Mistreatment of newborns following childbirth in Nepal

Photo credit: Diana Markosian / Save the Children. Please note: this image is not related to this study.

Quality of care is essential for ensuring a positive health facility experience and strengthening trust in the health system. 

The increasing attention given to a woman’s experience of care during childbirth as a marker of the quality of health care has been emphasized by the WHO Standards and Guidelines and as laid out in the Respectful Maternity Care charter. But for a woman’s experience, the quality of care her baby receives matters just as much as her own care. The expansion of the respectful maternity care agenda to incorporate newborn care has been notable, but until recently, few studies have measured the prevalence of disrespect and mistreatment among newborns.

To address this gap in knowledge, a large-scale observational study was undertaken in four public health facilities of Nepal of >31,000 healthy and spontaneously breathing newborns using a set of indicators to measure mistreatment for newborns. The study, recently published in PLoS One, unfortunately found a high level of mistreatment among these newborns. For example, more than two-thirds of the observed newborns were not breastfed within one hour of birth, and only 3.5% of newborns were kept in skin-to-skin contact with the mother after birth in the delivery room. One out of five newborns received unnecessary suctioning and were handled in a rough manner. Two-thirds of the newborns were provided a medical intervention without consent from the parents. Almost half of the infants were born in a room with temperature not adequately maintained. These findings paint a picture of how women and newborns experience care after childbirth.

In addition to observing high levels of mistreatment among newborns, the results varied by women’s age, ethnicity, and sex of newborns. Newborns born to women who were young and adolescent are more likely to receive less respectful care than other age group women. Newborn born to women from disadvantaged ethnic groups (“lower castes”) were more likely to receive less respectful care. Female newborns received less respectful care than male newborns. Each of these findings indicate the need to focus on marginalized and vulnerable populations.

The results from this study highlight some important messages.

  1. There is a high prevalence of disrespectful care to newborns following childbirth in health facilities in Nepal, which affects vulnerable and marginalized groups most. Action is needed now at different levels of the health system to improve respectful care during and after childbirth, including health worker shortages, health worker knowledge and skills, as well as addressing social norms.
  2. Developing a set of standard indicators to assess mistreatment for newborns and measure respectful newborn care will be crucial moving forward. Since this study was conducted, additional studies have also been published. Our study selected indicators to assess mistreatment of newborns based on the WHO’s 2016 “Standards for improving quality of maternal and newborn care in health facilities” quality of care statement and process of care. Having comparable indicators, and perhaps even a priority set of indicators, will be necessary for future studies.
  3. More research is needed to understand the underlying causes of mistreatment of newborns during and after childbirth. Implementation studies will be required to identify effective interventions to reduce mistreatment of newborns at birth in different contexts.
  4. Respectful maternity care requires an integrated agenda that considers both maternal and newborn health. Future studies that explore respectful maternity care for a woman or a newborn should include both the mother-baby dyad and measure outcomes for both, including care of a woman after a perinatal death, and the needs of the entire family and community.

Access the main findings from the study from Plos One.

Additional references

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