“A STUDY TO ASSESS THE EFFECTIVENESS OF PLANED

TEACHING PROGRAM REGARDING RESPECTFUL

MATERNAL CARE (RMC) AMONG NURSING OFFICERS, IN
SELECTED HOSPITALS AT UJJAIN, (MP).”

SYNOPSIS
SUBMITTED TO M.P.M.S.U. IN THE PARTIAL FULFILMENT OF THE DEGREE OF
MASTER OF SCIENCE IN NURSING

By
Mrs. RADHA RAGHUWANSHI

UNDER THE GUIDANCE OF

Dr. SUSHMA SHUKLA

DEPARTMENT OF OBSTETRICS AND

GYNAECOLOGICAL
NURSING,

GOVERNMENT COLLEGE OF NURSING UJJAIN

MADHYA PRADESH
YEAR 2022-23
 Name of the student Mrs. RADHA RAGHUWANSHI
1. (Block letters)

2. Department Nursing

3. Name of the Course M.Sc. NURSING

OBSTETRICS AND
Subject
4. GYNAECOLOGICAL
(Block letters)
NURSING

Academic Session of
5. 2022-23
admission to the course

Details of Guide Name

Designation Dr. SUSHMA SHUKLA
Department
Institute

6. Details of Co-Guide (If

any)
Name
Designation
Department
Institute
Part A: DETAILS OF THE CANDIDATE

Signature of the Student Signature of the Guide/Supervisor

Signature of the Co-Guide

 INTRODUCTION

Giving birth and being born Brings us into the essence of creation,

Where the human spirit is courageous and bold and the body, A miracle of wisdom

– Harriette Hartigan

Maternal health is important for the women during pregnancy, childbirth and the
postpartum period and maternal health care services includes antenatal care (ANC), delivery
care and postnatal care (PNC) services. Maternal health has been becoming a global
concern because the lives of millions of women in reproductive age can be saved through
maternal health care services. Despite efforts that have been made to strengthen maternal
health care services, maternal mortality is still high in most of the developing countries.
Every day, approximately 800 women die from preventable causes related to pregnancy
and childbirth and 99% of all maternal deaths occur in developing countries.

Major factors affecting maternal health reflects in maternal mortality and morbidity
which in turn again reflects the status of population health and quality of life across
nations. Poor understanding of the interplay of many antecedent factors, including
sociocultural, economic and logistic factors, combined with an overwhelming poor health
services delivery, is a basic challenge in several countries, particularly in rural settings
where functional health care services are relatively scarce. There are still uncertainty as
to the extent of this burden, owing to current challenges with information and data
collation.

The Respectful Maternity Care Charter addresses the issue of disrespect and abuse
toward women and newborns utilizing maternal and newborn care services and provides a
platform for improvement by:

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Raising awareness of women‟s and newborns‟ human rights guarantees recognized in
internationally adopted United Nations and other
multinational declarations, conventions and covenants; Highlighting the connection between
human rights guarantees and healthcare delivery relevant to maternal and newborn
healthcare; Increasing the capacity of maternal, newborn and child health advocates to
participate in human rights processes; Aligning women‟s demand for high‐
quality maternal and newborn care with international human rights law standards; and
Providing a foundation for holding governments, the maternity care system and
communities accountable to these rights Supporting
healthcare workers in providing respectful care to women and newborns and creating a
healthy working environment.

Globally, approximately 140 million births occurs every year. The majority of these are
vaginal births among pregnant women with no identified risk factors for complications,
either for themselves or their babies, at the onset of labour. Disrespectful and abusive care
of women during their pregnancies has been shown to be a barrier for women accessing
health care services for antenatal care and delivery. The journey toward respectful
maternity care began in the late 1940s with the Universal Declaration of Human
Rights.

In the 1990‟s, the United Nations issued the “Declaration on the Elimination of
Violence against Women” and a movement gained force in Latin America which was
termed “humanization” of childbirth. Some of the first reports on violations of women‟s
rights in childbirth came from the human rights community. From an initial focus on
reducing maternal and infant mortality the global focus shifted to developing human
rights standards on maternal and child mortality and morbidity reduction. More recently, this
has led to a focus on addressing disrespect and abuse as manifestations of the systemic
failure to uphold human rights standards.

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 With the conclusion of the Millennium Development Goals (MDGs) in 2015, and
with only a few countries achieving MDGs #4 and #5 related to reducing child mortality
and improving maternal health, global policy makers and advocates more earnestly
evaluated the obstacles to maternal and newborn survival and well-being. This included
the need to understand the comprehensive socio-cultural and gender-based influences in
clinical settings, health systems and ultimately, on health outcomes. During the MDG era,
much of the public health and development communities‟ focus had been on clinical
expertise and capacity building in targeted interventions to reduce mortality. But growing
awareness of often unaddressed issues of emotional, physical and psychological harm to
women during facility- based childbirth required greater consideration.

However, in situations where complications arise during labour, the risk of

serious morbidity and death increases for both the woman and baby. Over one third of
maternal deaths and a substantial proportion of pregnancy-related life-threatening conditions
are attributed to complications that arise during labour, childbirth or the immediate
postpartum period, often as result of haemorrhage, obstructed labour or sepsis.

Similarly, approximately half of all stillbirths and a quarter of neonatal deaths result
from complications during labour and childbirth. The burden of maternal and perinatal
deaths is disproportionately higher in low- and middle-income countries (LMICs)
compared to high-income countries (HICs). Therefore, improving the quality of care
around the time of birth, especially in LMICs, has been identified as the most impactful
strategy for reducing stillbirths, maternal and newborn deaths, compared with antenatal or
postpartum care strategies.

