Perceptions of Respectful Maternity Care among Postnatal Women at a Tertiary Care Hospital in New Delhi

Perceptions of Respectful Maternity Care among Postnatal Women at a Tertiary Care Hospital in New Delhi | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Perceptions of Respectful Maternity Care among Postnatal Women at a Tertiary Care Hospital in New Delhi Irena Mandal, Mongjam Meghachandra Singh, Bratati Banerjee, Nidhi Bhatnagar, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6896944/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 06 Oct, 2025 Read the published version in BMC Pregnancy and Childbirth → Version 1 posted 12 You are reading this latest preprint version Abstract Background: Compassionate support and a nurturing environment are essential for a positive, dignified birthing experience. A dearth of respectful maternity care not only undermines the overall quality of services but also has far-reaching implications on women's healthcare-seeking behaviour and trust in the health system. Despite increasing institutional deliveries in India, evidence suggests that mistreatment and lack of respectful care persist in healthcare settings. This study assesses the perceptions of RMC among postnatal women in a tertiary care hospital in New Delhi and explores its associations with socio-demographic factors. Methods: A hospital-based cross-sectional study was conducted among 300 postnatal women at Lok Nayak Hospital, New Delhi. Participants were selected using a simple random sampling technique. Data were collected using a pre-tested interview which consisted of questions related to their socio-demographic details, obstetric history, domestic or intimate partner violence history and the Person-centered Maternity care (PCMC) scale. Descriptive statistics, chi-square tests, and multivariate logistic regression were used to examine associations between socio-demographic and obstetric factors and RMC scores using Statistical Package for Social Science (SPSS) version 25, and p-value < 0.05 was considered significant. Results: All participants (100%) reported overall satisfaction with their delivery experience while significant gaps in RMC were observed. Primigravida subjects were more likely to receive an episiotomy compared to multigravida. Only 33.3% had a birth companion present, despite LaQshya guidelines, and a significant association was found between the presence of a birth companion during the current delivery and the PCMC scores. Multivariate analysis revealed that the presence of a birth companion (AOR = 4.593; 95% CI: 2.393–8.815; p < 0.001) and having a male baby (AOR = 1.718; 95% CI: 1.028–2.87; p = 0.039) were significantly associated with higher RMC scores. Conclusions: The findings highlight critical gaps in RMC implementation, despite high institutional delivery rates. Strengthening provider training, ensuring birth companionship, and fostering policy enforcement are recommended for improving maternity care quality. Trial registration: This study was registered in the Clinical Trials Registry - India (CTRI) on 31 st July 2023 under the postgraduate thesis as CTRI/2023/07/055918. Respectful Maternity Care Maternal Health Childbirth Pregnancy Person-Centred Maternity Care Figures Figure 1 Figure 2 Figure 3 BACKGROUND Childbirth is a stressful event for expecting mothers; both physically and emotionally. It is an empowering experience with a lot of anticipation and vulnerability, requiring a lot of support and care during this time. Women’s experience during this period stays with them lifelong and utmost importance must be given to make this a joyous yet safe journey. Historically, the concept of maternity care revolved predominantly around addressing the morbidity and mortality rates associated with maternal health, however, issues of disrespect, abuse, and gender-based violence must also be tackled to ensure a holistic approach to safe motherhood. A paradigm shift is imperative to broaden the scope of maternal care, integrating dimensions of respect, dignity, and gender equality into the core framework of healthcare provision. 1 Upholding the principles of human rights and gender equity, the provision of respectful maternity care emerges as a fundamental pillar of universal healthcare access for women worldwide. According to World Health Organization (WHO), “Every woman has the right to the highest attainable standard of health, which includes the right to dignified, respectful health care”. 2 Respectful maternity care (RMC) is a stepping stone towards achieving universal health coverage and serves as a conduit for mitigating disparities, and nurturing a healthcare landscape grounded in equity and inclusivity. Experiences of disrespect and abuse during childbirth not only hinder the establishment of a therapeutic patient-provider relationship but also exacerbate psychological distress and emotional burden during pregnancy and childbirth. 3 A seminal landscape analysis review conducted by Bowser and Hill, in 2010, outlined seven distinct categories including physical abuse, non-consented clinical care, non-confidential care, non-dignified care, discrimination, abandonment, and detention in healthcare facilities, highlighting the need for standardized tools and methodologies to assess and address these key issues within maternal healthcare settings. 4 In response to the identified gaps, the White Ribbon Alliance spearheaded the development and dissemination of the Respectful Maternity Care Charter. This pivotal document serves as a guiding framework for program development, advocacy initiatives, and policy reform efforts aimed at promoting respectful, dignified, and compassionate care for pregnant women worldwide. Positive patient-provider relationships are associated with improved maternal outcomes, reduced stress levels, and enhanced feelings of empowerment and trust among pregnant women. 5 Incorporating women's choices and preferences into maternity care practices not only enhances the birthing experience but also contributes to improved health outcomes and psychological well-being for both mothers and infants. 6 Despite the significance of these patient-centered elements in ensuring RMC, the challenges stemming from a healthcare system burdened with overworked and underappreciated providers pose a formidable barrier to the consistent delivery of high-quality maternity care. This, in turn, compromises the ability of providers to uphold the principles of RMC, such as respectful communication, personalised care, and shared decision-making, thereby jeopardising the overall quality of maternal health services. 7 Addressing gaps in respectful maternity care through evidence-based interventions, policy reforms, and stakeholder collaboration is essential for improving maternal health outcomes, strengthening patient-provider relationships, and upholding women’s rights and dignity in childbirth. This study aims to assess perceived RMC among postnatal women in a tertiary care hospital and identify socio-demographic associations. METHODS Study Design & Setting This hospital-based cross-sectional study was conducted in the Department of Obstetrics & Gynaecology at Maulana Azad Medical College & Lok Nayak Hospital, New Delhi, over 12 months. Study Population & Sample Size Postnatal women who delivered within 12–48 hours at the hospital were included. A sample size of 270 was calculated by taking the prevalence of self-reported mistreatment of women by providers during childbirth as 77.3% 8 and the women who received respectful maternity care was 22.7%, with an allowable absolute error of 5% and a confidence level of 95%. Considering 10% as a non-response rate, the sample size was calculated to be 297, rounding off to 300. Once selected, the participant wanted to discontinue during the interview; it was considered as non-response. Inclusion Criteria Women who had delivered between 12–48 hours in LN Hospital, New Delhi at the time of data collection. Exclusion Criteria Severely ill, bedridden women who were not in a position to communicate. Women under the age of 18 years and single mothers Sampling and Data Collection Simple random sampling was used to select participants admitted to the postnatal wards who fulfilled the inclusion criteria. The sampling frame consisted of the total number of postnatal women admitted to the wards on the day of the visit. They were numbered serially, and from the list, 5 women were selected in a day through a random number generator app called Random Ux. A pre-tested structured interview schedule was used to collect socio-demographic details, patient obstetric history and RMC perceptions using the modified Person-Centered Maternity Care (PCMC) scale. The Person-Centered Maternity Care (PCMC) scale developed by Afulani et al. was used with contextual modifications after pretesting to suit our tertiary care hospital setting. 9 Data Analysis Descriptive statistics including means, standard deviations, frequencies, and proportions were used to summarize sociodemographic and obstetric characteristics of the participants. A p value < 0.05 was considered statistically significant. Bivariate analysis using the Chi-square test was performed to assess the association between categorical independent variables and the level of respectful maternity care. A p value of < 0.05 was considered statistically significant. Variables that showed a significant association in bivariate analysis or were considered conceptually relevant were included in a multivariate logistic regression model to identify independent predictors of respectful maternity care. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) and corrected p values were reported. RESULTS Sociodemographic characteristics A total of 300 subjects were included in the study, with a response rate of 100%; the majority residing in urban areas (287, 95.7%). The subjects' ages varied, with the highest proportion being 112 (37.3%) aged between 36–40 years, and the mean age was found to be 27.3 years ± 4.7 (S.D.). The educational level of subjects and their husbands, as shown in Fig. 1 , revealed that the highest proportion had completed high school (37.3%), with a small fraction being graduates (1% of subjects and 2% of husbands). More women had higher education levels overall, while 19.7% of husbands had attended only primary school. In terms of occupation as depicted in Fig. 2 , half of the subjects (50%) were homemakers, while husbands were more widely distributed across unskilled (22.7%), semi-skilled (22.3%), and skilled (22%) work. Professional roles were rare for both groups (1.3% of subjects, 2.7% of husbands). This highlights traditional gender roles, with women primarily engaged in homemaking and men in low-skilled wage-earning jobs, reflecting disparities in workforce participation shaped by social norms, economic factors, and educational access. Most subjects lived in nuclear families (236, 78.7%), and their socioeconomic status, according to the Modified Kuppuswamy Scale 2022, 10 revealed that the upper-lower class comprised the largest group (120, 40.1%) as depicted in Table 1 . Table 1 Distribution of the study subjects according to their sociodemographic characteristics (N = 300) Characteristics Number (%) Age (in years) 18–25 40 (13.3) 26–30 45 (15.0) 31–35 49 (16.4) 36–40 112 (37.3) 41–45 54 (18.0) Caste* SC 8 (2.7) ST 3 (1.0) OBC 67 (22.3) Others 222 (74) Type of Family Nuclear 236 (78.7) Joint 64 (21.3) Socioeconomic status (Modified Kuppuswamy Scale 2022) 10 Upper 5 (1.7) Upper middle 65 (21.6) Lower Middle 85 (28.3) Upper Lower 120 (40.1) Lower 25 (8.3) * SC- Scheduled Caste; ST- Scheduled Tribes; OBC- Other Backward Castes Obstetric-related characteristics Table 2 Distribution of the study subjects according to their obstetric history (N = 300) Variable Number (%) Parity 1 (Primigravida) 120 (40.0) 2–4 176 (58.7) ≥ 5 4 (1.3) Type of labour Spontaneous 209 (96.7) Induced 10 (3.3) Mode of delivery Vaginal 216 (72.0) Assisted Vaginal 9 (3.0) Caesarean section 75 (25.0) The gestational age of the baby delivered Preterm 35 (11.7) Term 264 (88.0) Post Term 1 (0.3) Institutional delivery of previous pregnancy Yes 170 (56.7) No 10 (3.3) Not applicable* 120 (40.0) Timing of delivery Morning ( ≥ 5 AM - <12 PM) 127 (42.3) Afternoon ( ≥ 12 PM - <5PM) 42 (14.0) Evening ( ≥ 5 PM - <9PM) 65 (21.7) Night ( ≥ 9 PM - <5AM) 66 (22.0) Difficulty in initiating breastfeeding Yes 31 (10.3) No** 269 (89.7) *Primigravida women **Includes women who were unable to initiate as the child was in nursery or too ill to initiate. In terms of parity, as summarised in Table 2 , the majority (176, 58.7%) had between 2 to 4 previous pregnancies. Regarding the type of labour, most subjects (209, 96.7%) experienced spontaneous labour and 216 women (72%) had vaginal deliveries. Among those who had previous pregnancies, 170 (56.7%) had an institutional delivery in their previous pregnancy, while 10 (3.3%) did not, and 120 (40%) were primigravida, so this question did not apply to them. The timing of delivery was fairly evenly distributed, with 127 (42.3%) delivering in the morning, 42 (14%) in the afternoon, 65 (21.7%) in the evening, and 66 (22%) at night. 269 (89.7%) of subjects did not have difficulty initiating breastfeeding. Table 3 Association of parity of the study subjects with episiotomy given (n = 225) Parity of participant Episiotomy given χ 2 value, d.f., ‘p’ value Yes No Total 13.730, 1, < 0.0001* Primigravida 87 (94.5) 5 (5.5) 92 (40.8) Multigravida 101 (75.9) 32 (24.1) 133 (59.2) *p value calculated using Fisher exact test Table 3 shows a significant association between the parity of the study subject and the administration of episiotomy (p < 0.0001). Primigravida subjects were more likely to receive an episiotomy compared to multigravida subjects, highlighting a potential area of concern in terms of respectful maternity care. The higher rate of episiotomy among first-time mothers may reflect practices that contribute to experiences that could be perceived as labour violence. Table 4 Distribution of the study subjects according to benefits availed under the Reproductive and Child Health Programme (N = 300) Variable Number (%) Transport facilities availed Yes 35 (11.7) No 265 (88.3) Government incentive schemes availed JSY* 2 (0.6) PMMVY# 44 (14.7) None 254 (84.7) * Janani Suraksha Yojana # Pradhan Mantri Matru Vandana Yojana Table 4 details the benefits availed under the Reproductive and Child Health Programme. The utilisation of the Janani Suraksha Yojana (JSY) was notably low (2,0.6%) and only 35 (11.7%) subjects used transport facilities. Additionally, 44 (14.7%) benefited from the Pradhan Mantri Matru Vandana Yojana (PMMVY), while 254 (84.7%) did not avail any government schemes. Table 5 Distribution of the study subjects according to knowledge and practices related to the provision of birth companion (N = 300) Variable Number (%) Knowledge regarding the provision of birth companions as per LaQshya* guidelines before coming to the facility Yes 2 (0.7) No 298 (99.3) Birth companion present at the previous delivery Yes 0 (0.0) No 180 (60.0) Not applicable** 120 (40.0) Birth companion available and present during the current delivery Yes 100 (33.3) No 200 (66.7) *LaQshya - Labour room quality improvement initiative, National Health Mission, Ministry of Health and Family Welfare, Government of India, 2017. **Not applicable – Includes Primigravida/first-time mothers Table 5 shows that a majority of the subjects, 298 (99.3%) were unaware of the provision of birth companions as per the LaQshya guidelines before coming to the facility. During the current delivery, 100 (33.3%) had a birth companion present, while 200 (66.7%) did not. For those who had previous deliveries, none had a birth companion, indicating a gap in practice, even though the guidelines were in place. RMC perceived using the Modified PCMC Scale and its association with sociodemographic factors The scoring of the Modified PCMC Scale among the subjects showed a variation of experiences with respectful maternity care. The mean score was 64.6 ± 4.5 (S.D.), indicating a generally positive experience. The median score was 64 (interquartile range = 62–67). The score range was 44–81, highlighting variability in experiences of care among subjects. Age, religion, caste and educational status of both the subjects and their husbands did not show significant associations with PCMC scores (p > 0.05). Additionally, socioeconomic status did not significantly affect PCMC scores (p = 0.914), suggesting that respectful maternity care was consistently experienced across different socioeconomic strata. This lack of variation across diverse sociodemographic backgrounds highlights a generally equitable provision of respectful maternity care within the study subjects. Domain wise proportion of RMC perceived In examining the proportion of perceived disrespect using the Modified PCMC Scale as shown in Fig. 3 , we compiled the responses of each domain/subscale. The items in this subscale are designed to capture both positive (respectful) and negative (disrespectful) behaviours separately. Therefore, when care is respectful, responses tend to reflect high scores on items assessing respect (e.g., friendliness and valuing patient dignity) and lower scores on items assessing disrespect (e.g., experiences of verbal abuse and rudeness or physical violence). This division of responses results in a split of responses across positive and negative aspects when summarising perceptions of care. The distribution of Domains of Perceived Disrespect among study subjects reflects varied experiences across the different domains of maternity care and is as follows; Dignity and Respect With 48.7% of the responses reporting no disrespect and 39.7% experiencing respectful treatment consistently, responses here highlight both the presence of positive treatment (respectful behaviours) and the effective avoidance of negative behaviours (disrespect). Privacy and Confidentiality High scores seen here, with 93.7% of the responses consistently feeling their privacy was respected, reflect strong adherence to privacy standards. Only 0.4% reported issues with confidentiality, reinforcing that privacy is reliably maintained, with only isolated instances where physical privacy may need reinforcement. Communication and Autonomy This domain had mixed responses, with 37.4% reporting consistent communication and autonomy, while 27.9% only experienced these elements occasionally. While procedural autonomy of consent was generally respected, the variability suggests gaps in comprehensive communication, such as consistent explanations of care decisions and open dialogue. These findings indicate that while autonomy in decision-making is generally respected, opportunities for inclusive communication remain. Supportive Care The perception of supportive care was less consistent, with only 19.6% of the responses indicating feeling fully supported all the time, while 33.1% experienced a lack of support at least occasionally. Limited companionship during labour and occasional gaps in emotional support indicate a need for more consistent supportive practices that address both physical and emotional needs, especially during labour. Trust Trust in healthcare providers was notably high, with 96.8% expressing full trust. This level of trust likely stems from reliable clinical care and transparency, reinforced by respectful communication and confidentiality practices. However, improvements in emotional support and communication could further strengthen trust under challenging or stressful conditions. Facility and Environment While 60.3% of the responses reported satisfaction with the facility environment consistently, concerns about crowding were prevalent, with 68.3% describing the wards as somewhat crowded. These findings suggest that while facilities meet basic safety and utility standards, the physical environment could benefit from improved space management to enhance patient comfort and well-being. Predictability and Transparency of Payment This domain achieved full positive responses, with all subjects (100%) indicating that they were never asked for additional charges or required to buy items outside the facility. This complete transparency reinforces trust and contributes to the perception of a fair and respectful financial interaction. Multivariate Analysis of Factors Associated with Respectful Maternity Care Table 6 Multivariate logistic regression analysis of factors associated with respectful maternity care Variable Adjusted odds ratio 95% CI ‘p’ value Participant’s occupation 1.435 0.675 to 3.051 0.348 Husband’s occupation 0.875 0.485 to 1.58 0.659 Socio-economic status 1.509 0.835 to 2.727 0.173 Parity 1.035 0.623 to 1.719 0.895 Presence of birth companion in present pregnancy 4.593 2.393 to 8.815 0.000* Satisfaction with marriage 1.716 0.673 to 4.372 0.258 Sex of the current baby (male) 1.718 1.028 to 2.87 0.039* A multivariate logistic regression analysis, presented in Table 6 , was performed to identify independent predictors of respectful maternity care. The model included key socio-demographic and obstetric variables, as well as contextual factors such as parity, presence of a birth companion, and the sex of the baby. Two variables were found to be significantly associated with higher RMC scores: Presence of a birth companion during the current delivery was strongly associated with a higher likelihood of experiencing respectful maternity care (AOR = 4.593; 95% CI: 2.393–8.815; p < 0.001). Male sex of the newborn was also significantly associated with improved RMC perception (AOR = 1.718; 95% CI: 1.028–2.87; p = 0.039). Other variables such as participants’ occupation, husband’s occupation, socio-economic status, parity, and marital satisfaction did not show statistically significant associations with the PCMC scores in the adjusted model (p > 0.05). DISCUSSION This study assessed postnatal women’s perceptions of respectful maternity care (RMC) in a tertiary hospital in Delhi and examined its association with key demographic and obstetric factors. The caesarean section rate of 25% aligns with NFHS-5 data and global trends described by Betran et al., who noted a rising global prevalence of C-sections, projected to reach 29% by 2030. 