Born into Neglect

Why India's Public Maternity Wards Need More Than Policies to Deliver Change

Every woman deserves safety, dignity, and respect while giving life.

Yet India accounts for nearly 15% of global maternal deaths, according to WHO and UNICEF estimates, despite decades of schemes, policies, and investments.

This contradiction isn't rooted in lack of intent.

It's rooted in how systems behave on the ground.

During my academic research at a government district hospital in Gurugram in 2022, I witnessed a reality that statistics alone fail to capture. Mothers weren't just delivering babies, they were navigating fear, confusion, loss of privacy, and systemic neglect. What stood out wasn't a single broken component, but a chain of small failures that compounded into suffering.

This blog isn't about blaming institutions or governments. It's about recognizing that policy design alone doesn't drive change. Meaningful impact emerges when policies translate into action on the ground, supported by design-led and behavioral interventions.

The Illusion of Access

India has made undeniable progress in maternal healthcare on paper. National initiatives such as Janani Suraksha Yojana, Janani Shishu Suraksha Karyakaram, and Pradhan Mantri Surakshit Matritva Abhiyan have expanded institutional deliveries and reduced maternal mortality over the years.

Yet when access improves without fixing experience, quantity replaces quality.

In the maternity ward I studied, women arrived because they had no alternative. Compulsion-not trust-drove utilization. Once inside, they faced overcrowded spaces, unclear processes, and a complete absence of privacy-centered design.

Healthcare was available.

Care, often, was not.

What the Ground Reality Revealed

Through site visits, journey mapping, interviews with patients, visitors, and hospital staff, and behavioral diagnosis, three distinct yet interconnected realities emerged.

Patients: Present but Powerless

Pregnant women reported feeling unsafe, exposed, and unheard. Privacy, which they believed was their basic right, was routinely violated. External doors opened directly into delivery spaces. Unknown visitors hovered around beds. Cleanliness cues were absent, leading women to follow poor behavioral signals rather than hygienic practices.

Over time, this created disconnection. Patients felt like outsiders in a system meant to serve them.

Visitors: Anxious, Restless, and Misdirected

Visitors weren't disruptive by intent. They were anxious due to lack of information. With no clear waiting spaces, no updates on patient status, and no visible behavioral cues, they defaulted to the one place that felt reassuring: the maternity ward itself.

This led to overcrowding, chaos, and increased stress for patients and staff alike.

Hospital Staff: Overburdened and Depleted

Doctors and nurses operated under extreme cognitive and physical load. Roles were undefined, responsibilities overlapped, and motivation was low. Scarcity of time and clarity created tunnel vision where only the most visible tasks were addressed.

What appeared as rude behavior was often burnout in disguise.

The Real Problem Isn't Infrastructure Alone

A common assumption is that public healthcare fails due to lack of beds, funds, or buildings. While infrastructure gaps are real, my research showed that **many failures are behavioral and spatial, **not purely financial.

Confusing signage created disorientation.

Poorly designed waiting areas encouraged crowding.

Lack of visible rules enabled norm-breaking.

Absence of feedback loops silenced patient voices.

In short, spaces weren't designed to guide behavior, and systems weren't designed to support human limitations.

Designing for Dignity: Where Change Becomes Possible

True reform doesn't always require large budgets. It requires intentional design that aligns space, behavior, and systems.

Some of the most impactful interventions identified were deceptively simple:

• Privacy-first spatial design:** **secondary curtains, screened entry alleys, and restricted access points in delivery wards.
• Clear behavioral cues:** **implified signage, rule boards, and norm-nudging visuals.
• Information transparency:** **public address systems and visual patient-status panels to reduce visitor anxiety.
• Decentralized staff workstations:** **enabling clearer responsibility and easier patient access.
• Feedback and motivation loops:** **mandatory patient satisfaction surveys and staff recognition.
• Low-cost technology nudges:** **ring-bell systems connecting patients directly to staff.

Each intervention was evaluated not just for impact, but for feasibility, cost, and ease of implementation in a government hospital setting.

Why Implementation Is the Missing Link

Policies often fail not because they're wrong, but because implementation ignores human behavior.

When people are anxious, they crowd.

When rules are invisible, they're broken.

When systems are unclear, responsibility diffuses.

Design has the power to translate policy into lived experience. Behavioral insights help systems work with people, not against them.

This is where real change happens, not in launching new schemes, but in re-engineering everyday interactions inside public institutions.

Looking at the Larger Picture

Improving maternal healthcare isn't only about saving lives, it's about restoring trust in public systems.

When a woman feels safe during childbirth, she becomes an advocate for institutional care.

When visitors feel informed, chaos reduces naturally.

When staff feel supported, compassion resurfaces.

Change begins at the ground level, and it scales when design, behavior, and policy move together.

Closing Thought

This work reaffirmed one core belief for me:

Systems don't fail people.

Systems behave exactly as they're designed to.

If we want different outcomes, we must design differently.