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 Over the last two decades, women have been encouraged to give birth in health care
facilities to ensure access to skilled health care professionals and timely referral should the
need for additional care arise. However, accessing labour and childbirth care in health
care facilities may not guarantee good quality care. Disrespectful and undignified care is
prevalent in many facility settings globally, particularly for underprivileged populations,
and this not only violates their human rights but is also a significant barrier to
accessing intrapartum care services. In addition, the prevailing model of intrapartum care
in many parts of the world, which enables the health care provider to control the
birthing process, may expose apparently healthy pregnant women to unnecessary medical
interventions that interfere with the physiological process of childbirth.

BACKGROUND OF THE STUDY

As highlighted in the World Health Organization (WHO) framework for improving

quality of care for pregnant women during childbirth, experience of care is as important
as clinical care provision in achieving the desired person-centred outcomes.

This up-to-date, comprehensive and consolidated guideline on intrapartum care for

healthy pregnant women and their babies brings together new and existing WHO
recommendations that, when delivered as a package of care, will ensure good quality
and evidence-based care in all country settings. In addition to establishing essential clinical
and non-clinical practices that support a positive childbirth experience, the guideline highlights
unnecessary, non-evidence-based and potentially harmful intrapartum care practices that
weaken women‟s innate childbirth capabilities, waste resources and reduce equity.

The percentage of institutional birth in India has doubled from 38.7% to 78.9%
in the decade 2015-16, according to the National Family

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Health Survey (NFHS-4).However, this increase in coverage has not translated in
commensurate reduction of maternal and newborn mortality and stillbirths. One of the
major factors being inadequacies in the quality of care provided in health facilities. The
current figures of maternal mortality ratio of 130 and neonatal mortality rate of 24 suggest
that though there has been tremendous improvement in maternal newborn healthcare
indicators, there still exists a vast scope to achieve the targets set for our country.

It is estimated that approximately 46% maternal deaths, over 40% stillbirths and 25%
of under-5 deaths take place on the day of the delivery. Half of the maternal death each
year can be prevented if we provide higher quality health care.Quality of care is
increasingly recognized as a critical aspect of the unfinished maternal and newborn health
agenda, mainly with respect to care around labour and delivery and in the immediate
postnatal period.

Education and training programme of the Nurse Midwifery Practitioners would be

conducted at the National and Regional Midwifery Training Institutes identified by the
NMTF. The NMTI would fundamentally focus on a three-month training of midwifery
educators. Midwifery educators in turn would then be engaged for the 18 -month training of
NPMs at the Regional Midwifery Training Institutes (RMTIs).

In this respect, Ministry of Health and Family Welfare has launched program
„LaQshya‟- quality improvement initiative in labour room & maternity OT, aimed at
improving quality of care for mothers and newborn during intrapartum and immediate
post-partum period. It has been successfully implemented in Tamil Nadu especially in
Chennai and it has been framed that every maternal care set up specially labour ward
should be certified with the standard of LaQshaya.

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 The successful introduction of evidence-based policies related to intrapartum care
into national programmes and health care services depends on well-planned and
participatory consensus-driven processes of adaptation and implementation. These
processes may include the development or revision of national guidelines or protocols
based on this recommendation. The LaQshya programme has been introduced by the
Ministry of Health and Family Welfare, Government of India. The programme aims to give
qualitative care to the pregnant mother in the Labour Room and Maternity Operation
Theatres. It will minimize the risks associated with childbirth.

GLOBAL SCENARIO

Category Specific Prevalence Of Disrespect And Abuse 2016

Fig: 1.1 Category Specific Prevalence Of Disrespect And Abuse 2016

Above fig 1.1. shows, the overall prevalence (at least one form of disrespect and abuse)

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was 91.7% (266/290; 95%CI: 0.879, 0.946). The woman‟s right to information, informed
consent, and choice/preference were not protected in 261 (90%) of mothers. More than
four-fifths (255, [87.9%]) of women were not protected from physical harm or ill-
treatment during labor and delivery. Similarly, the woman‟s confidentiality and privacy
were not protected in more than four-fifths of mothers

Regional Midwifery Training Institutes: The Ministry of Health and Family

Welfare, Government of India, plans to establish five Regional Midwifery Training
Institutes, in existing Colleges of Nursing, established under the pre- service education
strengthening programme, which would offer the specialist NPM course to the selected
candidates. The essential criteria for setting up of a Regional Training Institute for Midwifery
would include state-of-art training infrastructure, access to a functional Obstetric department,
attached high load clinical practice site, pool of trained educators and midwifery experts,
willingness to initiate a new course and affiliation to a public university for certification of
graduating midwives. It is envisioned that these RMTIs will serve as model teaching
institutions and pedagogic resource centers for the midwifery training.

Most women (218, [75.2%]) were not given the care in a culturally appropriate
way by the care providers. Similarly, the care providers did not encourage the client to
ask questions in most cases (220, [75.9%]) and most mothers (232, [80.0%]) reported
that care provider didn‟t introduce him/herself during childbirth. The provider also did
not explain to the client what was being done and what to expect throughout labor and
birth in more than half of the cases (150, [51.7%]) and did not give her periodic updates on
status and progress of labor in nearly half of the cases (143, [49.3%]). In nearly two-thirds
of clients (185, [63.8%]), the provider did not obtain consent or permission prior to any
procedure. Again, the provider did not use curtains or other visual barriers to protect the
client in most cases (237, [81.7%])

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 Disrespect and abuse of women during child birth acts as a deterrent for the
women and her family to opt for institutional delivery. The Government of India has
stressed “Promoting Respectful Maternity Care and Cognitive Development of Baby”
under the LaQshya programme in Tamil Nadu.