11 This upward trend may be attributed to a combination of factors, including evolving maternal preferences, increasing medicalisation of childbirth, and institutional practices in high-volume hospitals in urban India. A significant association was found between primigravida status and the likelihood of receiving an episiotomy, with first-time mothers more frequently undergoing the procedure than multigravida women. This finding is consistent with studies by Bekele et al. and Garcia-Cerde et al., 12,13 which reported disproportionately high episiotomy rates among primiparous women, despite international and national guidelines advocating for restrictive, evidence-based use. The continued reliance on routine episiotomy in primigravida cases may reflect persistent clinical practices shaped by perceived obstetric risk or provider caution, rather than patient-centered decision-making. This gap between respectful maternity care training and its clinical application emphasises that repeated provider sensitisation and adherence to update obstetric guidelines are the need of the hour. Despite LaQshya guidelines, only 33.3% of participants had a birth companion, and nearly all (99.3%) were unaware of the policy. This aligns with findings by Bharti et al. and Singh et al., 14,15 who identified implementation barriers such as overcrowding, privacy concerns, and lack of institutional preparedness. Importantly, our study found a significant association between the presence of a birth companion and higher PCMC scores, reinforcing the role of companionship in enhancing emotional support, reducing mistreatment, and improving overall maternity care experiences. These findings support calls for operationalizing low-cost, high-impact interventions such as birth companionship to promote more respectful, person-centered childbirth care in public health facilities. Only 14.6% availed PMMVY and 0.6% used JSY, similar to Verma et al. and Dhariwal et al., who noted documentation challenges, delays in payments, and low awareness. 16,17 In our context, these barriers were likely worsened by lack of outreach, promised cash benefits not reaching bank accounts and the procedural burden of Aadhaar-linked eligibility, as also seen in Dhariwal et al.’s Gujarat study. 17 Our findings revealed high levels of respectful treatment (88%), maintenance of privacy (88.7%), and confidence in confidentiality (98.7%), aligning with studies by Singh et al., Devi et al., and Montagu et al., which highlight the positive impact of respectful maternity care (RMC) training and standardized protocols. 18,19,20 However, notable gaps remain in communication and emotional support. Only 12.3% of participants fully understood the care being provided, and just 1.7% reported consistently receiving emotional support from staff. These findings point to missed opportunities for shared decision-making and meaningful patient-provider dialogue. Kapula et al. similarly emphasized that inadequate communication, particularly among women with complications, can heighten distress and undermine trust in the care process. 21 Although no sociodemographic disparities in RMC were observed, the presence of a birth companion emerged as a key driver of better care experiences, reinforcing the value of emotional and social support during childbirth, as highlighted in prior literature. The consistent association between companionship and higher PCMC scores in our study adds to growing evidence that integrating support persons into maternity care can enhance both perceived and actual quality of care. CONCLUSIONS The present study highlights that while foundational aspects of respectful maternity care (RMC) including respectful treatment, privacy, and trust were largely upheld, critical gaps remain. Most women reported positive interactions and strong adherence to privacy standards, yet only a third felt consistently involved in decision-making, indicating limited patient autonomy. Emotional support and the presence of birth companions were notably lacking. Structural challenges such as overcrowding, inconsistent staffing, and cleanliness issues also detracted from the overall care environment. These findings call for thoughtful improvements that prioritise emotional connection, meaningful involvement of women in their care, and a nurturing environment, so that every woman feels seen, heard, and respected throughout her childbirth experience. LIMITATIONS This study has a few limitations, as it focused solely on women's perspectives, excluding insights from healthcare providers, which could have enriched the understanding of the systemic challenges in delivering respectful care. The findings are limited to similar tertiary care hospitals in the metropolis and cannot be generalised to other settings. Participants’ responses may have been influenced by their fear of reprisal, as some women might have felt reluctant to speak openly about negative experiences out of concern for their future care at the same facility. The absence of qualitative data limits the ability to capture the nuanced, lived experiences of women during childbirth, including subtle forms of mistreatment that may have been normalised over time; such insights could have provided a deeper understanding of how respectful maternity care is perceived and where it may fall short. Abbreviations RMC Respectful Maternity Care PCMC scale Person-centered Maternity care (PCMC) scale SPSS Statistical Package for Social Science (SPSS) version 25 CTRI Clinical Trials Registry-India AOR Adjusted Odds Ratio SC Scheduled Caste ST Scheduled Tribes OBC Other Backward Castes JSY Janani Suraksha Yojana PMMVY Pradhan Mantri Matru Vandana Yojana Declarations Ethics approval and consent to participate: Ethical approval was obtained from the Institutional Ethics Committee, Maulana Azad Medical College & Associated Hospitals, New Delhi (Ref. No. F.1/IEC/MAMC/(93/01/2023/No.423)). The objectives and procedure of the study were explained to all subjects and a patient information sheet was given to them. Informed written consent was obtained from all participants before inclusion in the study. The name or any personally identifiable information was not disclosed to any third party. Confidentiality was maintained throughout. Data was used for research purposes only. The study was conducted following the ethical principles of the Declaration of Helsinki (2013). Consent for publication: Not applicable. Availability of data and materials: Data is available from the corresponding author upon reasonable request. Competing interests: The authors declare no competing interests . Funding: The authors declare no competing interests. Authors' contributions: I.M. conceptualized the study, designed the methodology, conducted data collection, performed the initial data analysis, and drafted the original manuscript. M.M.S., B.B., and N.B. provided guidance on study design, supervised the research process, and contributed to the critical review and revision of the manuscript. S.T. offered clinical expertise during tool development and supported interpretation of obstetric-related findings. A.S. assisted with data analysis and contributed to revising the results and discussion sections. All authors have read and approved the final version of the manuscript. All authors agree to be accountable for all aspects of the work, ensuring the integrity and accuracy of the research. Acknowledgements Authors' information (optional) References 1. White Ribbon Alliance. Respectful maternity care charter. Washington, DC: White Ribbon Alliance; 2011. 2. World Health Organization. The prevention and elimination of disrespect and abuse during facility-based childbirth: WHO statement. Geneva: World Health Organization; 2014. 3. Jones A, Smith B, Johnson C. Impact of disrespect and abuse during childbirth on maternal health service utilization. J Matern Child Health. 2019;10(2):123 − 35. 4. Bowser D, Hill K. Exploring evidence for disrespect and abuse in facility-based childbirth: report of a landscape analysis. USAID-TRAction Project. 2010. 5. Johnson A, Smith B, Williams C, Taylor D, Brown E, Wilson R, et al. Patient-provider communication and maternal health outcomes: a longitudinal study. J Obstet Gynecol. 2018;25(3):345 − 58. 6. Smith L, Anderson M. Maternal autonomy and decision-making in childbirth: implications for maternity care practices. J Midwifery Womens Health. 2019;30(4):567 − 80. 7. Brown S, Thompson R. Healthcare provider well-being and its impact on respectful maternity care. J Healthc Qual. 2020;18(2):89–102. 8. Dey A, Shakya HB, Chandurkar D, Kumar S, Das AK, Anthony J, et al. Discordance in self-report and observation data on mistreatment of women by providers during childbirth in Uttar Pradesh, India. Reprod Health. 2017 Dec;14(1):152. 9. Afulani PA, Diamond-Smith N, Phillips B, Singhal S, Sudhinaraset M. Validation of the person-centered maternity care scale in India. Reprod Health [Internet]. 2018 [cited 2024 Jun 11];15(1):147. Available from: https://doi.org/10.1186/s12978-018-0591-7 10. Sood P, Bindra S. Modified Kuppuswamy socioeconomic scale: 2022 update of India. Int J Community Med Public Health. 2022;9(10):3841-4. 11. Betran AP, Ye J, Moller AB, Souza JP, Zhang J. Trends and projections of caesarean section rates: global and regional estimates. BMJ Glob Health. 2021;6(6):532. 12. Bekele H, Tamiru D, Debella A, Getachew A, Yohannes E, Lami M, et al. Magnitude of episiotomy practice and associated factors among women who gave birth at Hiwot Fana Specialized University Hospital, Eastern Ethiopia. Front Glob Womens Health. 2022 Oct 10;3:911449. 13. Garcia-Cerde R, Torres-Pereda P, Olvera-Garcia M, Hulme J. Health care workers’ perceptions of episiotomy in the era of respectful maternity care: a qualitative study of an obstetric training program in Mexico. BMC Pregnancy Childbirth. 2021 Dec;21(1):767. 14. Bharti J, Kumari A, Zangmo R, Mathew S, Kumar S, Sharma AK. Establishing the practice of birth companion in labour ward of a tertiary care centre in India—a quality improvement initiative. BMJ Open Qual. 2021 Jul 1;10(Suppl 1) 15. Seth I, Sunayana N, Singhal S, Seth A, Garg AM. The impact of birth companion on respectful maternity care and labour outcomes among Indian women: a prospective comparative study. Int J Reprod Contracept Obstet Gynecol. 2023;12(12):3508-14. 16. Verma A, Pandey E, Ramanathan A, Saluja N. Impact of Janani Suraksha Yojana (JSY): a study across two Delhi hospitals. MPRA Paper. 2015 [revised 2017 Oct 15; cited 2023 Nov 15]. University Library of Munich, Germany. Available from: https://mpra.ub.uni-muenchen.de/109995/ 17. Dhariwal M, Divakar P, Gupta V. Evaluation of implementation and impact in Gujarat. Indus Action. [Internet]. 2020 [cited 2023 Nov 15]. Available from: https://www.indusaction.org/wp-content/uploads/2023/08/PMMVY_GJ_2020.pdf 18. Singh M, Baruhee S, Saxena P. Impact of respectful maternal care training of health care providers on satisfaction with birth experience in mothers undergoing normal vaginal birth: A prospective interventional study. IJGO. [Internet]. 2024 Aug 22; Available from: https://pubmed.ncbi.nlm.nih.gov/39175269/ 19. Devi SP, Meetei ST, Suriya P, Rajkumari B, Wahengbam R, Selvaraju E, et al. Respectful maternity care during childbirth: experiences and observation among mothers in a tertiary-care institute in Manipur. J Fam Med Prim Care. 2024;13(5):1766-71. 20. Montagu D, Giessler K, Nakphong MK, Roy KP, Sahu AB, Sharma K, et al. Results of a person-centered maternal health quality improvement intervention in Uttar Pradesh, India. PLoS One. 2020;15(12):102. 21. Kapula N, Sacks E, Wang DT, Odiase O, Requejo J, Afulani PA, et al. Associations between self-reported obstetric complications and experience of care: a secondary analysis of survey data from Ghana, Kenya, and India. Reprod Health. 2023;20(1):11. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 06 Oct, 2025 Read the published version in BMC Pregnancy and Childbirth → Version 1 posted Editorial decision: Revision requested 17 Jul, 2025 Reviews received at journal 16 Jul, 2025 Reviewers agreed at journal 16 Jul, 2025 Reviewers agreed at journal 15 Jul, 2025 Reviews received at journal 07 Jul, 2025 Reviewers agreed at journal 06 Jul, 2025 Reviewers agreed at journal 05 Jul, 2025 Reviewers invited by journal 24 Jun, 2025 Editor assigned by journal 24 Jun, 2025 Editor invited by journal 17 Jun, 2025 Submission checks completed at journal 17 Jun, 2025 First submitted to journal 17 Jun, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6896944","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":475828697,"identity":"a8edef61-7110-444d-88fd-a1fddd00eff6","order_by":0,"name":"Irena Mandal","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABDUlEQVRIiWNgGAWjYBACNjjrAHP7hw88EnJg9gPitDC2Mc6QsTEGsxOIsg+ohZnHJi2xAcTBp4VP+vCxBz9z7PL4jh9se8yTczh9ftjhh0Bb7OR0G3A4jC8t3bB3W3Kx5JnEdsM5Zw7nbrydZgDUkmxsdgCHFh4eMwnebcyJGw4kNki87QFqmZ0A0nIgcRtOLfzfJP9uq0/ccP5hgwTvv8PphrPTPxDQwsMmzbvtcOKGG4ltkjw8aQny0jmEbGEzk5bddjxx5o2HzYYzeGwMN0jnFBxIMMDtF/ke5meSb7dVJ/adTz74ABiV8vKz0zd/+FBhJ4dLCyYwAKs0IFY52N4GUlSPglEwCkbBSAAAH3JmiC3WjTcAAAAASUVORK5CYII=","orcid":"","institution":"Maulana Azad Medical College \u0026 Lok Nayak Hospital","correspondingAuthor":true,"prefix":"","firstName":"Irena","middleName":"","lastName":"Mandal","suffix":""},{"id":475828698,"identity":"33012f05-31c4-4a12-b005-803aa483d177","order_by":1,"name":"Mongjam Meghachandra Singh","email":"","orcid":"","institution":"Maulana Azad Medical College \u0026 Lok Nayak Hospital","correspondingAuthor":false,"prefix":"","firstName":"Mongjam","middleName":"Meghachandra","lastName":"Singh","suffix":""},{"id":475828699,"identity":"29402030-fb58-4c23-942f-dcbfec3cd19d","order_by":2,"name":"Bratati Banerjee","email":"","orcid":"","institution":"Maulana Azad Medical College \u0026 Lok Nayak Hospital","correspondingAuthor":false,"prefix":"","firstName":"Bratati","middleName":"","lastName":"Banerjee","suffix":""},{"id":475828700,"identity":"5b93cadf-c7e2-4c83-b1d1-493963294d3e","order_by":3,"name":"Nidhi Bhatnagar","email":"","orcid":"","institution":"Maulana Azad Medical College \u0026 Lok Nayak Hospital","correspondingAuthor":false,"prefix":"","firstName":"Nidhi","middleName":"","lastName":"Bhatnagar","suffix":""},{"id":475828701,"identity":"18c417cb-22f4-4778-8d1a-7b1e4c1922f6","order_by":4,"name":"Shakun Tyagi","email":"","orcid":"","institution":"Maulana Azad Medical College \u0026 Lok Nayak Hospital","correspondingAuthor":false,"prefix":"","firstName":"Shakun","middleName":"","lastName":"Tyagi","suffix":""},{"id":475828702,"identity":"3a38cba1-14f4-46b4-b1fa-c232f8637f44","order_by":5,"name":"Anjali Singh","email":"","orcid":"","institution":"Maulana Azad Medical College \u0026 Lok Nayak Hospital","correspondingAuthor":false,"prefix":"","firstName":"Anjali","middleName":"","lastName":"Singh","suffix":""}],"badges":[],"createdAt":"2025-06-15 07:23:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6896944/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6896944/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12884-025-08211-w","type":"published","date":"2025-10-06T15:58:21+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":85644250,"identity":"eda942ed-a231-407e-bd05-1e0683dae057","added_by":"auto","created_at":"2025-06-30 08:10:13","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":36884,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDistribution of the educational status of study participants and their husbands (N = 300)\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6896944/v1/f2b8e26dc9feab79dfdc37f1.png"},{"id":85644251,"identity":"dbf6a5dd-4598-48c4-b539-8ad1c5e24a16","added_by":"auto","created_at":"2025-06-30 08:10:13","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":46905,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDistribution of the occupational status of study participants and their husbands (N = 300).\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6896944/v1/45794d2086a9b6146ee499d9.png"},{"id":85644724,"identity":"308bad42-5f1c-4177-a900-c4a09736a0f5","added_by":"auto","created_at":"2025-06-30 08:18:13","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":150729,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDistribution of domains of perceived disrespect according to Modified PCMC Scale among the study subjects (N=300)\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6896944/v1/9d948e221c64a4d9166d5ed4.png"},{"id":93419931,"identity":"4e7eaf78-6461-4661-8cc3-137ede5e75a6","added_by":"auto","created_at":"2025-10-13 16:08:58","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1506279,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6896944/v1/734998e4-f13d-4277-93ec-a9a8f9dbf92c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Perceptions of Respectful Maternity Care among Postnatal Women at a Tertiary Care Hospital in New Delhi","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eChildbirth is a stressful event for expecting mothers; both physically and emotionally. It is an empowering experience with a lot of anticipation and vulnerability, requiring a lot of support and care during this time. Women\u0026rsquo;s experience during this period stays with them lifelong and utmost importance must be given to make this a joyous yet safe journey. Historically, the concept of maternity care revolved predominantly around addressing the morbidity and mortality rates associated with maternal health, however, issues of disrespect, abuse, and gender-based violence must also be tackled to ensure a holistic approach to safe motherhood.\u003c/p\u003e \u003cp\u003eA paradigm shift is imperative to broaden the scope of maternal care, integrating dimensions of respect, dignity, and gender equality into the core framework of healthcare provision.\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eUpholding the principles of human rights and gender equity, the provision of respectful maternity care emerges as a fundamental pillar of universal healthcare access for women worldwide. According to World Health Organization (WHO), \u0026ldquo;Every woman has the right to the highest attainable standard of health, which includes the right to dignified, respectful health care\u0026rdquo;.\u003csup\u003e2\u003c/sup\u003e Respectful maternity care (RMC) is a stepping stone towards achieving universal health coverage and serves as a conduit for mitigating disparities, and nurturing a healthcare landscape grounded in equity and inclusivity.\u003c/p\u003e \u003cp\u003eExperiences of disrespect and abuse during childbirth not only hinder the establishment of a therapeutic patient-provider relationship but also exacerbate psychological distress and emotional burden during pregnancy and childbirth.\u003csup\u003e3\u003c/sup\u003e A seminal landscape analysis review conducted by Bowser and Hill, in 2010, outlined seven distinct categories including physical abuse, non-consented clinical care, non-confidential care, non-dignified care, discrimination, abandonment, and detention in healthcare facilities, highlighting the need for standardized tools and methodologies to assess and address these key issues within maternal healthcare settings.\u003csup\u003e4\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e In response to the identified gaps, the White Ribbon Alliance spearheaded the development and dissemination of the Respectful Maternity Care Charter. This pivotal document serves as a guiding framework for program development, advocacy initiatives, and policy reform efforts aimed at promoting respectful, dignified, and compassionate care for pregnant women worldwide. Positive patient-provider relationships are associated with improved maternal outcomes, reduced stress levels, and enhanced feelings of empowerment and trust among pregnant women.\u003csup\u003e5\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIncorporating women's choices and preferences into maternity care practices not only enhances the birthing experience but also contributes to improved health outcomes and psychological well-being for both mothers and infants.\u003csup\u003e6\u003c/sup\u003e Despite the significance of these patient-centered elements in ensuring RMC, the challenges stemming from a healthcare system burdened with overworked and underappreciated providers pose a formidable barrier to the consistent delivery of high-quality maternity care. This, in turn, compromises the ability of providers to uphold the principles of RMC, such as respectful communication, personalised care, and shared decision-making, thereby jeopardising the overall quality of maternal health services.\u003csup\u003e7\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAddressing gaps in respectful maternity care through evidence-based interventions, policy reforms, and stakeholder collaboration is essential for improving maternal health outcomes, strengthening patient-provider relationships, and upholding women\u0026rsquo;s rights and dignity in childbirth. This study aims to assess perceived RMC among postnatal women in a tertiary care hospital and identify socio-demographic associations.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design \u0026amp; Setting\u003c/h2\u003e \u003cp\u003eThis hospital-based cross-sectional study was conducted in the Department of Obstetrics \u0026amp; Gynaecology at Maulana Azad Medical College \u0026amp; Lok Nayak Hospital, New Delhi, over 12 months.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy Population \u0026 Sample Size\u003c/h3\u003e\n\u003cp\u003ePostnatal women who delivered within 12\u0026ndash;48 hours at the hospital were included. A sample size of 270 was calculated by taking the prevalence of self-reported mistreatment of women by providers during childbirth as 77.3% \u003csup\u003e8\u003c/sup\u003e and the women who received respectful maternity care was 22.7%, with an allowable absolute error of 5% and a confidence level of 95%. Considering 10% as a non-response rate, the sample size was calculated to be 297, rounding off to 300. Once selected, the participant wanted to discontinue during the interview; it was considered as non-response.\u003c/p\u003e\n\u003ch3\u003eInclusion Criteria\u003c/h3\u003e\n\u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eWomen who had delivered between 12\u0026ndash;48 hours in LN Hospital, New Delhi at the time of data collection.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e\n\u003ch3\u003eExclusion Criteria\u003c/h3\u003e\n\u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eSeverely ill, bedridden women who were not in a position to communicate.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eWomen under the age of 18 years and single mothers\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e\n\u003ch3\u003eSampling and Data Collection\u003c/h3\u003e\n\u003cp\u003eSimple random sampling was used to select participants admitted to the postnatal wards who fulfilled the inclusion criteria. The sampling frame consisted of the total number of postnatal women admitted to the wards on the day of the visit. They were numbered serially, and from the list, 5 women were selected in a day through a random number generator app called Random Ux. A pre-tested structured interview schedule was used to collect socio-demographic details, patient obstetric history and RMC perceptions using the modified Person-Centered Maternity Care (PCMC) scale. The Person-Centered Maternity Care (PCMC) scale developed by Afulani et al. was used with contextual modifications after pretesting to suit our tertiary care hospital setting.