Role of practical medical training in the provision of respectful intrapartum care: insights from two large public teaching hospitals in Southern India.

backgroundFor over a decade, the maternal health discourse has focused on a phenomenon that is alternatively termed "obstetric violence," "disrespect and abuse" (D&A) or the "mistreatment of women" in institutional obstetric care. The search for what drives D&A includes questions around the role of medical education in shaping not just what doctors know, but how they learn to treat women as well. However, medical education as an additional pathway to D&A is under-studied. We explore how one aspect of medical education- practical medical training during internships and residencies- operate in labour rooms in public teaching hospitals. METHODOLOGY: We conducted 37 semi-structured in-depth interviews with a cross-section of obstetric care providers representing all cadres of two large public teaching hospitals in a south Indian city. We coded the interview transcripts thematically, examined themes related to teaching and learning, and considered their implications for Respectful Maternity Care (RMC).

resultsWe identified four pathways through which practical medical training had implications for RMC: (a) professional hierarchies and social hierarchies; (b) institutional and educational prioritization of clinical outcomes over respectful care; (c) limited presence and supervision by senior providers in labour rooms; and (d) teaching responsibilities primarily falling on inexperienced and overworked peers. The results suggest that ad-hoc teaching adaptations prompted students to rely on informal learning, which fostered an obstetric practice which runs counter to the principles of RMC.

conclusionReforms in practical medical training, particularly with regard to intrapartum care in resource-constrained public hospital settings, can help in the realization of RMC.