The Ministry of Health and Family Welfare, Government of India, plans to establish
five Regional Midwifery Training Institutes, in existing Colleges of Nursing ,established under
the pre- service education strengthening programme, which would offer the specialist
NPM course to the selected candidates. The essential criteria for setting up of a Regional
Training Institute for Midwifery would include state-of-art training infrastructure, access to a
functional. Obstetric department, attached high load clinical practice site, pool of trained
educators and midwifery experts, willingness to initiate a new course and affiliation to a public
university for certification of graduating midwives.

INTERNATIONAL LOCATIONS OF REGIONAL MIDWIFERY TRAINING

INSTITUTES

Fig 1.2 Locations Of Regional Midwifery Training Institutes

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 The above figure 1.2 shows Five nodal centres upgraded into regional midwifery
training institutes as given below.

 Regional College of Nursing, Guwahati, Assam

 Kasturba Nursing College, Wardha, Maharashtra

 Government College of Nursing, Vadodara, Gujarat

 College of Nursing, Madras Medical College, Chennai, Tamil Nadu

 College of Nursing Varanasi, Banaras Hindu University, Uttra Pradesh

Although the above mentioned institutes have been identified currently, the
commitment of the State Governments to implement the midwifery programme would be the
deciding factor for development of these State Nodal Centres into RMTIs.

National Midwifery Training Institute: For the Midwifery programme, the National
Midwifery Training Institute shall be established in an existing College of Nursing which
has the necessary infrastructure such as Maternal and Child Health labs, classrooms and
other facilities such as a library. The training institute would be further strengthened through
collaborations and partnerships with various international and national institutions of repute
for transfer of expertise, student exchange programmes, faculty learning, research activities,
innovations etc. The Government of India with the support and criteria defined by the NMTF
would identify the National Midwifery Training Institute. Maternal Health Division,
MoH&FW has established National/State Nodal Centres of nursing excellence under
the Pre- Service Education strengthening programme. The centres have been

9
accredited under the programme and have been found to fulfil the above mentioned criteria.

However, respectful maternity care is missing from the current nursing and medical
curriculum. Midwifery-led care can address these issues by promoting quality, continuity of
care through provision of women-centric care and promoting natural birth. This model of
care is well supported by global evidence.

NEED FOR THE STUDY

The Global Respectful Maternity Care Council – a broad group of stakeholders

representing research, clinical, human rights and advocacy perspectives – came together
to develop the Respectful Maternity Care Charter: Universal Rights of Mothers
and Newborns which clarifies and clearly articulates the rights of women and newborns
while receiving maternity care within a healthcare facility.

Human rights are rights inherent to all people, without discrimination, regardless of
age, nationality, place of residence, sex, national or ethnic origin, color, religion, language or
any other status. Universal human rights are often expressed and guaranteed by legal
instruments, such as international treaties. International human rights law determines
obligations of States to act in certain ways or to refrain from certain acts, in order to
respect, protect and fulfil human rights and fundamental freedoms of individuals or groups.

Zainab Azhar et al, (2018) conducted a cross sectional study to assess the prevalence
and determinants of the disrespect and abuse (D & A) during child birth in rural Gujrat,
Pakistan.The study conclude that D & A during childbirth is highly prevalent and under-
recognized in Pakistan. High prevalence at facilities and particularly at public
facilities can be a reason for underutilization of this sector for

10
childbirth. Maternal health policies in Pakistan need to be revised based on the charter of
respectful maternity care.

Simin Taavoni et al, (2018) conducted a study to evaluate and measure Respectful
Maternity Care (RMC) in three sections of labor, delivery and post-partum. The study
results were concluded as that it was developed a new instrument as the 59 -item QRMCQI
for evaluating respectful maternity care in Iran through a rigorous process of item generation
and validity-reliability assessment besides confirmatory factor analysis that were in an
acceptable range and can be used as a reliable instrument for RMC in Iran.

Das Debyani et al (2018) conducted a quantitative study to evaluate the effect of

awareness programme on knowledge regarding respectful maternity care (RMC) among
antenatal women in a selected hospital of West Bengal. Quasi experimental research
approach along with non-randomised control group design was adopted for the study. Non-
probability purposive sampling technique was used to select 60 antenatal women (30 each
in experimental and control group) were selected. Results revealed that the mean post-
test knowledge score (32.53) of experimental group was significantly higher than mean
pre- test knowledge score (18.50). There was significant difference between the mean
post-test knowledge scores of experimental and control groups, indicating the effectiveness
of awareness programme. The study a lso found that there is also significant association
between knowledge score of women with educational qualification and socio-economic
status. The study has implications in different nursing fields. The study recommends
for a qualitative and survey on adherence to RMC.

Government of India has launched “LaQshya” (Labour room Quality improvement

Initiative) to improve quality of care in labour room and maternity operation theatres in
public health facilities. It‟s a

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multipronged approach focused at Intrapartum and immediate postpartum period.
It is aimed to reduce preventable maternal and newborn mortality, morbidity and
stillbirths associated with the care around delivery in Labour room and Maternity
Operation Theatre and ensure respectful maternity care.

It is being planned to implement the programme in Government Medical Colleges

(MCs) besides District Hospitals (DHs), and high delivery load Sub- District Hospitals
(SDHs) and Community Health Centres (CHCs). There are plans to undertake quality
certification of labour rooms and also catalyse the facilities therein in order to attain the
targets outlined.