\u003csup\u003e9\u003c/sup\u003e\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eDescriptive statistics including means, standard deviations, frequencies, and proportions were used to summarize sociodemographic and obstetric characteristics of the participants. A p value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003cp\u003eBivariate analysis using the Chi-square test was performed to assess the association between categorical independent variables and the level of respectful maternity care. A p value of \u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003cp\u003eVariables that showed a significant association in bivariate analysis or were considered conceptually relevant were included in a multivariate logistic regression model to identify independent predictors of respectful maternity care. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) and corrected p values were reported.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n\u003ch2\u003eSociodemographic characteristics\u003c/h2\u003e\n\u003cp\u003eA total of 300 subjects were included in the study, with a response rate of 100%; the majority residing in urban areas (287, 95.7%). The subjects' ages varied, with the highest proportion being 112 (37.3%) aged between 36\u0026ndash;40 years, and the mean age was found to be 27.3 years\u0026thinsp;\u003cspan class=\"Underline\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;4.7 (S.D.). The educational level of subjects and their husbands, as shown in Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e, revealed that the highest proportion had completed high school (37.3%), with a small fraction being graduates (1% of subjects and 2% of husbands). More women had higher education levels overall, while 19.7% of husbands had attended only primary school.\u003c/p\u003e\n\u003cp\u003eIn terms of occupation as depicted in Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e, half of the subjects (50%) were homemakers, while husbands were more widely distributed across unskilled (22.7%), semi-skilled (22.3%), and skilled (22%) work. Professional roles were rare for both groups (1.3% of subjects, 2.7% of husbands). This highlights traditional gender roles, with women primarily engaged in homemaking and men in low-skilled wage-earning jobs, reflecting disparities in workforce participation shaped by social norms, economic factors, and educational access.\u003c/p\u003e\n\u003cp\u003eMost subjects lived in nuclear families (236, 78.7%), and their socioeconomic status, according to the Modified Kuppuswamy Scale 2022,\u003csup\u003e10\u003c/sup\u003e revealed that the upper-lower class comprised the largest group (120, 40.1%) as depicted in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eDistribution of the study subjects according to their sociodemographic characteristics (N\u0026thinsp;=\u0026thinsp;300)\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eCharacteristics\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eNumber (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"5\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAge (in years)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18\u0026ndash;25\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e40 (13.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e26\u0026ndash;30\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e45 (15.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e31\u0026ndash;35\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e49 (16.4)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e36\u0026ndash;40\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e112 (37.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e41\u0026ndash;45\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e54 (18.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"4\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eCaste*\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSC\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8 (2.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eST\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3 (1.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOBC\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e67 (22.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOthers\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e222 (74)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eType of Family\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNuclear\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e236 (78.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eJoint\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e64 (21.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"5\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSocioeconomic status\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(Modified Kuppuswamy Scale 2022)\u003c/strong\u003e \u003csup\u003e10\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUpper\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5 (1.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUpper middle\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e65 (21.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLower Middle\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e85 (28.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUpper Lower\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e120 (40.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLower\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e25 (8.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\"\u003e* SC- Scheduled Caste; ST- Scheduled Tribes; OBC- Other Backward Castes\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n\u003ch2\u003eObstetric-related characteristics\u003c/h2\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"char\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eDistribution of the study subjects according to their obstetric history (N\u0026thinsp;=\u0026thinsp;300)\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eVariable\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eNumber (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eParity\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (Primigravida)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e120 (40.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u0026ndash;4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e176 (58.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cspan class=\"Underline\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e4 (1.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eType of labour\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSpontaneous\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e209 (96.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eInduced\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e10 (3.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eMode of delivery\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eVaginal\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e216 (72.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAssisted Vaginal\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e9 (3.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCaesarean section\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e75 (25.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eThe gestational age of the baby delivered\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePreterm\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e35 (11.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTerm\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e264 (88.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePost Term\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1 (0.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eInstitutional delivery of previous pregnancy\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e170 (56.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e10 (3.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNot applicable*\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e120 (40.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"4\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eTiming of delivery\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMorning (\u003cspan class=\"Underline\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;5 AM - \u0026lt;12 PM)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e127 (42.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAfternoon (\u003cspan class=\"Underline\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;12 PM - \u0026lt;5PM)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e42 (14.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEvening (\u003cspan class=\"Underline\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;5 PM - \u0026lt;9PM)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e65 (21.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNight (\u003cspan class=\"Underline\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;9 PM - \u0026lt;5AM)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e66 (22.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eDifficulty in initiating breastfeeding\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e31 (10.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e269 (89.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\"\u003e*Primigravida women\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e**Includes women who were unable to initiate as the child was in nursery or too ill to initiate.\u003c/p\u003e\n\u003cp\u003eIn terms of parity, as summarised in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e, the majority (176, 58.7%) had between 2 to 4 previous pregnancies. Regarding the type of labour, most subjects (209, 96.7%) experienced spontaneous labour and 216 women (72%) had vaginal deliveries.\u003c/p\u003e\n\u003cp\u003eAmong those who had previous pregnancies, 170 (56.7%) had an institutional delivery in their previous pregnancy, while 10 (3.3%) did not, and 120 (40%) were primigravida, so this question did not apply to them. The timing of delivery was fairly evenly distributed, with 127 (42.3%) delivering in the morning, 42 (14%) in the afternoon, 65 (21.7%) in the evening, and 66 (22%) at night. 269 (89.7%) of subjects did not have difficulty initiating breastfeeding.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eAssociation of parity of the study subjects with episiotomy given (n\u0026thinsp;=\u0026thinsp;225)\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eParity of participant\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eEpisiotomy given\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003e\u0026chi;\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e value, d.f.,\u003c/p\u003e\n\u003cp\u003e\u0026lsquo;p\u0026rsquo; value\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eTotal\u003c/p\u003e\n\u003c/th\u003e\n\u003cth rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e13.730, 1, \u0026lt;\u0026thinsp;0.0001*\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ePrimigravida\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e87 (94.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5 (5.