Quality of care, maternal attitude and common physician practices across the socio-economic spectrum: a community survey

To evaluate the quality of maternity care, women's perception of the quality of care and factors influencing the same in Delhi. 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. 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 a parts per thousand yen10 antenatal visits and 87.8% had a parts per thousand yen3 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. 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.