Many studies had focused on knowledge of respectable maternity care among

staff nurses. Till now there are only few studies has been conducted on knowledge and
performance of staff nurse and the satisfaction level of the mother, which justifies the
need for this study. Staff nurses and midwives are the back bone of midwifery they
should know the importance of respectful maternity care so that they can develop
positive attitude towards respectful maternity care

Hence the researcher has selected this study even today there is some lack in
maternity care rendered to the mothers in labour. Hence, the researcher felt to
identify ad impart the the knowledge and performance of respectable maternity care
among staff nurse will definitely improve the satisfaction level of care for the
postnatal mothers .

STATEMENT OF THE PROBLEM

A study to assess the effectiveness of planed teaching program regarding respectful

maternal care (RMC) among Nursing officers, in selected hospitals at Ujjain, (MP).

OBJECTIVES

1.To assess the pretest knowledge score regarding respectful maternal care (RMC) among
Nursing officers, in selected hospitals at Ujjain, (MP).

2.To assess the effectiveness of planed teaching program regarding respectful maternal care
(RMC) among Nursing officers, in selected hospitals at Ujjain, (MP).
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3.To assess the post-test knowledge score regarding respectful maternal care (RMC) among
Nursing officers, in selected hospitals at Ujjain, (MP).

4.To find out the association between pretest knowledge score and selected demographical
variables.

HYPOTHESIS

H 01 - There is no significant difference between pre and post- test knowledge score
regarding respectful maternal care among Nursing officers in selected hospital at Ujjain
(M.P.).

H A1 - There is a significant difference between pre and post-test knowledge score

regarding respectful maternal care among Nursing officers in selected hospital at Ujjain
(M.P.).

H 02 - There is no significant effectiveness of planed teaching program regarding

respectful maternal care (RMC) among Nursing officers, in selected hospitals at Ujjain,
(MP).

H A2 - There is significant effectiveness of planned teaching program on knowledge

regarding respectful maternal care among Nursing officers in selected hospital at Ujjain
(M.P.).

H 03 - There is no significant association of pretest knowledge score regarding respectful

maternal care among Nursing officers in selected hospital at Ujjain (M.P.).

H A3 - There is significant association of pretest knowledge score regarding respectful

maternal care among Nursing officers in selected hospital at Ujjain (M.P.).

H 04 - There is no significant association of Post Test knowledge score regarding respectful

maternal care among Nursing officers in selected hospital at Ujjain (M.P.).

H A4 - There is significant association of Post Test knowledge score regarding respectful

maternal care among Nursing officers in selected hospital at Ujjain (M.P.).

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 OPERATIONAL DEFINITIONS

Assess

In this study it refers to the determined outcome of Midwife led education

programme regarding respectful maternity care among staff nurses

Effectiveness

It refers to desired changes brought by Midwife led respectable maternity care

education programme.

Respectful Maternity Care

Respectful maternity care is a universal human right due to every childbearing

woman in every health system around the world. The interventions aim to improve
access to skilled birth care; less attention has been focused on the quality of
relationships with caregivers during maternity care.

ASSUMPTIONS

 Staff nurses will have some existing knowledge on respectful maternity care.

 Respectful maternity care education programme can impart adequate language to the
staff nurses.

 Respectful maternity care will improve the practice standard of staff nurses.

 Midwife respectful maternity care education to staff nurses will help to improve the
quality of care of the postnatal mother‟s satisfaction level.

 The subjects may actively participate in the study,

DELIMITATIONS
1. Delimited to Nursing officers in selected hospitals at Ujjain, MP.

2. Nursing officers who are available at the time of study and willing to participate in
the study.

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 REVIEW OF LITERATURE

According to Nancy Burns (2013) a literature review is an organized written

presentation of what has been published on a topic by scholars. Review of literature is an
ongoing process and it covers the entire planning stage. A good research is always
supported by its evidences and review of literature serves as a mean of support.

Review of literature is important to an investigator in order to know what has

been established and documented as there are critical summaries of what is known about
a particular topic. Therefore a review of literature helps to relate the present study to
the previous ones in the same field.

– Polit and Hungler ( 2 0 0 5 )

Reviews for this study has been collected from primary and secondary sources
of books, journals and net references.

It has been organized and presented under the following sections:

SECTION-A: REVIEW RELATED TO POSTNATAL CARE.

SECTION-B: REVIEW RELATED TO UNDER GRADUATE NURSES‟S

KNOWLEDGE REGARDING RESPECTFUL MATERNITY CARE.

SECTION-C:REVIEWS RELATED TO EFFECTIVENESS OF

EDUCATIONAL PROGRAMME ON RESPECTFUL MATERNITY CARE.

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SECTION-A: REVIEW RELATED TO POSTNATAL CARE.

Indu, P et al, (2021) conducted a Study to assess the knowledge and practice
on selected aspects of postnatal care among primi mothers. One group pre-test post-
test experimental design was adapted in the study. Primi mothers who had normal
delivery at Aravindan hospital were consider as the population for the study. Sample size
was 35. Non- probability convenient sampling techniques were used to select the
sample. Descriptive statistics was used to analyses the frequency, mean and standard
deviation of demographic variables, knowledge and practice. Inferential statistics was
used to determine comparison, correlation and association. The pre-test score was
less in knowledge and practice regarding postnatal care among primi. The finding of
the study revealed that there was a significant difference between pretest and post-
test knowledge and practice scores. In association of demographic variable
independent „t‟ test was used to evaluate the significant association between the
selected demographic variables with the knowledge score in the pre-test and post-
test. In the post-test there was a significant association between sources of
information with the level knowledge on postnatal care. There is a significant
association between age, education, sources of information0 02 regarding postnatal
care and area of residence with the level of practice scores in the post test.

