 Thank you so much. And now that we know that, I'm going to be introducing our speaker today. We are very, very pleased and privileged to have Professor Manju Chagani, who is the Dean of the School of Nursing Sciences and Adult Health in Jamiahamdar. And she is a leader, a trainer, a researcher and an influential academician with more than 28 years of extensive hands-on experience in the area of maternal and child health and university teaching. Prof Manju initiated the Society of Midwives in India in 2000, as well as the Delhi chapter in 2019. And our following that, she launched the Society of Midwives in Rajasthan and Jammu and Kashmir. She is a great inspiration to all the staff members and is presently working as the Dean of School of Nursing Sciences, inspiring midwifery education and practices, as well as her research blending her knowledge and expertise in the field of midwifery. And she is going to be speaking to us today and sharing the results of a study where she assessed the practices adopted regarding respectful maternity care by health professionals in labour rooms of selected hospitals in New Delhi, India. So thank you very much, Manju, for joining us today. And thank you to everybody who is has joined us today as well. And I'm going to be handing over to you so that you're able to start the presentation. That it is the experience of the woman which matters, whether positive or negative. And despite a lot of improvements in access to quality services is not guaranteed for many, especially in developing countries like India. Even when services are available, care may be compromised by social, ethnic and cultural barriers and unwelcoming reception at the health care facility and lack of privacy and information for the client and disrespect and abuse. So keeping these in mind, we worked on the various categories of disrespect. And it is the failure to meet professional standards of care due to lack of informed consent, lack of confidentiality, unduly rough or painful examinations without giving any explanation to them, refusal to provide pain relief, performance of unconsented procedures and then neglect, abandonment or long delays because of maybe long queues or shortage of staff, whatever may be the reason, but this is the one of the factor. And then absent skilled attendant at delivery. And then going into what is the respectful maternity care, if we look at the just a definition, it is a universal human right due to every woman in every health system. Could it be the maternal, it could be maternal health, family planning or abortion services. And in short, if I have to explain in very simple words, it is the respect for women's right choices and dignity. It is care that is kind, competent and improves outcomes. It care, it is the care that does no harm. It is care that is culturally sensitive and valued by the woman and her community. So we took this charter. This is a respectful maternity care charter developed by by tribunal lines where we have categories of disrespect, seven categories and the corresponding rights which women should have. First one is the physical abuse and we expect freedom from harm and ill treatment. The second category is non-consented care, where we expect right to information informed consent and refusal and respect for choices and preferences, including the right to companionship of voice choice wherever possible. Then non-confidential care, so we expect confidentiality and privacy. Fourth category is non-dignified care, including verbal abuse and dignity and respect as expected. Then discrimination based on specific attributes, where we expect equality, freedom from discrimination, equitable care. Then abandonment or denial of care, where we expect right to timely health care and to the highest available level of health. Then detention in facilities where we expect liberty, autonomy, self-determination and freedom from co-action. And in going through all these categories, this was the charter which was developed and it was translated into three languages also, this charter. And White Ribbon Alliance, India works for safe motherhood and it is an alliance of maternal health advocates committed to reducing maternal mortality and morbidity in India. The White Ribbon Alliance functions as an informal coalition not registered open to all stakeholders, interested groups and individuals. There are more than 1,800 members and five state alliances. It is affiliated to the White Ribbon Alliance International and the headquarter is in Washington DC as you all must be aware of. In 2011, White Ribbon Alliance launched a global campaign to promote clear standards of respectful maternity care that is rooted in international human rights. Working along with other organizations produced the RMC charter, the Universal Rights of Childly Bearing Women. It affirms maternal health rights as basic human rights, rights grounded in international declarations and dozed by WHO, the International Federation of Gynecology and Obstaterics and International Confederation of Midwives. About 85 Indian organizations have endorsed the charter so far. It is available in Hindi, English, Uriya and Assamese. And the study, this study was done because when we were working on this charter, we realized that there is not a, I would not say single study, but I would say that there is a very, very little work done in the field of respectful maternity care. And it is very, very important that human beings are treated in a human manner and they provide the care with a respectful manner, empathetic manner, and all nursing officers and doctors should be, should be following this so that the woman's experience of child bearing becomes a memorable one rather than a traumatic one. And they should provide the care with respect as the providers are looked upon as the deliverers of quality care coupled with emotions and sentiments. Hence the researcher felt the need to assess the practices adopted by the health professionals with regard to respectful maternity care in the labor room of three hospitals in New Delhi. And the objectives of the study were to assess the practices adopted by the health professionals in regard to respectful maternity care working in labor room. And then later to seek the relationship between the number of health professionals and respectful maternity care. Because most of the people used to say that because the number of cases are too many so they are not able to follow the protocol or the standards of the respectful maternity care. So we wanted to check this relationship as well. And the research methodology was the approach adopted was quantitative research approach and the design was descriptive survey research design. Setting was labor room of three selected hospitals of New Delhi and population was health professionals working in the labor room of selected hospitals of New Delhi. Sample size was 63 health professionals which included registered obstetricians and gynecologist and nurse midwives