Quality of care, maternal attitude and common physician practices across the socio-economic spectrum: a community survey.
OBJECTIVE
To evaluate the quality of maternity care, women's perception of the quality of care and factors influencing the same in Delhi.


METHODS
Women who delivered a viable live birth in the past 6 months were recruited from South Delhi by a two-stage stratified cluster randomized sampling. In stage 1, two colonies each from three predefined economic strata (high-, middle- or low-income areas) were selected by simple-random sampling. In stage 2, a sequential house-to-house survey was conducted in each selected colony. The information was collected by interview and review of medical records.


RESULTS
A total of 5,279 houses were screened to recruit 249 subjects. Several disparities were notable. 25.2 and 14.8% of the women from middle- and lower-income areas delivered by cesarean section, while the rate was 53.6% in the higher-income areas. In women from lower-income areas urine testing was not done in 76.9% and blood sugar was not tested in 18.2%, while in high-income areas 44.6% had > or =10 antenatal visits and 87.8% had > or =3 ultrasounds. Of the women who experienced labor only 11% received support from a friend or family member, 4.4% received any medicine/measures for pain relief, 44.3% were allowed to walk and 14.6% were catheterized.


CONCLUSIONS
Health care providers are unable to meet national minimal care standards in poorer areas, while over investigation and over intervention appear prevalent in higher-income areas. This warrants a more representative evaluation to enable more equitable and evidence-based practice.
Dhar
Rinku Sengupta
RS
Department of Gynecology and Obstetrics, Sitaram Bhartia Institute of Science and Research, B-16, Qutab Institutional Area, New Delhi, India.
Nagpal
Jitender
J
Bhargava
Vijaylakshmi
V
Sachdeva
Aarti
A
Bhartia
Abhishek
A
D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D019538:Health Care Surveys; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D055815:Young Adult