Muna Maharjan et al, (20121) conducted a descriptive cross sectional study

to assess the level of knowledge among postnatal mothers about postnatal care.
Non probability purposive sampling technique was used to select the postnatal mothers.
Fifty seven postnatal mothers were interviewed face to face using structured
interview schedule. The findings were, among 57 postnatal mother half of the postnatal
mothers, 30 (52.63%) had average level of knowledge regarding postnatal care.
Highest knowledge was in the area of

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breastfeeding and lowest in the areas of family planning. There is still lack of
knowledge among mothers regarding postnatal period, postnatal exercise, timing of first
bath after birth of baby. There were statistically significant association between religion
and knowledge of postnatal mothers (p-value 0.006). Similarly, there was no any
statistical significant association of knowledge with others socio demographic variables.

P.Kavitha et al, (2020) conducted a descriptive study to assess the knowledge

regarding postnatal care among the postnatal mothers. 20 samples were selected by
convenient sampling method. Structured interview questionnaire was used as
evaluation tool. The samples were free to express their knowledge and ideas. Then the
knowledge level was assessed and pretest evaluation was made. The data was analyzed and
conclusion was drawn. The present study concluded that knowledge assessment regarding
postal care among the postal mothers shows that 85% of mothers had moderately
adequate and 15% had adequate knowledge. The mean and standard deviation as
follows 16.75 and 1.57.

SECTION-B: REVIEW RELATED TO STAFF NURSES’S KNOWLEDGE

REGARDING RESPECTFUL MATERNITY CARE

Bregje Christina De Kok et al (2022) conducted a study to explore how

international standards translate into local realities, we conducted a team ethnography,
involving observations in labor wards in government facilities in central Malawi, and
interviews and focus groups with midwives, women, and guardians. We identified a
dual disconnect between, first, universal RMC principles and local notions of good care
and, second, between midwives and women and guardians. The latter disconnect
pertains to fraught relationships, reproduced by and manifested in mechanistic
care, mutual responsibilization for trouble, and misunderstandings and distrust.
RMC initiatives should be

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formulated to local contexts and midwife-client relationships. In a hierarchical,
resource-strapped context like Malawi, promoting mutual love, understanding and
collaboration may be a more productive way to stimulate “respectful” care than the
current emphasis on formal rights and respect.

Ashenafi Mekonnen et al (2021) conducted a study that aims to assess the status
of disrespectful and abusive maternity care during childbirth and associated factors
among postnatal women in public hospitals of Bale zone, Southeast Ethiopia. An
institutional-based cross- sectional study was done from March, 1 to July 25, 2018,
among 580 postnatal women in three public hospitals of Bale zone using exit
interview. Epi info for data entry and SPSS for analyzing were use and based on the
results it was stated as The status of disrespectful and abusive maternity care is
37.5%. In the association result, the significantly associated factors with
disrespectful and abusive maternity care are; marital status with married women are 82%
less likely to get disrespectful and abusive maternity care than their counterpart
(AOR=0.18, CI: 0.04-0.78). Secondly, women who do not have antenatal care
follow-up history are 8.62 times more likely to encounter disrespectful and abuse
maternity care compared to those who had.

Cindy Aliza Stein (2021) conducted a qualitative descriptive study aimed to

to define what women consider respectful care to be so that minimum standards
can be applied with an eye towards training staff, creating regulations that
encourage or require RMC, or other potential interventions aimed at better serving
women during childbirth. Using semi structured interviews that explored themes in
respectful maternity care through the lens of ten women who had recently given birth
in California. Based on the findings the study was concluded as, women experiencing
childbirth consider respectful care to involve attitudes and behaviours of maternity
staff that encompass treating the

18
women with kindness, providing care that is based on current evidence to ensure
their and their infants‟ safety, being attentive to their needs in a timely manner,
and including them in conversations about plans of care while considering their
desires reflecting a patient-centered approach to care.

Maryam Moridi et al (2019) conducted a qualitative study aimed to explore

the perceptions of Iranian midwives regarding respectful maternity care during labour
and childbirth. Twenty four semi-structured interviews were conducted with
midwives, who had more than one year work experience in labor and childbirth
units,through a
purposive sampling method. The result was stated as three themes were extracted
including showing empathy, women centered care and protecting rights. Showing
empathy reflects that establishing a friendly relationship and being with women.
Women-centered care indicated keeping women safe and participating in decision
making. Protecting rights reflected a need for safe guarding dignity as well as giving
equal care and preparing appropriate environment. Based on the findings the study was
concluded as Iranian midwives considered respectful maternity care a broader concept
rather than preventing mistreatment. Promoting respectful care also should be
through performing safe care by implementing evidence- based care and women‟s
involvement in their care as well as appropriate environment for women, families
and caregivers.

Amole TG et al (2019) conducted a study which focused to determine the

prevalence, pattern, perpetrators, and determinants of disrespect and abuse (D&A)
during childbirth among recently parturient women in Kano, north western Nigeria.
Using a cross-sectional design, 332 women accessing child immunization and postnatal
services were selected. The results were Respondents (n = 306) had a mean age of
27.7

± 6.3 years and more than half had experienced at least one form of

19
D&A during childbirth. Commonest forms of abuse were abandonment and
nonconfidential care. Main perpetrators were nurses. The experience during the last
childbirth was significantly higher among respondents of non-Hausa/Fulani ethnic
group, of the Christian faith, and with formal education. Based on the findings the
study was concluded as D&A during childbirth is prevalent in our setting.
Educating healthcare providers and women about their responsibilities and rights
will enhance provision and utilization of quality maternal health services.