working in labor room of selected three hospitals. And the purposive sampling technique was adopted to select the health professionals in the labor room. And the ethical permission was sought from the institutional review board of Jamia Hamdar. And the data collection tools were observation checklist which consisted of two parts. First one was demographic profile of health professionals and the second one was clinical profile of the mothers. And there was the second part was observation checklist based on respectful maternity care charter. And the seven categories which which I showed you it was based on that charter the checklist and the content validity of tool was sought from the seven experts in the field of obstetrical and gynecological nursing to check the content relevance visibility organization clarity and suggestions from them were incorporated into this and the reliability was worked out by adopting the interator sorry the reliability in the current research it was 0.96. The pilot study was conducted by observing five health professionals in the labor room and the the blueprint of RMC charter was like this there were items in each category physical harm and ill treatment there were 11 items right to information again 11 items confidentiality privacy seven dignity and respect nine items provision of equitable care free of discrimination five left without care five items detained or confined against will four items total there were 52 items and this was used to collect the data and the hospitals this slide presents the findings related to background data of the hospitals because these three hospitals which were selected and there we saw the number of labor tables total number of deliveries observed number of health professionals and the number of days these cases were observed so in the hospital a the number of labor tables were four and the number of deliveries observed were 40 health professionals working there in the category of gynecologist and the nurse midwives were 21 number of days observed in all three hospitals were eight days hospital b had again four tables and the number of deliveries were maximum in this observed 56 and the health professionals 24 in third hospital there were only two tables and 33 deliveries were observed and 18 health professionals were were involved in the study and then the section two is findings related to practices adopted by the health professionals with regard to respectful maternity care this section is divided into two parts first part is findings related to the respectful maternity care performance standards of health professionals during labor and delivery in three hospitals and the part two is findings related to respectful maternity care in three hospitals and if we look at the modified mean and modified mean and rank order of respectful maternity care performance standards of health professionals in three hospitals we could see very clearly that we have done the ranking also so the most commonest one is the left without care that is ranking number one number two is right to information and consent and preferred choices and the last one is provision of equitable care free of discrimination so and you can see the mean and modified mean then this is just the bar diagram showing the same findings of that table into the bar diagram which also shows that the maximum was in the area that they are left without care then the next one is respectful maternity care performance standards of health professionals working in three hospitals by the number of times the behavior was observed the similar behavior like for example physical harm or ill treatment in hospital A was seen or observed 424 times and in hospital B 247 times and total if we take it as 805 times that physical harm or ill treatment was observed and similarly the right to information or informed consent and preferred choices in hospital C it was observed for 151 times and you can you can notice that the detained or confined against will was observed 53 times in hospital A 58 times in hospital B and 34 times in hospital C so that is a highest one was the category one that is physical harm or ill treatment and the least was in provision of equitable care free of discrimination that is 22 times total and then these are the findings where we worked out to see the relationship and in this we saw that the possible range of obtained scores in all it was 0 to 52 and the range of scores obtained was 20 to 32 with the mean 29.62 highest mean in hospital A and the standard deviation lowest standard deviation was in hospital C and the next findings are the relationship between the two or whether the number of the respectful maternity care and the number of health care professionals have any relationship or not in this the scores were worked out in hospital A, B and C and from the scores you can see that the official exact test was applied in this and this indicates that there was a significant relationship score of respectful maternity care with the number of health professionals there was a relationship because when there are less number of health professionals and more number of cases to attend the standards or the protocols which were followed were not that good so we compared it with many other studies also and the study findings are largely consistent with those from recent international studies of patient mistreatment in maternity services both in terms of the extent of abuse they describe and the triggers for abuse they identify and another study was conducted in East and South Africa by Heather A. Rosen, Pamela Lainem and Catherine the findings of a 2164 labor and delivery observations revealed that women overall were treated with dignity and in a supportive manner by providers but many women experienced poor interactions with providers and were not well informed about their care the findings of the study is in line with the present study where there was a significant physical and verbal abuse was observed and the implication of the study was in the field of nursing practice education administration and research and if we take in nursing practice it is of paramount importance that human beings should be treated in human manner including doctors and nurses so that the women's experience of childbearing becomes a memorable one rather than a traumatic one they should be given care with respect as providers are looked upon as a delivers of quality care coupled with emotions and sentiments and in nursing education it should be included as a chapter from the beginning itself because this is a behaviour which they have to pick up from the beginning itself if after coming out of the course we expect them to suddenly give respectful maternity care and we have not sensitized them on this aspect during their coursework then it cannot happen over the day so we need to start it from the beginning itself to the nursing students and so that they take it as a part of their their development and behaviour and attitudes from the