Cashless childbirth, but at a cost: A grounded theory study on quality of intrapartum care in public health facilities in India.
OBJECTIVE
this study aimed to explore and understand the perceptions and experiences of women regarding quality of care received during childbirth in public health facilities.


METHODS
qualitative in-depth interviews were conducted and analysed using the Grounded Theory approach.


METHODS
thirteen women who had given vaginal birth to a healthy newborn infant.


METHODS
participants were interviewed in their homes in one district of Chhattisgarh, India.


METHODS
the interview followed a pre-tested guide comprising one key question: How did the women experience and perceive the care provided during labour and childbirth?


RESULTS
'cashless childbirth but at a cost: subordination during childbirth' was identified as the core category. Women chose a public health facility due to their socio-economic limitations, and to have a cashless and safe childbirth. Participants expressed a sense of trust in public health facilities, and verbalised that free food and ambulance services provided by the government were appreciated. Care during normal birth was medicalised, and women lacked control over the process of their labour. Often, the women experienced verbal and physical abuse, which led to passive acceptance of all the services provided to avoid confrontation with the providers.


CONCLUSIONS
increasingly higher numbers of women give birth in public health facilities in Chhattisgarh, India, and women who have no alternative place to have a safe and normal birth are the main beneficiaries. The labour rooms are functional, but there is a need for improvement of interpersonal processes, information-sharing, and sensitive treatment of women seeking childbirth services in public health facilities.
Department of Women's and Children's Health, Uppsala University, Sweden. Electronic address: paridhi.jha@kbh.uu.se.
Paridhi
P
Jha
Department of Women's and Children's Health, Karolinska Institutet, Sweden. Electronic address: kyllike.christensson@ki.se.
Kyllike
K
Christensson
Department of Women's and Children's Health, Uppsala University, Sweden. Electronic address: agneta.skoog-svanberg@kbh.uu.se.
Agneta Skoog
AS
Svanberg
Department of Women's and Children's Health, Uppsala University, Sweden. Electronic address: margareta.larsson@kbh.uu.se.
Margareta
M
Larsson
Indian Institute of Public Health, Gandhinagar, Gujarat, India. Electronic address: bsharma@iipghg.org.
Bharati
B
Sharma
Department of Public Health, Karolinska Institutet, Sweden. Electronic address: eva.johansson@ki.se.
Eva
E
Johansson
D001291:Attitude of Health Personnel; D036861:Delivery, Obstetric / Q000191:economics* / Q000523:psychology* / Q000592:standards*; D005260:Female; D066296:Grounded Theory; D006779:Hospitals, Public / Q000191:economics / Q000592:standards; D006801:Humans; D007194:India; D008427:Maternal Health Services / Q000191:economics / Q000592:standards; D061214:Patient Safety / Q000592:standards; D017060:Patient Satisfaction; D011247:Pregnancy; D036301:Qualitative Research; D011787:Quality of Health Care / Q000191:economics*
Abuse; Birth experience; Care providers; Communication; Grounded theory; Institutional delivery