Dzomeku Veronica Millicent et al (2019) conducted a Phenomenological

qualitative research on Exploring midwives‟ understanding of respectful and non-
abusive maternal care in Kumasi, Ghana. Data were generated through individual
in-depth interviews, which were audio-recorded and transcribed. The results were,
understanding of respectful maternity care was comprised of the following
components: non-abusive care, consented care, confidential care, non-violation
childbearing women‟s basic human rights, and non- discriminatory care. Based on the
results it was concluded as Midwives reported an understanding of most components of
respectful maternity care, but their gap in knowledge on evidenced-based care requires
policy attention and in-service training. To understand the extent to which this gap in
knowledge can be generalized for midwives across Ghana to warrant a redesign of the
national midwifery curriculum, the authors recommend a nationwide cross-sectional
quantitative study.

Alageswari et al (2019) conducted a study to assess the knowledge and

perception of mothers on Respectful Maternity Care and to associate the level of
knowledge with the selected demographic and obstetric variables using Non –
experimental descriptive design, 60 postnatal mothers were selected by using purposive
sampling technique. Data was collected by interview method by using modified Pattern

20
Matrix RMC Scale. The majority of 26(43.3%) mothers were in the age group of 21-25
years, 26(43.3%) mothers had education upto graduate, 39(65%) mothers were from joint
family and 37(61.7%) mothers were primiparity. The majority of 51(85%) mothers had
poor knowledge, 9(15%) mothers had moderately adequate knowledge and none of
them had adequate knowledge on Respectful Maternity Care. The majority of 58(96.7%)
mothers received friendly care, 51(85%) mothers reported abuse free care, 57(95%)
mothers acknowledged timely care, 60(100%) mothers received discrimination free care,
and 49 (81.7%) mothers received consented care and 47 (78.3%) mothers acquired
confidential care. The variable type of family showed significant association with the
level of knowledge on Respectful Maternity care among the postnatal mothers at p level
<0.05. Women should be empowered with universal human rights, the health provider
should be aware of the rights and enrich them with quality based care.

Ephrem D Sheferaw, et al (2017) conducted a cross sectional study on

Respectful maternity care in Ethiopian public health facilities. Trained external observers
assessed care provided to 240 women in 28 health centers and hospitals during labor and
childbirth using structured observation checklists. Based on the results and findings the
study was concluded as Quality improvement using Standard- based Management and
Recognition and having a companion during labor and delivery were associated with
respectful maternity care (RMC). Policy makers need to consider the role of quality
improvement approaches and accommodating companions in promoting RMC.
More research is needed to identify the reason for superior RMC performance of male
providers over female providers and midwives compared to other professional cadre, as
are longitudinal studies of quality improvement on RMC and mistreatment of
women during labor and childbirth services in public health facilities.

21
 Heather E. Rosen et al (2015) conducted the study to report prevalence of
respectful maternity care and disrespectful and abusive behaviour at facilities in multiple low
resource countries. Structured, standardized clinical observation checklists were used to
directly observe quality of care at facilities in five countries: Ethiopia, Kenya, Madagascar,
Rwanda, and the United Republic of Tanzania. Respectful care was represented by 10
items describing actions the provider should take to ensure the client was informed and
able to make choices about her care, and that her dignity and privacy were respected.
A total of 2164 labor and delivery observations were conducted. The results were concluded
as efforts to increase use of facility-based maternity care in low income countries are
unlikely to achieve desired gains if there is no improvement in quality of care provided,
especially elements of respectful care. This analysis identified insufficient communication
and information sharing by providers as well as delays in care and abandonment of
laboring women as deficiencies in respectful care. Failure to adopt a patient-centered
approach and a lack of health system resources are contributing structural factors. Further
research is needed to understand these barriers and develop effective interventions to
promote respectful care in this context.

Hannah L. Ratcliffe (2013) conducted a study in the view of, creating an evidence
base for the promotion of respectful maternit y care. Risk factors and possible
interventions were identified through an extensive structured literature review and key-
informant interviews with public health practitioners and clinicians working in related
fields. Based on the findings it was concluded as the framework and catalogue of
interventions developed in this thesis highlight the interconnectedness of actors and
activities involved in the provision of respectful maternity care. Given the complexity of
providing respectful care and the wide variety of stakeholders involved, no one
intervention is likely to be efficacious on its own coordination and synergy between levels
and stakeholders will be required. The plethora of interventions indentified in this
thesis demonstrates that disrespect and abuse is far from an incurable problem and that
many potential solutions exist. It is sincerely hoped that this work will be useful as more
groups begin engaging with the issue of respectful maternity care, and that the lessons
and successes of the Hansen Project will provide additional guidance.

Aastha Singh et al (2017) conducted a Cross Sectional Study regarding Direct

Observation on Respectful Maternity Care in India Study on Health Professionals of
three different Health Facilities in New Delhi. In the present study findings showed that the
22
practices adopted by Health Professionals with regard to Respectful Maternity Care We
find that mistreatment of patients during labor and delivery(98% )– particularly verbal
abuse(93%) – is relatively common and that this abuse has the potential to reduce
patient demand for services. My findings are largely consistent with those from recent
international studies of patient mistreatment in maternity services both in terms of the extent
of abuse they describe and the triggers for abuse they identify. Based on the results it
was concluded as Efforts to use facility based maternity care for low socio-economic
woman are unlikely to achieve the desired gains if there is no improvement in quality
of care provided by health professionals especially for different elements of respectful
maternity care.