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e92 (40.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eMultigravida\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e101 (75.9)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e32 (24.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e133 (59.2)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\"\u003e*p value calculated using Fisher exact test\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e shows a significant association between the parity of the study subject and the administration of episiotomy (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). Primigravida subjects were more likely to receive an episiotomy compared to multigravida subjects, highlighting a potential area of concern in terms of respectful maternity care. The higher rate of episiotomy among first-time mothers may reflect practices that contribute to experiences that could be perceived as labour violence.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab4\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eDistribution of the study subjects according to benefits availed under the Reproductive and Child Health Programme (N\u0026thinsp;=\u0026thinsp;300)\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eVariable\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eNumber (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eTransport facilities availed\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e35 (11.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e265 (88.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eGovernment incentive schemes availed\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eJSY*\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2 (0.6)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePMMVY#\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e44 (14.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e254 (84.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\"\u003e\u003cstrong\u003e*\u003c/strong\u003e Janani Suraksha Yojana\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\"\u003e\u003cstrong\u003e#\u003c/strong\u003e Pradhan Mantri Matru Vandana Yojana\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e details the benefits availed under the Reproductive and Child Health Programme. The utilisation of the Janani Suraksha Yojana (JSY) was notably low (2,0.6%) and only 35 (11.7%) subjects used transport facilities. Additionally, 44 (14.7%) benefited from the Pradhan Mantri Matru Vandana Yojana (PMMVY), while 254 (84.7%) did not avail any government schemes.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab5\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eDistribution of the study subjects according to knowledge and practices related to the provision of birth companion (N\u0026thinsp;=\u0026thinsp;300)\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eVariable\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eNumber (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eKnowledge regarding the provision of birth companions as per LaQshya* guidelines before coming to the facility\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2 (0.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e298 (99.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eBirth companion present at the previous delivery\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0 (0.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e180 (60.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNot applicable**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e120 (40.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eBirth companion available and present during the current delivery\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e100 (33.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e200 (66.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e*LaQshya - Labour room quality improvement initiative, National Health Mission, Ministry of Health and Family Welfare, Government of India, 2017.\u003c/p\u003e\n\u003cp\u003e**Not applicable \u0026ndash; Includes Primigravida/first-time mothers\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e shows that a majority of the subjects, 298 (99.3%) were unaware of the provision of birth companions as per the LaQshya guidelines before coming to the facility. During the current delivery, 100 (33.3%) had a birth companion present, while 200 (66.7%) did not. For those who had previous deliveries, none had a birth companion, indicating a gap in practice, even though the guidelines were in place.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n\u003ch2\u003eRMC perceived using the Modified PCMC Scale and its association with sociodemographic factors\u003c/h2\u003e\n\u003cp\u003eThe scoring of the Modified PCMC Scale among the subjects showed a variation of experiences with respectful maternity care. The mean score was 64.6\u0026thinsp;\u003cspan class=\"Underline\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;4.5 (S.D.), indicating a generally positive experience. The median score was 64 (interquartile range\u0026thinsp;=\u0026thinsp;62\u0026ndash;67). The score range was 44\u0026ndash;81, highlighting variability in experiences of care among subjects. Age, religion, caste and educational status of both the subjects and their husbands did not show significant associations with PCMC scores (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Additionally, socioeconomic status did not significantly affect PCMC scores (p\u0026thinsp;=\u0026thinsp;0.914), suggesting that respectful maternity care was consistently experienced across different socioeconomic strata. This lack of variation across diverse sociodemographic backgrounds highlights a generally equitable provision of respectful maternity care within the study subjects.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n\u003ch2\u003eDomain wise proportion of RMC perceived\u003c/h2\u003e\n\u003cp\u003eIn examining the proportion of perceived disrespect using the Modified PCMC Scale as shown in Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e, we compiled the responses of each domain/subscale. The items in this subscale are designed to capture both positive (respectful) and negative (disrespectful) behaviours separately. Therefore, when care is respectful, responses tend to reflect high scores on items assessing respect (e.g., friendliness and valuing patient dignity) and lower scores on items assessing disrespect (e.g., experiences of verbal abuse and rudeness or physical violence). This division of responses results in a split of responses across positive and negative aspects when summarising perceptions of care.\u003c/p\u003e\n\u003cp\u003eThe distribution of Domains of Perceived Disrespect among study subjects reflects varied experiences across the different domains of maternity care and is as follows;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDignity and Respect\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWith 48.7% of the responses reporting no disrespect and 39.7% experiencing respectful treatment consistently, responses here highlight both the presence of positive treatment (respectful behaviours) and the effective avoidance of negative behaviours (disrespect).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrivacy and Confidentiality\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHigh scores seen here, with 93.7% of the responses consistently feeling their privacy was respected, reflect strong adherence to privacy standards. Only 0.4% reported issues with confidentiality, reinforcing that privacy is reliably maintained, with only isolated instances where physical privacy may need reinforcement.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCommunication and Autonomy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis domain had mixed responses, with 37.4% reporting consistent communication and autonomy, while 27.9% only experienced these elements occasionally. While procedural autonomy of consent was generally respected, the variability suggests gaps in comprehensive communication, such as consistent explanations of care decisions and open dialogue. These findings indicate that while autonomy in decision-making is generally respected, opportunities for inclusive communication remain.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSupportive Care\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe perception of supportive care was less consistent, with only 19.6% of the responses indicating feeling fully supported all the time, while 33.1% experienced a lack of support at least occasionally. Limited companionship during labour and occasional gaps in emotional support indicate a need for more consistent supportive practices that address both physical and emotional needs, especially during labour.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrust\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTrust in healthcare providers was notably high, with 96.8% expressing full trust. This level of trust likely stems from reliable clinical care and transparency, reinforced by respectful communication and confidentiality practices. However, improvements in emotional support and communication could further strengthen trust under challenging or stressful conditions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFacility and Environment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWhile 60.3% of the responses reported satisfaction with the facility environment consistently, concerns about crowding were prevalent, with 68.3% describing the wards as somewhat crowded. These findings suggest that while facilities meet basic safety and utility standards, the physical environment could benefit from improved space management to enhance patient comfort and well-being.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePredictability and Transparency of Payment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis domain achieved full positive responses, with all subjects (100%) indicating that they were never asked for additional charges or required to buy items outside the facility. This complete transparency reinforces trust and contributes to the perception of a fair and respectful financial interaction.