Maternity care in South Asia: requiring a chain of change

When dealing with maternity care, there are a multitude of complexities related to both maternal and fetal health. These can be both antenatal, during birth and postnatal, each requiring their own protocols and decisions to account for all outcomes. A recent publication in International Journal of Women’s Health has highlighted that poor maternal care, involving both abuse and neglect, remains a troubling issue in South Asia1.

The paper begins by summarizing the problem of maternal mortality through preventable causes, going on to suggest that in South Asia, there are multiple factors contributing to mortality1. It is also acknowledged that the South Asian countries involved in the analysis – including but not limited to Afghanistan, Bangladesh, Bhutan, India and more – have limited resources available for maternal care. The lack of resources, in combination with alternative factors (e.g., cultural, social and other contributors), could potentially increase the likelihood of abuse, neglect or additional poor outcomes.

In order to do so, the authors collated studies completed within South Asia. These studies were varied in nature and contained a variety of perspectives. Participants included not only patients themselves, but family, students, additional stakeholders and healthcare staff themselves. By employing a combined inductive and deductive thematic analysis in the article, the authors were able to better understand the realities of maternal care. Themes were placed into two groups, either highlighting the experience of dissatisfactory maternal care, and the other stressing the importance of improving the care provided.

The variance within these two groups is considerable, which further emphasizes the multifaceted nature of maternal care to begin with. Such examples include neglecting the choices of women and their families, alongside more practical elements that could present challenges when delivering high-quality care. This level of care was noted to be exacerbated by patient groups who already experience levels of health inequity, which links back to the authors point of these issues manifesting beyond healthcare settings alone.

When faced with the prospect of tackling these issues, the authors were able to highlight some routes for improvement. Without disregarding the idea that maternal care is particularly unique to every patient, some findings from the authors appear intuitive. These include the involvement of friends and family to increase confidence and comfort throughout pregnancy, as women were keen to seek advice and share decisions with individuals close to them.

Confidence in decisions may also be facilitated in another theme mentioned by the authors, involving care without judgement and supportive responses from healthcare professionals. An interesting point further complicates improving this aspect of maternal care, as healthcare professionals involved in some studies reported institutional restrictions beyond their control.

Therefore, it is suggested that a wider institutional change is needed. It comes as no surprise that the present analysis found a demand for more resources in healthcare centers, but additional training also. Lacking resources in these centers meant respectful maternity care could not be provided, as the means to do so is not consistently available. It is acknowledged that private institutions in South Asia may be able to provide the necessary resources, implying inequity in maternal care based on socioeconomic status as much as individual healthcare centers themselves.

How can high-quality resources and consistent training be implemented? The authors point to the perhaps highest level of the chain, suggesting that the aforementioned changes may not be possible without introducing, or altering pre-existing, policies. While societies may widely agree that respectful maternity care is important and should occur without discrimination, it could be said that without political mandates there is no obligation for the previously mentioned changes to happen.

Ultimately, this manuscript from Kaphle, Vaughan and Subedi (2022) has highlighted the degrees of change that could make a marked difference in South Asian maternity care. Many of the individual papers utilized in this review express how their findings may be implemented at multiple levels but acknowledge that the change in more local areas may be facilitated by government. In doing so, it is hoped that less patients in South Asia will avoid receiving maternity care due to increased confidence about their safety and agency.

However, the authors do acknowledge that pregnancy is subject to many influences, including those unrelated to healthcare facilities. Moreover, some issues raised in the paper may be closely related to each respective region and culture across South Asia, implying a degree of flexibility. In sum, the recommendations to improve healthcare are unlikely to fully solve all the potential issues faced during pregnancy, but that changes to maternity care services in South Asia may alleviate some of the current challenges in the region.

You can read the article referred to in this blog post on the Dovepress website at this link.

¹ Kaphle S, Vaughan G, Subedi M. Respectful maternity care in South Asia: what does the evidence say? Experiences of care and neglect, associated vulnerabilities and social complexities. Int J Womens Health. 2022;14:847—879.

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