SECTION-C: REVIEWS RELATED TO EFFECTIVENESS OF EDUCATIONAL

PROGRAMME ON RESPECTFUL MATERNITY CARE

Nasir Umar et al (2022) conducted a study towards improving respectful maternity

care: a discrete choice experiment with rural women in northeast Nigeria. Developed
and implemented a cross- sectional discrete choice experiment with a random sample
of 426 women who had facility- based childbirth to elicit their stated preferences for
facility birth experience of care attributes. The results are, majority belonged to Fulani
ethnic group (60%) and were married (95%). Almost half (45%) had no formal
education. Parameter estimates were all of expected signs suggesting internal validity.
The most important influence on choice of place of delivery was good health system
condition, followed by absence of sexual abuse, then absence of physical and verbal abuse.
The study findings further underline the important relationship between facility birth
experience and utilisation. Achieving universal health coverage would require efforts
toward addressing poor facility birth experiences and promoting respectful maternity care,
to ensure women want to access the services available.

Khadije Hajizadeh et al (2021) conducted a study on Respectful maternity care and

its related factors in maternal units of public and private hospitals in Tabriz: a sequential
explanatory mixed method study protocol. The study aims to: a) assess the status of D&A and
respectful maternity care (RMC) during childbirth and their relationships with childbirth
experience, socio- demographic and obstetrics characteristics;

b) explain women‟s perceptions of various RMC aspects and determinants during

childbirth; and c) present a guideline for promoting of RMC. A mixed methods
23
sequential explanatory design will be used to conduct this study in 3 phases. The first
phase is a quantitative study with a longitudinal descriptive-analytical design to
identify any D&A and RMC and their relationships with childbirth experience
among 334 women who have given birth in public and private hospitals in Tabriz, Iran.
The sample will be selected proportional to each population. The second phase is a
qualitative study to explore women‟s perceptions of various RMC aspects and their
determinants during childbirth. The conventional content analysis approach will be used to
analyze the data. The third phase is focused on developing a guideline to improve the
quality of maternity care. Considering the vulnerability of women during labor and
delivery and the effect of D&A on cesarean section rates, a supportive guideline can
improve the quality of maternity care and reduce D&A during childbirth, and improve
women‟s childbirth experiences.

Reham Khresheh et al (2019) conducted a study to assess the Effectiveness of an

Educational Workshop Designed to Improve Caring Behaviors of Midwives at Public
Hospitals in Jordan. This is a pre- and post-interventional study. A workshop focused on
teaching specific caring behaviors was held for 20 midwives who worked in the labor
ward. The results were stated as Significant increases were observed in the overall
scores of midwives caring behaviors and women‟ satisfaction 6 weeks and 3 years after
the intervention compared with prior scores. Increased overall satisfaction scores were
observed 6 weeks and 3 years after the intervention compared with the scores before the
intervention. Based on the findings it was concluded as The study can inform midwifery
educators on the importance of teaching and learning of caring behaviors to future
midwives in their preservice preparation. The program that was developed can be used
with some modification, as part of midwifery students‟ educational program or as an
in-service program for employed midwives.

Amnesty E LeFevre et al (2019) conducted a study aimed to Development of a Phone

Survey Tool to Measure Respectful Maternity Care during Pregnancy and Childbirth
in India. Available tools havebeen limited to the measurement of RMC during
childbirth and confined to observational and face-to-face survey modes. Phone surveys are
less invasive, low cost, and rapid alternatives to traditional face-to-face methods, yet little
is known about their validity and reliability. Based on the results it was concluded as, to
our knowledge, this is the first RMC phone survey tool developed for India, which
may provide an opportunity for the rapid, routine collection of data essential for
24
improving the quality of care during pregnancy and childbirth. Elsewhere, phone
survey tools are emerging; however, efforts to develop these surveys are often not
inclusive of rigorous pretesting activities essential for ensuring quality data, including
cognitive, reliability, and validity testing. In the absence of these activities, emerging
data could overestimate or underestimate the burden of disease and health care practices
under assessment. In the context of RMC, poor quality data could have adverse consequences
including the naming and shaming of providers. By outlining a blueprint of the minimum
activities required to generate reliable and valid survey tools, we hope to improve efforts to
develop and deploy face-to-face and phone surveys in the health sector.

Das Debyani et al (2018) conducted a quantitative study was undertaken to evaluate

the effect of awareness programme on knowledge regarding respectful maternity care (RMC)
among antenatal women in a selected hospital of West Bengal. Quasi experimental research
approach along with non-randomised control group design was adopted for the study.
Non-probability purposive sampling technique was used to select 60 antenatal women
(30 each in experimental and control group) were selected. Results revealed that the
mean post-test knowledge score (32.53) of experimental group was significantly higher
than mean pre- test knowledge score (18.50). There was significant difference
between the mean post-test knowledge scores of experimental and control groups,
indicating the effectiveness of awareness programme. The study also found significant
association between knowledge score of women with educational qualification and socio-
economic status. The study has implications in different nursing fields. The study
recommends for a qualitative and survey on adherence to RMC.

Jennifer Wesson et al (2018) conducted a study to assess the Provider and client
perspectives on maternity care in Namibia: results from two cross-sectional studies.
The health worker study involved medical officers, matrons, and registered or enrolled
nurses working in Namibia‟s 35 district and referral hospitals. The study included a
survey (N =281) and 19 focus group discussions. The community study conducted 12
focus groups in five southern regions with recently delivered mothers and relatives.
Based on the results it was concluded as, Namibia‟s public sector hospital maternity
units confront health workers and clients with structural and cultural impediments to
quality care. Negative interactions between health workers and laboring women were
reported as common, despite high health worker commitment to babies‟ welfare. Key
recommendations include multicomponent interventions that address heavy workloads and
25
other structural factors, educate communities and the media about maternity care and
health workers‟ roles, incorporate client-centered care into preservice education, and
ensure ongoing health worker mentoring and supervision.