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n\u003ch2\u003eMultivariate Analysis of Factors Associated with Respectful Maternity Care\u003c/h2\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab6\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eMultivariate logistic regression analysis of factors associated with respectful maternity care\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVariable\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eAdjusted odds ratio\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e95% CI\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u0026lsquo;p\u0026rsquo; value\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eParticipant\u0026rsquo;s occupation\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.435\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.675 to 3.051\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.348\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHusband\u0026rsquo;s occupation\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.875\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.485 to 1.58\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.659\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSocio-economic status\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.509\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.835 to 2.727\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.173\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eParity\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.035\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.623 to 1.719\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.895\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePresence of birth companion in present pregnancy\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e4.593\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.393 to 8.815\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.000*\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSatisfaction with marriage\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.716\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.673 to 4.372\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.258\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSex of the current baby (male)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e1.718\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.028 to 2.87\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e\u003cstrong\u003e0.039*\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eA multivariate logistic regression analysis, presented in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003e, was performed to identify independent predictors of respectful maternity care. The model included key socio-demographic and obstetric variables, as well as contextual factors such as parity, presence of a birth companion, and the sex of the baby.\u003c/p\u003e\n\u003cp\u003eTwo variables were found to be significantly associated with higher RMC scores:\u003c/p\u003e\n\u003cp\u003ePresence of a birth companion during the current delivery was strongly associated with a higher likelihood of experiencing respectful maternity care (AOR\u0026thinsp;=\u0026thinsp;4.593; 95% CI: 2.393\u0026ndash;8.815; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Male sex of the newborn was also significantly associated with improved RMC perception (AOR\u0026thinsp;=\u0026thinsp;1.718; 95% CI: 1.028\u0026ndash;2.87; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.039).\u003c/p\u003e\n\u003cp\u003eOther variables such as participants\u0026rsquo; occupation, husband\u0026rsquo;s occupation, socio-economic status, parity, and marital satisfaction did not show statistically significant associations with the PCMC scores in the adjusted model (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\n\u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003e This study assessed postnatal women\u0026rsquo;s perceptions of respectful maternity care (RMC) in a tertiary hospital in Delhi and examined its association with key demographic and obstetric factors. The caesarean section rate of 25% aligns with NFHS-5 data and global trends described by Betran et al., who noted a rising global prevalence of C-sections, projected to reach 29% by 2030.\u003csup\u003e11\u003c/sup\u003e This upward trend may be attributed to a combination of factors, including evolving maternal preferences, increasing medicalisation of childbirth, and institutional practices in high-volume hospitals in urban India.\u003c/p\u003e \u003cp\u003eA significant association was found between primigravida status and the likelihood of receiving an episiotomy, with first-time mothers more frequently undergoing the procedure than multigravida women. This finding is consistent with studies by Bekele et al. and Garcia-Cerde et al.,\u003csup\u003e12,13\u003c/sup\u003e which reported disproportionately high episiotomy rates among primiparous women, despite international and national guidelines advocating for restrictive, evidence-based use. The continued reliance on routine episiotomy in primigravida cases may reflect persistent clinical practices shaped by perceived obstetric risk or provider caution, rather than patient-centered decision-making. This gap between respectful maternity care training and its clinical application emphasises that repeated provider sensitisation and adherence to update obstetric guidelines are the need of the hour.\u003c/p\u003e \u003cp\u003e Despite LaQshya guidelines, only 33.3% of participants had a birth companion, and nearly all (99.3%) were unaware of the policy. This aligns with findings by Bharti et al. and Singh et al.,\u003csup\u003e14,15\u003c/sup\u003e who identified implementation barriers such as overcrowding, privacy concerns, and lack of institutional preparedness. Importantly, our study found a significant association between the presence of a birth companion and higher PCMC scores, reinforcing the role of companionship in enhancing emotional support, reducing mistreatment, and improving overall maternity care experiences. These findings support calls for operationalizing low-cost, high-impact interventions such as birth companionship to promote more respectful, person-centered childbirth care in public health facilities.\u003c/p\u003e \u003cp\u003eOnly 14.6% availed PMMVY and 0.6% used JSY, similar to Verma et al. and Dhariwal et al., who noted documentation challenges, delays in payments, and low awareness.\u003csup\u003e16,17\u003c/sup\u003e In our context, these barriers were likely worsened by lack of outreach, promised cash benefits not reaching bank accounts and the procedural burden of Aadhaar-linked eligibility, as also seen in Dhariwal et al.\u0026rsquo;s Gujarat study.\u003csup\u003e17\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eOur findings revealed high levels of respectful treatment (88%), maintenance of privacy (88.7%), and confidence in confidentiality (98.7%), aligning with studies by Singh et al., Devi et al., and Montagu et al., which highlight the positive impact of respectful maternity care (RMC) training and standardized protocols.\u003csup\u003e18,19,20\u003c/sup\u003e However, notable gaps remain in communication and emotional support. Only 12.3% of participants fully understood the care being provided, and just 1.7% reported consistently receiving emotional support from staff. These findings point to missed opportunities for shared decision-making and meaningful patient-provider dialogue. Kapula et al. similarly emphasized that inadequate communication, particularly among women with complications, can heighten distress and undermine trust in the care process.\u003csup\u003e21\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAlthough no sociodemographic disparities in RMC were observed, the presence of a birth companion emerged as a key driver of better care experiences, reinforcing the value of emotional and social support during childbirth, as highlighted in prior literature. The consistent association between companionship and higher PCMC scores in our study adds to growing evidence that integrating support persons into maternity care can enhance both perceived and actual quality of care.\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eThe present study highlights that while foundational aspects of respectful maternity care (RMC) including respectful treatment, privacy, and trust were largely upheld, critical gaps remain. Most women reported positive interactions and strong adherence to privacy standards, yet only a third felt consistently involved in decision-making, indicating limited patient autonomy. Emotional support and the presence of birth companions were notably lacking. Structural challenges such as overcrowding, inconsistent staffing, and cleanliness issues also detracted from the overall care environment. These findings call for thoughtful improvements that prioritise emotional connection, meaningful involvement of women in their care, and a nurturing environment, so that every woman feels seen, heard, and respected throughout her childbirth experience.\u003c/p\u003e "},{"header":"LIMITATIONS","content":"\u003cp\u003eThis study has a few limitations, as it focused solely on women's perspectives, excluding insights from healthcare providers, which could have enriched the understanding of the systemic challenges in delivering respectful care. The findings are limited to similar tertiary care hospitals in the metropolis and cannot be generalised to other settings.\u003c/p\u003e\u003cp\u003e Participants’ responses may have been influenced by their fear of reprisal, as some women might have felt reluctant to speak openly about negative experiences out of concern for their future care at the same facility. The absence of qualitative data limits the ability to capture the nuanced, lived experiences of women during childbirth, including subtle forms of mistreatment that may have been normalised over time; such insights could have provided a deeper understanding of how respectful maternity care is perceived and where it may fall short.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRMC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRespectful Maternity Care\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePCMC scale\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePerson-centered Maternity care (PCMC) scale\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSPSS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStatistical Package for Social Science (SPSS) version 25\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCTRI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eClinical Trials Registry-India\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAOR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAdjusted Odds Ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eScheduled Caste\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eST\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eScheduled Tribes\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eOBC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eOther Backward Castes\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eJSY\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eJanani Suraksha Yojana\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePMMVY\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePradhan Mantri Matru Vandana Yojana\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003eEthical approval was obtained from the Institutional Ethics Committee, Maulana Azad Medical College \u0026amp; Associated Hospitals, New Delhi (Ref. No. F.1/IEC/MAMC/(93/01/2023/No.423)). The objectives and procedure of the study were explained to all subjects and a patient information sheet was given to them. Informed written consent was obtained from all participants before inclusion in the study. The name or any personally identifiable information was not disclosed to any third party. Confidentiality was maintained throughout. Data was used for research purposes only. The study was conducted following the ethical principles of the Declaration of Helsinki (2013).