Maternal and neonatal health remains a critical public health challenge in developing nations like India, where maternal and neonatal mortality rates, though improved, continue to exceed global averages. With a maternal mortality ratio (MMR) of 113 per 100,000 live births (2016-18)1 and a neonatal mortality rate of 23 per 1,000 live births (2018)2. Common causes of maternal deaths include hemorrhage, hypertensive disorders, sepsis, and complications related to unsafe abortions, while neonatal deaths are often due to prematurity, infections, and birth asphyxia, there is an urgent need to enhance the quality of maternal care.3,4 Recognizing this, the Ministry of Health and Family Welfare launched the LaQshya Programme in 2017, aiming to improve the quality of care in labour rooms and maternity operation theatres across public health facilities.5,6 A key component of LaQshya is Respectful Maternal Care (RMC), which prioritizes dignified, compassionate, and patient-centered care during childbirth.7 RMC focuses on maintaining confidentiality, obtaining informed consent, involving birth companions, and providing emotional support while ensuring non-discriminatory care.8 The World Health Organization (WHO) recognizes Respectful Maternal Care (RMC) as vital to quality maternal care, improving childbirth experiences and outcomes for mothers and newborns.9 Studies show RMC increases satisfaction, reduces stress, and enhances health outcomes,10 while its absence can lead to negative experiences, discouraging women from seeking institutional deliveries.11 Research shows that such practices significantly enhance maternal satisfaction, reduce stress, and promote institutional deliveries. Conversely, the absence of respectful care can result in negative experiences that deter women from seeking maternal health services in the future.12,13,14

The LaQshya Programme integrates RMC principles to provide respectful, dignified care during childbirth. It includes training healthcare providers, improving labour room infrastructure, and ensuring continuous care quality monitoring.15 By involving families and communities, the program enhances support systems, aiming to improve maternal satisfaction and health outcomes in India. This study evaluated patient satisfaction with RMC under the LaQshya Programme at HIMS, VARANASI. It highlights the program's role in fostering dignity, improving care quality, reducing mortality, and promoting positive childbirth experiences. This cross-sectional observational study evaluated maternal satisfaction after implementing Respectful Maternal Care (RMC) under the LaQshya Programme at Heritage Institute of medical sciences, Varanasi. Conducted in the Department of Obstetrics and Gynecology at this tertiary care hospital, which serves a diverse patient population, the study spanned 18 months (October 15, 2023, To April 15, 2025), allowing sufficient time for a comprehensive assessment of maternal experiences and care quality. Inclusion Criteria: • Mothers who delivered in the Department of Obstetrics and Gynecology at HIMS, Varanasi. Exclusion Criteria: • Mentally ill patients. • Critically ill patients. • Patients who refused participation. Participant Recruitment Eligible participants were approached after delivery. The study’s purpose, procedures, benefits, and risks were explained, and informed consent was obtained. Questionnaires were provided in a language understood by the participants, ensuring accessibility and clarity. Sample Size Using the formula n=Z2⋅P⋅Q/d2, with P=0.50, Q=0.50, d=0.03, and Z=1.96 for 95% confidence, the sample size was calculated as 1067, ensuring statistical validity. Study Procedure A systematic and structured procedure was followed: 1. Eligibility Screening: Mothers delivering at HIMS, Varanasi were screened for inclusion and exclusion criteria. 2. Consent and Questionnaire: Eligible participants were briefed about the study, and written informed consent was obtained. A pre-structured questionnaire was provided, covering demographics, obstetric history, and satisfaction levels. 3. Data Collection: The questionnaire, available in local languages, was administered in a private and comfortable setting to ensure honest and accurate responses. Assistance was provided when needed to clarify questions. 4. Quantitative and Qualitative Measures: Satisfaction levels were assessed using Likert scales, while open-ended questions captured qualitative insights. 5. Data Storage: Completed questionnaires were securely stored for analysis to maintain confidentiality. Study Parameters Key parameters included: 1. Demographics: Age, education, socio-economic status, and residence (urban, semi-urban, rural). 2. Clinical Data: Parity, antenatal care, mode of delivery, and complications like PIH and anemia. 3. Satisfaction Levels: Assessment of the registration process, cleanliness, staff behaviour, privacy, and postnatal care, including breastfeeding support and neonatal vaccination. 4. Respect and Dignity: Perceptions of communication, informed consent, and the presence of a birth companion. Data Analysis Data analysis using IBM-SPSS version 23.0 included descriptive statistics to summarize participant characteristics, inferential tests like t-tests and Pearson correlation to identify satisfaction factors, thematic coding for qualitative responses, and multivariate analysis to control confounders and determine satisfaction predictors. Ethical Considerations Ethical approval was obtained from the Institutional Ethics Committee of HIMS, Varanasi. Participants provided informed consent, and their confidentiality was protected. Participation was voluntary, with the option to withdraw at any time. The study adhered to ethical standards to ensure participant well-being and data integrity.