beginning itself and health personnel should make the woman aware regarding her rights during childbearing period because once they are aware of their rights then they can also demand if they are not aware of it it is not possible many times that they are not asking for what is required then student nurses should be trained to deal with the patient politely and pathetically without discrimination and not just providing them with mechanical care and the respectful maternity care charter can be included in the syllabus as a charter which they all must be aware of then in nursing administration we should make it as a part of in-service education program because the nurses who have already passed out and it is not taught in their syllabus during their course during their pre-service period so we can start with the in-service education and start sensitizing people on this aspect and strategies and newer approaches can be incorporated for the inclusion of respectful maternity care in continuing nursing education programs and there is requirement or the need of a lot of research to be undertaken in this field because still the documentation in this field is very little available in India and further studies can be done to assess the respectful maternity care in many hospitals over the period of longer duration to generalize the findings and sensitize the health professionals regarding RMC and if I say the limitation of the study because the time period was limited and because of that only the morning shift during morning shift the observations were made and the data collected was based on observation made by the investigator as the study might have had an effect if the observations were noted down in front of the health professionals so it was done without informing except the HOD was informed and permission was sought and based on this the recommendations are that further research to explore the effectiveness of respectful maternity care thereby improving the institutional deliveries and the quality of care and all hospitals should adopt respectful maternity care practices and more knowledge to be provided to the health professionals about women's right during childbearing as for the cognitive development of the fetus and pregnancy outcome is important for mother as well as family the respectful maternity care charter can be displayed in the labor rooms of all hospitals so as the health professionals and women be aware of their rights during the childbirth and many hospitals in India have already adopted this that they have displayed this charter in different languages wherever they are displaying like I said it has already translated in four languages and it has also included respectful maternity care is also included in our ministry guidelines which is called Lakshya through this the training is given to all health care providers including doctors nurses and other health workers to sensitize them on this and a lot of progress have been made after this study actually and to conclude I would say that the study identified a suffering of women physically as well as emotional breakthrough during labor there were many women who said that like 100% women when I asked them they said that they were not greeted at all then they were not encouraged to ask questions they wanted to ask many questions they had those queries but they were not they were not allowed I would not say but they were not able to ask the questions and privacy was also a issue which was which was mentioned by them specifically and insufficient communication and information sharing by providers as well as delay in care and abandonment of laboring women were the deficiencies in respectful maternity care and failure to adopt a patient-centered approach and lack of health system resources are contributing structural factors and that's all this was the references I used and thank you so much remember that disrespect and abuse during maternity care are violations of a woman's basic human rights so this is all about my presentation and look forward to have questions when you are thank you thank you so much Manju for your wonderful presentation you brought up so many important points about respectful care in maternity and it was really wonderful to see the studies and research that you have done I see there are some comments from from the delegates and and one of the questions is is there a plan to translate into other languages and the charter or the findings um she didn't mention it so Deepa maybe if you just the charter yeah charter charter is they are free to translate into different languages actually we have chapters of white ribbon alliance in states like Assam Orissa so they are taking initiative and translating it into these languages so whosoever wants to use this English charter they can translate it into their own languages and it would be very good that if this charter in their local language is put up outside the hospital health facility so that people are aware of it and they can demand it wonderful that's so good to hear and then we had another question asking if the hospital administration would be a wanting to make any changes to the practice in their hospitals as a result of the study I would say that not exactly due to the as a result of study but yes because this study was used for advocacy with ministry also and there the changes have taken place so I'm happy that the study was not very big but has made change in through advocacy at ministry and the guidelines in the ministry guidelines Lakshya which I mentioned it has been included as one of the chapter in that and in the training of all healthcare professionals in labor rooms and in maternity area people are taught this whole concept of respectful maternity care the privacy information not detaining them against their wishes and all that is being done now in India and I'm so happy and glad to inform you that white ribbon alliance was doing this advocacy continuously with the ministry and our health ministry that is maternal health division has realized it and everyone is now working on this that's absolutely wonderful to hear and thank you so much for your detailed answer are there any other questions that anybody would like to pose to Dr Manju we have another five minutes before we will be closing this room and moving on to the next presentation and Deepa is asking if there's public access to the to the Lakshya guidelines and if you could maybe share that with us yeah it is there on the website of the ministry of health and family welfare if you go into the publication section and if there is any difficulty Deepa my email address you can write to me I can forward it to you it is Manju Chugani at theredgmail.com and what we'll try and do is make that available remember that these presentations are being recorded and there will be notes so we will try and make that available to everybody so that they're able to find those details yeah so I'm just going to be switching off record for the moment and