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003eData is available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eThe authors declare no competing interests\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions:\u0026nbsp;\u003c/strong\u003eI.M. conceptualized the study, designed the methodology, conducted data collection, performed the initial data analysis, and drafted the original manuscript. M.M.S., B.B., and N.B. provided guidance on study design, supervised the research process, and contributed to the critical review and revision of the manuscript. S.T. offered clinical expertise during tool development and supported interpretation of obstetric-related findings. A.S. assisted with data analysis and contributed to revising the results and discussion sections. All authors have read and approved the final version of the manuscript. All authors agree to be accountable for all aspects of the work, ensuring the integrity and accuracy of the research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' information (optional)\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003e1. White Ribbon Alliance. Respectful maternity care charter. Washington, DC: White Ribbon Alliance; 2011.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e2. World Health Organization. The prevention and elimination of disrespect and abuse during facility-based childbirth: WHO statement. Geneva: World Health Organization; 2014.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e3. Jones A, Smith B, Johnson C. Impact of disrespect and abuse during childbirth on maternal health service utilization. J Matern Child Health. 2019;10(2):123\u0026thinsp;\u0026minus;\u0026thinsp;35.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e4. Bowser D, Hill K. Exploring evidence for disrespect and abuse in facility-based childbirth: report of a landscape analysis. USAID-TRAction Project. 2010.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e5. Johnson A, Smith B, Williams C, Taylor D, Brown E, Wilson R, et al. Patient-provider communication and maternal health outcomes: a longitudinal study. J Obstet Gynecol. 2018;25(3):345\u0026thinsp;\u0026minus;\u0026thinsp;58.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e6. Smith L, Anderson M. Maternal autonomy and decision-making in childbirth: implications for maternity care practices. J Midwifery Womens Health. 2019;30(4):567\u0026thinsp;\u0026minus;\u0026thinsp;80.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e7. Brown S, Thompson R. Healthcare provider well-being and its impact on respectful maternity care. J Healthc Qual. 2020;18(2):89\u0026ndash;102.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e8. Dey A, Shakya HB, Chandurkar D, Kumar S, Das AK, Anthony J, et al. Discordance in self-report and observation data on mistreatment of women by providers during childbirth in Uttar Pradesh, India. Reprod Health. 2017 Dec;14(1):152.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e9. Afulani PA, Diamond-Smith N, Phillips B, Singhal S, Sudhinaraset M. Validation of the person-centered maternity care scale in India. Reprod Health [Internet]. 2018 [cited 2024 Jun 11];15(1):147. Available from: https://doi.org/10.1186/s12978-018-0591-7\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e10. Sood P, Bindra S. Modified Kuppuswamy socioeconomic scale: 2022 update of India. Int J Community Med Public Health. 2022;9(10):3841-4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e11. Betran AP, Ye J, Moller AB, Souza JP, Zhang J. Trends and projections of caesarean section rates: global and regional estimates. BMJ Glob Health. 2021;6(6):532.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e12. Bekele H, Tamiru D, Debella A, Getachew A, Yohannes E, Lami M, et al. Magnitude of episiotomy practice and associated factors among women who gave birth at Hiwot Fana Specialized University Hospital, Eastern Ethiopia. Front Glob Womens Health. 2022 Oct 10;3:911449.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e13. Garcia-Cerde R, Torres-Pereda P, Olvera-Garcia M, Hulme J. Health care workers\u0026rsquo; perceptions of episiotomy in the era of respectful maternity care: a qualitative study of an obstetric training program in Mexico. BMC Pregnancy Childbirth. 2021 Dec;21(1):767.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e14. Bharti J, Kumari A, Zangmo R, Mathew S, Kumar S, Sharma AK. Establishing the practice of birth companion in labour ward of a tertiary care centre in India\u0026mdash;a quality improvement initiative. BMJ Open Qual. 2021 Jul 1;10(Suppl 1)\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e15. Seth I, Sunayana N, Singhal S, Seth A, Garg AM. The impact of birth companion on respectful maternity care and labour outcomes among Indian women: a prospective comparative study. Int J Reprod Contracept Obstet Gynecol. 2023;12(12):3508-14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e16. Verma A, Pandey E, Ramanathan A, Saluja N. Impact of Janani Suraksha Yojana (JSY): a study across two Delhi hospitals. MPRA Paper. 2015 [revised 2017 Oct 15; cited 2023 Nov 15]. University Library of Munich, Germany. Available from: https://mpra.ub.uni-muenchen.de/109995/\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e17. Dhariwal M, Divakar P, Gupta V. Evaluation of implementation and impact in Gujarat. Indus Action. [Internet]. 2020 [cited 2023 Nov 15]. Available from: https://www.indusaction.org/wp-content/uploads/2023/08/PMMVY_GJ_2020.pdf\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e18. Singh M, Baruhee S, Saxena P. Impact of respectful maternal care training of health care providers on satisfaction with birth experience in mothers undergoing normal vaginal birth: A prospective interventional study. IJGO. [Internet]. 2024 Aug 22; Available from: https://pubmed.ncbi.nlm.nih.gov/39175269/\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e19. Devi SP, Meetei ST, Suriya P, Rajkumari B, Wahengbam R, Selvaraju E, et al. Respectful maternity care during childbirth: experiences and observation among mothers in a tertiary-care institute in Manipur. J Fam Med Prim Care. 2024;13(5):1766-71.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e20. Montagu D, Giessler K, Nakphong MK, Roy KP, Sahu AB, Sharma K, et al. Results of a person-centered maternal health quality improvement intervention in Uttar Pradesh, India. PLoS One. 2020;15(12):102.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e21. Kapula N, Sacks E, Wang DT, Odiase O, Requejo J, Afulani PA, et al. Associations between self-reported obstetric complications and experience of care: a secondary analysis of survey data from Ghana, Kenya, and India. Reprod Health. 2023;20(1):11.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Respectful Maternity Care, Maternal Health, Childbirth, Pregnancy, Person-Centred Maternity Care","lastPublishedDoi":"10.21203/rs.3.rs-6896944/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6896944/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eCompassionate support and a nurturing environment are essential for a positive, dignified birthing experience. A dearth of respectful maternity care not only undermines the overall quality of services but also has far-reaching implications on women's healthcare-seeking behaviour and trust in the health system. Despite increasing institutional deliveries in India, evidence suggests that mistreatment and lack of respectful care persist in healthcare settings. This study assesses the perceptions of RMC among postnatal women in a tertiary care hospital in New Delhi and explores its associations with socio-demographic factors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA hospital-based cross-sectional study was conducted among 300 postnatal women at Lok Nayak Hospital, New Delhi. Participants were selected using a simple random sampling technique. Data were collected using a pre-tested interview which consisted of questions related to their socio-demographic details, obstetric history, domestic or intimate partner violence history and the Person-centered Maternity care (PCMC) scale. Descriptive statistics, chi-square tests, and multivariate logistic regression were used to examine associations between socio-demographic and obstetric factors and RMC scores using Statistical Package for Social Science (SPSS) version 25, and p-value \u0026lt; 0.05 was considered significant.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eResults:\u0026nbsp; \u003c/strong\u003eAll participants (100%) reported overall satisfaction with their delivery experience while significant gaps in RMC were observed. Primigravida subjects were more likely to receive an episiotomy compared to multigravida. Only 33.3% had a birth companion present, despite LaQshya guidelines, and a significant association was found between the presence of a birth companion during the current delivery and the PCMC scores. Multivariate analysis revealed that the presence of a birth companion (AOR = 4.593; 95% CI: 2.393–8.815; p \u0026lt; 0.001) and having a male baby (AOR = 1.718; 95% CI: 1.028–2.87; p = 0.039) were significantly associated with higher RMC scores.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eThe findings highlight critical gaps in RMC implementation, despite high institutional delivery rates. Strengthening provider training, ensuring birth companionship, and fostering policy enforcement are recommended for improving maternity care quality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial registration: \u003c/strong\u003eThis study was registered in the Clinical Trials Registry - India (CTRI) on 31\u003csup\u003est\u003c/sup\u003e July 2023 under the postgraduate thesis as CTRI/2023/07/055918.\u003c/p\u003e","manuscriptTitle":"Perceptions of Respectful Maternity Care among Postnatal Women at a Tertiary Care Hospital in New Delhi","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-30 08:10:09","doi":"10.21203/rs.3.rs-6896944/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-07-17T05:00:40+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-16T18:37:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"40182472190570326062635496177177699266","date":"2025-07-16T05:54:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"185136922012821567939104072729562766083","date":"2025-07-15T22:51:08+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-07T04:18:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"181623481491036886495057228075957591761","date":"2025-07-07T02:25:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"62234809642110858302946717453568826999","date":"2025-07-05T05:59:40+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-24T05:54:29+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-24T05:52:23+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-06-17T16:55:25+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-17T12:46:51+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2025-06-17T12:43:56+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"83ccfe5b-4360-45ac-b657-fef5c934f97d","owner":[],"postedDate":"June 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-10-13T16:05:54+00:00","versionOfRecord":{"articleIdentity":"rs-6896944","link":"https://doi.org/10.1186/s12884-025-08211-w","journal":{"identity":"bmc-pregnancy-and-childbirth","isVorOnly":false,"title":"BMC Pregnancy and Childbirth"},"publishedOn":"2025-10-06 15:58:21","publishedOnDateReadable":"October 6th, 2025"},"versionCreatedAt":"2025-06-30 08:10:09","video":"","vorDoi":"10.1186/s12884-025-08211-w","vorDoiUrl":"https://doi.org/10.1186/s12884-025-08211-w","workflowStages":[]},"version":"v1","identity":"rs-6896944","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6896944","identity":"rs-6896944","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}