Distribution of cases by age, locality, socioeconomic status, parity, booking status, and gestational age is shown in Table 1. It highlights the majority of cases being among 18–29 years (86.4%), rural residents (65.8%), and lower socioeconomic status (44.82%), with term deliveries (72.64%) predominating. Table 1: Demographic and Clinical Characteristics of Study Participants Parameter Frequency (N) Percentage (%) Age (Years) 18–29 1287 86.4 30–37 189 12.7 >38 12 0.8 Locality Urban 509 34.2 Rural 979 65.8 Socio-economic status Lower Class 667 44.82 Middle Class 581 39.04 Upper Class 240 16.12 Booking Status Booked 583 39.18 Unbooked 905 60.82 Parity Primigravida 679 45.63 2nd Gravida 357 23.99 Multigravida 452 30.38 Gestational Age Term (37–42 weeks) 1081 72.64 Preterm (<37 weeks) 381 26.60 Postdated (>42 weeks) 26 1.74 Table 2: Maternal and Fetal Outcomes: Mode of Delivery, Complications, and Neonatal Status Parameter Frequency (N) Percentage (%) Mode of Delivery Vaginal Delivery 872 58.60 C-Section 616 41.40 Maternal Complications Anaemia 525 35.28 Preterm 381 25.60 Oligohydramnios 108 7.25 Diabetes 63 4.23 PIH 121 8.13 Severe Pre-eclampsia 88 5.91 Others 92 6.18 None 110 7.39 Fetal Outcomes Mother Side 1409 94.70 Admitted in NICU 73 4.90 Died/IUD 6 0.40 Patient satisfaction scores across various hospital services, including registration, signage display, bed availability, daily meals, wheelchair access, and Aya Bai availability are shown in Table 3. "Score 4" (good satisfaction) was the most frequent across parameters like Time for Registration and Signage Display and Moderate satisfaction ("Score 3") dominated for Bed Availability, Wheelchair & Ward Boy Facility, and Availability of Aya Bai. The chart provides a clear visual representation of these distributions with percentage values for easy interpretation. Table 3: Patient Satisfaction Scores Across Various Hospital Services and Facilities Parameter Score Frequency (N) Percentage (%) Time for Registration 1 112 7.52 2 95 6.38 3 189 12.70 4 1083 72.78 5 9 0.60 Signage Display 1 104 6.98 2 193 12.97 3 93 6.25 4 1067 71.70 5 31 2.08 Bed Availability 1 121 8.13 2 197 13.23 3 404 27.15 4 669 44.95 5 97 6.51 Daily Meal Plan 1 91 6.11 2 97 6.51 3 74 4.97 4 362 24.32 5 51 3.42 Wheelchair & Ward Boy Facility 1 87 5.84 2 111 7.45 3 810 54.43 4 407 27.35 5 73 4.90 Availability of Aya Bai 1 123 8.26 2 93 6.25 3 786 52.82 4 444 29.83 5 42 2.82 Time taken for the initiation of treatment and breastfeeding after delivery is shown in Table 4. Most treatments were initiated much faster within 15 to 30 minutes (93.88%), with a significant portion of participants experiencing delays in breastfeeding initiation 37.14% started within 30 minutes–1 hour. Table 4: Time Distribution for Initiation of Treatment and Breastfeeding Among Participants Parameter Time Category Frequency (N) Percentage (%) Initiation of Treatment 15–30 minutes 1397 93.88 30 minutes–1 hour 89 5.99 >1hour 2 0.13 Initiation of Breastfeeding 30–30 minutes 319 21.4 30 minutes–1 hour 553 37.14 1–2 hours 127 8.53 >2 hours 489 32.86

