ETHICAL CONSIDERATION:- Ethical approval for the study obtained from Ethical
Committee of Saraswati Nursing Institute . All participants will be informed that their
participation in study will be voluntary and they can refuse to participate and withdrawn from the
study at any time. Apart from this, written informed consent will be taken each participant and
permission will be taken from authorities. Confidentiality and anonymity of the study subjects
will be taken care of.

PLAN OF ANALYSIS:- The data will be analyzed as per the objectives as per the objectives
differential and analytical statistic will be used and data will be presented in graphs and tables.

DISSCUSSION :- Discussion will be based on statistical analysis and previously related

research studies.
REFERENCES: -

1. WHO recommendation on respectful maternity care during labour and childbirth | RHL
[Internet]. [cited 2019 Jan 31]. Available from:
https://extranet.who.int/rhl/topics/preconception-pregnancy-childbirth-and-postpartum-
care/care-during-childbirth/who-recommendation-respectful-maternity-care-during-labour-
and-childbirth

2. A Little Respect: Improving Maternity Care – Maternal Health Task Force [Internet]. [cited
2019 Jan 31]. Available from: https://www.mhtf.org/2017/09/05/a-little-respect-improving-
maternity-care/

3. Jhpiego. All Women Deserve Respectful Maternity Care [Internet]. The Development Set.
2016 [cited 2019 Jan 31]. Available from: https://thedevelopmentset.com/eight-things-
respectful-maternity-care-is-f63c12bf7c00

4. India endorses ‘Respectful Maternity Care’ charter for the country on Safe Motherhood Day |
Women Health Task Force (WHTF) [Internet]. [cited 2019 Jan 31]. Available from:
https://womenhealthtaskforce.wordpress.com/2016/04/23/121/

5. www.ETHealthworld.com. White Ribbon Alliance India endorses ‘Respectful Maternity

Care’ charter for the country on Safe Motherhood Day - ET HealthWorld [Internet].
ETHealthworld.com. [cited 2019 Jan 31]. Available from:
http://health.economictimes.indiatimes.com/news/industry/white-ribbon-alliance-india-
endorses-respectful-maternity-care-charter-for-the-country-on-safe-motherhood-
day/51805326

6. Global FG. Respectful Maternity Care [Internet]. [cited 2019 Jan 31]. Available from:
https://www.healthpolicyproject.com/index.cfm?id=topics-RMC

7. Rosen HE, Lynam PF, Carr C, Reis V, Ricca J, Bazant ES, et al. Direct observation of
respectful maternity care in five countries: a cross-sectional study of health facilities in East
and Southern Africa. BMC Pregnancy Childbirth [Internet]. 2015 Nov 23 [cited 2019 Feb
23];15. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4657214/

8. Downe S, Lawrie TA, Finlayson K, Oladapo OT. Effectiveness of respectful care policies for
women using routine intrapartum services: a systematic review. Reprod Health. 2018 Feb
6;15(1):23.

9. Webber G, Chirangi B, Magatti N. Promoting respectful maternity care in rural Tanzania:

nurses’ experiences of the “Health Workers for Change” program. BMC Health Serv Res.
2018 Aug 22;18(1):658.

10. Mousa O, Turingan OM. Quality of care in the delivery room: Focusing on respectful
maternal care practices. J Nurs Educ Pract. 2018 Aug 22;9(1):1.
11. Vedam S, Stoll K, Rubashkin N, Martin K, Miller-Vedam Z, Hayes-Klein H, et al. The
Mothers on Respect (MOR) index: measuring quality, safety, and human rights in childbirth.
SSM - Popul Health. 2017 Dec 1;3:201–10.