Project Inception year :

2015

Project area :

Pan India

Promoting Respectful Maternity Care in India

Goal :

The project aims to break the veil of silence around disrespectful and abusive maternity care and empower health care providers, women and communities to recognize respectful maternity care as a basic human right.

Need :

A rapid situation analysis on Respectful Maternity Care (RMC), revealed a huge gap vis-à-vis RMC provision during maternal health services. The analysis found that disrespect and abuse of women during maternity care is not explicitly recognized as a barrier to utilization of health services. There are many anecdotal reports, in the mainstream media, of cases of denial, disrespect and abuse but the community remains largely ignorant of their right to respectful care. Government policies, protocols, guidelines, training and health provider’s pre- and in-service curricula does not specifically mention respectful care. Grievance redressal in hospitals and facilities, even if available was mostly not known by patients.

Our program

Given the above context, C3 is leading the White Ribbon Alliance for Safe Motherhood India’s 3-year project to Promote Respectful Maternity Care in India. Funded by the MacArthur Foundation, the project aims to break the veil of silence around disrespectful and abusive maternity care and eduacte health care providers, women and communities to recognize respectful maternity care as a basic human right.

This project adopts a multi-sectoral approach to fulfil its objective and has the following strategies in place:

  • Institutionalize RMC in the mainstream healthcare provisions and policies through collaboration with professional organizations such as the Indian Council of Medical Research (ICMR) and the Trained Nurses Association of India (TNAI).
  • Create a model Health Facility that provides maternity care services with all components of RMC incorporated. Memorandum of Understanding (MoU) with Government Medical College, Aurangabad (GMCA), a large tertiary care hospital and medical college, to incorporate RMC Standards into its maternity care services
  • Include respectful maternity care into key nursing textbooks such as the Fundamentals of Nursing Manual and the Community Health Nursing Manual.
  • Gather evidence of disrespect and abuse and its impact on maternal health and use them as advocacy tools through partnerships with organizations such as PGIMER in Chandigarh, IPRT for Orissa, Diya Foundation in Assam.
  • Generate endorsement for the RMC Charter. The RMC Charter has been revised and adapted to Indian context and has been endorsed by about 85 national and international organizations. It has been widely disseminated among the 1800 strong WRAI member network and 5 WRA State Chapters with networks of their own. The Charter has also been translated to Hindi, Assamese and Oriya.
Case story
Laxmi (name changed) had her partial Anti Natal Care (ANC) checkups done.

Laxmi (name changed) had her partial Anti Natal Care (ANC) checkups done. Her haemoglobin level was checked and was 8.7 during her last ANC, her urine was checked for sugar and Albumin level, she received her TT injections and consumed 100 IFA tablets, but her blood pressure was never recorded. She had only 2 ANC and her Mother Child Protection card was not properly filled. During her labour, she was referred to the Sub divisional hospital in Cooch Bihar, West Bengal which is in another state and very far from her residence. She was from an economically poor family so could not afford services from the local private hospital. The inter facility transport was not available for her referral. She somehow managed to reach the Sub divisional hospital. Seeing her situation, the Obstetrics and Gynaecology department admitted her immediately in the hospital, despite the SHD being a high caseload facility. Although she received all the immediate care, she was not informed about the procedures when they were undertaken. She delivered a healthy baby and there was no out-of-pocket expense.

However, because of overcrowding she and her newborn shared the postpartum bed with another mother and newborn. The toilets were over used and not cleaned frequently enough so were very dirty. She shared with the WRA member that she received transport to return home, free medicines and care at facility and stayed for 48 hours after birth. She did not receive any Family Planning counseling or method during pregnancy and did not accept a method at the hospital. She does not know about the INR 1400 she is entitled to under the Janani Surakhsha Yojana although she has a bank account. Despite problems that she faced at the referral facility and incomplete antenatal care, she is satisfied with the overall quality of care. She feels poor women like her will not be able to bring change and improve services.