Ensuring dignity, privacy, and respect for women during childbirth is central to the concept of respectful maternity care, aligning with global healthcare standards. The LaQshya Programme is committed to enhancing the quality of maternal and neonatal care in public health facilities. This study explores the implementation of these principles at HIMS, Varanasi and evaluates their impact on maternal satisfaction and the overall standard of care. In our study, the majority of participants were aged 22–25 years (30%) and 26–29 years (56.4%), consistent with findings by Yadav et al. (2022)17 in Odisha, where most participants were 25–29 years. These findings reflect the younger demographic of maternal care users in India, attributed to early marriages, particularly in rural areas. We observed a predominantly rural population (65.8%), similar to the findings of Yadav et al. (2022)17, where 65% of participants were from rural areas. This reflects the critical role of HIMS, Varanasi as a tertiary referral center catering to rural communities. Most participants in our study belonged to lower socioeconomic groups (44.82%) and (39.04%) from middle class. Similarly, Yadav et al. (2022)17 reported 63.8% of participants from middle-class and 11.8% from low-income groups in Odisha. The higher proportion of lower-income participants in our study highlights the reliance of economically weaker populations on public healthcare facilities. Nearly half of the participants in our study were primigravida (45.63%), with 23.99% second gravida and 30.38% multigravida. Sharma et al. (2022)18 reported challenges faced by first-time mothers in accessing compassionate care. Yadav et al. (2022)17 found that second-time mothers had better maternity experiences, while Bangal et al. (2020)3 noted higher satisfaction among multigravida participants (4.3 out of 5). Our study found most deliveries were at term (72.64%), with 26.60% preterm and 1.74% postdated. Kaur et al. (2022)19 observed better satisfaction in term deliveries compared to preterm and postdated deliveries, which required more neonatal care and had lower maternal comfort. The majority of deliveries in our study were vaginal (58.60%), with 41.40 % cesarean. Kumar and Dhillon (2020)20 noted increased complications and reduced postnatal care with early discharge after cesarean sections. Complications in our study included preterm delivery (25.60%), anemia (35.28%), and PIH (8.13%), severe preeclampsia (6.1%). Kaur et al. (2022)19 reported mistreatment rates of 8% in women with PIH and 7% with anemia. Yadav et al. (2022)17 found severe preeclampsia significantly associated with poor maternity care and mistreatment (6.5%). In our study, 72.78% of participants rated registration highly. Sharma et al. (2019)21 emphasized that streamlined registration enhances patient retention and satisfaction. For signage, 71.70% rated satisfaction highly, aligning with Rajbangshi et al. (2022)22, who highlighted signage improvements for accessibility. Clean beds and availability scored moderately (62.6%), similar to Tripathi et al. (2019)23. For daily meals, (24.32%) rated satisfaction high. Wheelchair and Aya Bai services had moderate satisfaction (73.3%), aligning with Saxena et al. (2018)24, who reported gaps in support staff availability impacting satisfaction. Treatment initiation was timely, with 93.88 % treated within 15 minutes to 30minutes. Kumar and Dhillon (2020)20 emphasized that early treatment reduces anxiety and dissatisfaction. However, breastfeeding initiation was delayed, with 57.8% starting after 2 hours. Abuse during labor was reported by only 2.61% of participants, significantly lower than Bhattacharya and Rabindranath (2018)25 in Varanasi (28.8%) and Sharma et al. (2019)21 in Uttar Pradesh. Privacy during labor was reported by 91%, contrasting with Sharma et al. (2022)18, where 60% of participants expressed dissatisfaction. The presence of a birth companion (94.09%) improved maternal experience, supported by Bharti et al. (2021)26, who noted reduced mistreatment and increased satisfaction. This study demonstrates the positive impact of LaQshya Programme interventions on maternal satisfaction and care quality. However, areas such as breastfeeding initiation and support services require further improvement to optimize outcomes. STRENGTHS This study comprehensively evaluates maternity care under the LaQshya Programme with a large, diverse sample, making findings representative of the target population. Systematic data collection and comparisons with previous studies enhance reliability and provide valuable insights into care quality. LIMITATIONS The cross-sectional design limits causal inferences, and self-reported data may introduce bias. The study's focus on a single tertiary care hospital may restrict generalizability, particularly to non-tertiary or private settings.

The LaQshya Programme has significantly improved respectful maternity care and maternal satisfaction. While services like registration and meal provision received high satisfaction, areas like breastfeeding initiation and support services need improvement. This study underscores the effectiveness of the program and highlights opportunities for further enhancement of maternal healthcare.

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