Guwahati, Dec 10: A new study conducted at healthcare facilities across Meghalaya has shed light on a surprising gap in maternal health awareness: urban mothers in the state have significantly lower knowledge of Respectful Maternity Care (RMC) than rural mothers, even though both groups report largely positive childbirth experiences
The research, led by Gayatree Devi, Catherine Eva Myrthong, and K. Rosema Kom, from the Department of Community Health Nursing, College of Nursing, NEIGRIHMS is the first comparative examination of RMC knowledge and experiences among urban and rural mothers in the state. The study has been published in the International Journal of Community Medicine and Public Health journal.
Conducted between January 15 and February 10, 2024, the study surveyed 120 postnatal mothers—60 from the Maternal and Child Hospital in Shillong and 60 from rural health centres located 35 to 60 kilometres away from NEIGRIHMS. All participants had undergone vaginal deliveries within ten days of the survey period.
Regarding education, 17 (28.3%) of urban mothers completed upper primary, while 20(33.3%) of rural mothers reached secondary level. The vast majority of mothers are housewives, with 93.3% in urban areas and 95% in rural areas. Most urban 49 (81.7%) and rural 42 (70%) mothers identify as Christian. Additionally, 37 (61.7%) of urban mothers and 44 (73.3%) of rural mothers come from nuclear families. Interestingly, 35 (58.3%) of urban mothers are unfamiliar with respectful maternity care, whereas 46 (76.7%) of rural mothers are aware of RMC.
According to the “World Health Organization”, respectful maternity care (RMC) ensures that women maintain dignity, privacy, and informed choice, while being free from harm, mistreatment, and abuse, with continuous support during labor and childbirth. In December 2017, India’s “Ministry of Health and Family Welfare” launched the “LaQshya” initiative to improve labor room standards and promote respectful maternity care. LaQshya aims to reduce maternal and newborn deaths, enhance care quality during delivery and postpartum, and improve patient satisfaction in public health facilities.
A key finding is that 65.8% of mothers had poor knowledge of respectful maternity care, which includes women’s rights to privacy, dignity, informed consent, non-discrimination, and freedom from abuse. Urban mothers were less aware than rural mothers: just 23.3% of urban respondents demonstrated good knowledge, compared with 45% in rural areas. The study’s statistical analysis shows this difference to be significant (p=0.012).
Data shows awareness gaps across core RMC components—only 18.3% of urban mothers and 30% of rural mothers understood what constitutes disrespect or mistreatment during childbirth. Awareness of confidential care, equitable treatment, and women’s privacy also remained low.
Despite the low awareness, 86.7% of mothers reported positive childbirth experiences, with rural mothers again reporting slightly better outcomes (90%) than urban mothers (83.3%). However, the study notes that knowledge and experience do not strongly correlate; mothers may report satisfaction even without understanding their rights or recognizing disrespect.
The study also found that nurses play a critical role in shaping mothers’ understanding of maternity care. The authors note that 56% of urban mothers and 67.4% of rural mothers received whatever information they had about RMC from nursing staff.
The researchers warn that the knowledge gap could leave women vulnerable to mistreatment—an issue documented across India, where studies show disrespect and abuse during childbirth ranging from 15% to 98%. They call for stronger awareness programmes, better patient-provider communication, and continuous quality improvement efforts in both urban and rural facilities.
The study’s recommendations include providing educational sessions during prenatal visits to inform mothers about their rights regarding RMC, implementing continuous quality improvement initiatives to evaluate and enhance maternal care services, and establishing a feedback mechanism for mothers to share their experiences and suggest improvements.
The study highlighted the need for respectful practices in healthcare settings to uphold women’s rights, dignity, and autonomy throughout the maternity care continuum.
“By prioritizing ongoing training for healthcare providers, fostering community engagement, implementing quality improvement initiatives, advocating for policy changes, and conducting further research, we can create a healthcare environment that values respect, compassion, and cultural sensitivity” the authors note. “Embracing RMC not only enhances childbirth experiences for women but also contributes to positive maternal and neonatal outcomes, fostering healthier communities overall”.
