Respectful Maternity Care Practices During Normal Delivery at the Public Health Facilities in Tamil Nadu, Southern India: A Descriptive Study.

INTRODUCTION: The quality of maternity care in Tamil Nadu has significantly improved in the past few years and various public health initiatives have helped to reduce crucial indicators like Maternal Mortality Ratio and Infant Mortality Rate. The improvement in quality of interface between the mothers and service providers in term of language, behaviour and attitude for ensuring 'Respectful Maternity Care' would support further enhancement of maternal and new born outcomes. Delivery of appropriate and respectful care to each pregnant woman would not only go a long way in reducing mortality and morbidity for the woman and new-born but also help in improved cognitive development of the baby. OBJECTIVE: To assess the quality of delivery care practices provided during normal delivery among women accessing public health facilities in Tamil Nadu. METHODS: A descriptive evaluation study was conducted from May to December 2018 in 16 facilities across 14 districts in Tamil Nadu. The health facilities were stratified according to the level of services, Government Medical College hospitals (MC), District headquarter hospitals (DHQ), Sub-district hospitals (SDH), and PHCs, 4 facilities in each category were selected. Data was collected by direct observation using a facility observation check list in an Android-based tablet application. Informed consent was obtained from all participants. RESULTS: A total of 1006 pregnant women out of 2242 women who had normal delivery were assessed and included in the study. More than 50% of deliveries were conducted by nurses and midwives and the perinatal and maternal outcomes were found to be good. The parameters for the respectful maternity care were recorded. Routine care monitoring parameters helped to reduce mortality rate and improved delivery care. CONCLUSION: The state though has achieved substantial success in promoting institutional delivery practices, still needs certain crucial improvements in the quality of respectful maternal care during the delivery.

The overall pooled prevalence of disrespectful maternity care in India was 71.31% (95% CI 39.84­102.78) where every individual study prevalence ranged from 20.9 to 100%. Institutional delivery is 100 percent in Puducherry and Tamil Nadu (NFHS V) and hence it is important to assess the quality of maternity care provided in public healthcare facilities in the state. The improvement in the quality of the interface between the women and service providers in terms of language, behavior, and attitude for ensuring 'Respectful Maternity Care' would thus contribute to positive outcomes for women and their newborns, and also to ensure the cognitive development of children later in life.

Ethical rationing of healthcare resources during COVID-19 outbreak: Review.

While rationing of healthcare resources is inevitable even in the most developed economies, particularly on the wake of a pandemic, ethical basis of its implementation needs to be reviewed. With sudden and huge demand for drugs and medical supplies and equipments, the need for rationing arises and thus the concept becomes unavoidable. Thus, we aimed to review and analyse on the key ethical issues in the concept of healthcare rationing. Our search in various PubMed databases resulted articles explaining on the concept of strategizing the priorities based on universal ethical principles of justice, benevolence and ensuring equality rather than wealth, power, geographical location or other personal biases. Concrete and pragmatic regulations and guidelines for systematic rationing have to be framed and followed. In addition, physicians being sensitive and empowered on deciding bedside rationing in coordination with the recommendations of ethicists and healthcare officials, will ensure fair practice.