METHODOLOGY

Research methodology is a way to solve the research problem systematically.

It deals with defining the problem, formulation of hypothesis, methods adopted for data
collection and statistical techniques used for analyzing the data with logical reason behind it. 53

This chapter deals with the description of methodology and different steps
adopted for study. It includes description of research approach, research design, setting of the
study, population, sample and sampling technique, development and description of tool,
testing of the tools, pilot study, procedure for data collection, plan for data analysis.

Research approach

An evaluative research approach was used to evaluate the effectiveness of planned

teaching programme through the difference between the pre test and post test knowledge
score. Evaluative research consists of four phases, namely;

 Determining the objectives of the programme

 Develop a means of measuring the attainment of those objectives.

 Collecting data

 Interpret data in terms of objectives.

Based on the statement of the study and objectives, an evaluative research approach was
considered an appropriate research approach for the present study.

Research design

Research design of a study spells out the basic strategies that the researchers adopt to
develop information that is accurate and interpretable. It is the overall plan on obtaining
answers to the questions being studied and handling some of the

26
 difficulties encountered during the research process54.

In the present study quasi experimental one group pre test and post test design
was used to evaluate the effectiveness of PTP on knowledge regarding respectful
maternal care (RMC) among Nursing officers, in selected hospitals at Ujjain, (MP).

Group Pretest Intervention Post test

Nursing officers, in knowledge regarding Planned teaching Knowledge
selected hospitals at respectful maternal
programme regarding
Ujjain, (MP)
care (RMC) before knowledge regarding
administration of respectful maternal
PTP. care (RMC) after
administration
of PTP
01 X 02

Variables under study

‘Variable’ is an attribute of a person or an object that varies, that is taken on different

values. Variables in this study, are

Independent variables: Planned teaching programme regarding respectful

maternal care (RMC)

Dependent variables: Knowledge regarding respectful maternal care (RMC) among

Nursing officers, in selected hospitals at Ujjain, (MP).

Setting: ‘Settings’ are the more specific place where data collections will occur. The present
study was conducted at selected selected hospitals at Ujjain, (MP).

Socio-demographic variable: The socio-demographic variables considered for this

study were age, religion, type of family, family income, place of residence and
source of information.

Population

The term ‘population’ refers to “the aggregate or mass of subjects upon which
researcher intended to generalize the findings.” “The accessible population is the
27
 population of subjects which can be enumerated and studied.” The ‘target population’ is the
total group of subjects about which the investigator is interested to make generalization 55.

The population for this study will be Nursing officers, in selected hospitals at Ujjain,
(MP).

Sample and Sample size

Sample consists of a subset of a population selected to participate in research study.

In the present study Nursing officers who met the inclusion criteria were selected as
samples. The sample size for the present study is 60.

Sampling technique

Sampling technique is the procedure, which the researcher adopts in selecting the
samples for the study. Purposive sampling technique is used for the present study.

Sampling criteria

Inclusion criteria: Nursing officers

 Who are willing to participate in this study

 Who are available during the study
 Who are able to read and write English.

Exclusion criteria: Nursing officers

 Who are not available during the study

 Who are not willing to participate in the study.

Selection and development of the study tool

The tool is the vehicle that could obtain data pertinent to the study and at the same
time adds to the body of general knowledge in the discipline. Data collection tools were used
by the researcher to observe or measure the key.

28
 Selection and development of the tool was done based on the
objectives of the study. After the review of the related literature the self-
administered knowledge questionnaire is found appropriate. The developed
tool was refined and valid by the subject experts, guide.

Description of tool:
Self-administered knowledge questionnaire: Self-administered
knowledge questionnaire is a structured questionnaire which consists of
2 sections
Section A: Socio-Demographic Data: The first part of the tool consists of
seven items for obtaining information of the selected socio demographic
factors such as age, religion, type of family, family income, place of residence
and source of information.

Section B: Self-administered knowledge questionnaire: Self-

administered knowledge questionnaire was prepared in the form of
multiple choice questions. It consists of 36 items regarding respectful
maternal care (RMC). The total maximum score is 30.

For every right answer the

score is – 1 For every

wrong answer the score is -

The knowledge level has been arbitrarily divided in to three categories based
on the knowledge score.

 Adequate knowledge: >75%

 Moderately adequate knowledge: 50% - 75%

 Inadequate knowledge: <50%

 Pilot study

Pilot study will be conducted in selected hospital. The investigator

obtained prior permission from the authority. The topic will be explained
and confidentiality will be assured and the investigator collected data from
06 participants with the purpose of finding feasibility of the study before
starting the main study.

Data collection process

Prior to data collection permission will be obtained from the

concerned authorities. The investigator administered the structured
questionnaire for assessing their knowledge regarding RMC. The PTP
will be administered after pre-test. After that post-test was conducted
using the same questionnaire to evaluate the effectiveness of PTP.

Plan for Data Analysis

The data is analyzed by both descriptive and inferential statistics

on the basis of objectives and hypothesis of the study. To compute the
data, master data sheet will be prepared by the investigator.

Ethical consideration:

The research title and objectives will be approved by the research committee.
Formal permission will be obtained from the directors of the hospitals.
Confidentiality will be ensured. An informed consent will be obtained from the
nursing officers.
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