Several questions were asked to women post delivery to determine if the services provided in the rural health centers were satisfactory and met expectations.
"The aspect of care, respect for the woman's privacy, and good behaviour by the medical staff -- these are important indicators in enthusing women to want to go for institutional deliveries," says Sanghita Bhattacharyya, a senior public health specialist with the Public Health Foundation of India.
"While women want a healthy child, what is equally important to them is that they want to be treated nicely during the delivery," Bhattacharyya told IANS.
The government's Janani Suraksha Yojana, under which women going for free institutional deliveries are given Rs.1,400 as incentive, has helped increase the number of such deliveries from 53 percent in 2005 to 73 percent in 2009.
But women are still made to spend money for deliveries, said Bhattacharyya who along with others has conducted a study on women's satisfaction with maternal health services in Jharkhand.
"Women are made to cough up informal payments, for transport, medicines, which amounts to 40 percent more than the Rs.1,400 they get," she said.
According to Bilal Avan of the London School of Hygiene and Tropical Medicine (LSHTM), the experience of satisfaction is an important criteria in helping women choose between home and institutional delivery.
"While there is relatively less safety in home delivery, but the comfort level is high for them. They decide to go for home delivery though they know it will be safer at a public health centre. Therefore quality of service is an area where we must concentrate to improve maternal health,' Avan told IANS on the sidelines of an event here
With regard to cleanliness and hygiene, women were okay with the levels during home deliveries and did not have much expectations from institutions either, he said.
According to P. Padmanabhan, advisor, National Health Systems Resource Centre, service providers have to be sensitized on issues of quality.
He mentioned a health centre that he visited recently where the "instruments in the labour room were rusted and the newly-born baby was kept on the floor. But the labour room was air conditioned".
"If we have quality guidelines in place, it will lead to an attitudinal change in service providers," said Padmanabhan, adding that "there is reluctance on the part of the service provider to change coupled with low expectations on the part of beneficiaries".
The Maternal Death Review could be an important tool to improve health care, suggested Padmanabhan.
Under it, the health officials and district magistrate sit face to face with the family of a woman who died in labour and get feedback on the gaps in service, the delays that led to death.
"It should be non-punitive in nature, so that the service providers realize where they are falling short," he said.
Abusive behaviour by staff at health centres is one of the factors that makes women opt for home deliveries, said Avan. "Here the socio-economic status and literacy level of the women plays a role in them opting for home delivery for fear of abuse."
Among the findings of a study conducted by PHFI, the LSHTM and Britain's University of Abderdeen, is that more than a third of women delivered at home because they could not reach the facility on time, 40 percent of women spent more than the Rs.1,400 incentive given to them for delivery at an institution, one out of seven women preferred home delivery for fear of abuse at the health facility and nearly two-fifths of women said they preferred home delivery due to better comfort and privacy.
The survey was conducted in Jharkhand among 500 women who had delivered. The study is expected to help the government in its efforts to improve maternal health care.