scholarly journals “The midwife helped me... Otherwise I could have died” Women’s experience of professional midwifery services in rural Afghanistan.  A qualitative study in the provinces Kunar and Laghman

2019 ◽  
Author(s):  
Trude Thommesen ◽  
Hallgeir Kismul ◽  
Ian Kaplan ◽  
Khadija Safi ◽  
Graziella Van den Berg
Keyword(s):  
Professional Education ◽  
Quality Care ◽  
Emergency Obstetric Care ◽  
Newborn Health ◽  
Skilled Birth Attendant ◽  
Obstetric Care ◽  
Maternal And Newborn Health ◽  
Skin Contact ◽  
Birth Attendance ◽  
Maternal And Newborn

Abstract Background Afghanistan has one of the world’s highest maternal mortality ratios, in some areas more than 60% of women have no access to a skilled birth attendant. The main challenges for Afghan childbearing women are access to skilled birth attendance, emergency obstetric care and reliable contraception. The NGO-based project Advancing Maternal and Newborn Health in Afghanistan has supported education of midwives since 2002, according to the national plan for midwifery education. The aim of this study is to explore women´s experiences with professional midwifery care in four villages in Afghanistan covered by the project, to uncover challenges and improve services in rural and conflict-affected areas of the country.MethodsAn explorative case study approach was adopted. Fourteen in-depth interviews and four focus group discussions were conducted. Totally, 39 women participated; 25 who had given birth during the last six months, 11 mothers-in-laws and three community midwives in the provinces of Kunar and Laghman. Data generated by the interviews and observations was analysed through a thematic content analysis.Findings The women reported that the trained midwives’ life-saving competence, skills and care were important reasons for giving birth in a clinic, and the midwives seemed to be appreciated by many of the women, making more women to choose to give birth in the clinic. Women further appreciated midwives’ promotion of immediate skin-to-skin contact and breastfeeding. However, some women experienced rudeness, discrimination and negligence from the midwives. Moreover, disapproval from relatives, shame and problems with transport and security were important obstacles to women giving birth in the clinics.Conclusions Local recruitment and professional education of midwives as promoted by Afghan authorities and applied in the project seem successful in promoting utilization and satisfaction with maternal and newborn health services in rural Afghanistan. Nevertheless, the quality of the services is still wanting, with some women complaining of disrespectful care. There seems to be a need to focus more on communication issues during the education of midwives. An increased focus on in-service training and factors promoting quality care and respectful communication is necessary and should be prioritized.

scholarly journals “The midwife helped me... Otherwise I could have died” Women’s experience of professional midwifery services in rural Afghanistan.  A qualitative study in the provinces Kunar and Laghman

2020 ◽  
Author(s):  
Trude Thommesen ◽  
Hallgeir Kismul ◽  
Ian Kaplan ◽  
Khadija Safi ◽  
Graziella Van den Berg
Keyword(s):  
Professional Education ◽  
Quality Care ◽  
Emergency Obstetric Care ◽  
Newborn Health ◽  
Skilled Birth Attendant ◽  
Obstetric Care ◽  
Maternal And Newborn Health ◽  
Skin Contact ◽  
Birth Attendance ◽  
Maternal And Newborn

Abstract Background Afghanistan has one of the world’s highest maternal mortality ratios, in some areas more than 60% of women have no access to a skilled birth attendant. The main challenges for Afghan childbearing women are access to skilled birth attendance, emergency obstetric care and reliable contraception. The NGO-based project Advancing Maternal and Newborn Health in Afghanistan has supported education of midwives since 2002, according to the national plan for midwifery education. The aim of this study is to explore women´s experiences with professional midwifery care in four villages in Afghanistan covered by the project, to uncover challenges and improve services in rural and conflict-affected areas of the country. Methods An explorative case study approach was adopted. Fourteen in-depth interviews and four focus group discussions were conducted. Totally, 39 women participated; 25 who had given birth during the last six months, 11 mothers-in-laws and three community midwives in the provinces of Kunar and Laghman. Data generated by the interviews and observations was analysed through a thematic content analysis. Findings The women reported that the trained midwives’ life-saving competence, skills and care were important reasons for giving birth in a clinic, and the midwives seemed to be appreciated by many of the women, making more women to choose to give birth in the clinic. Women further appreciated midwives’ promotion of immediate skin-to-skin contact and breastfeeding. However, some women experienced rudeness, discrimination and negligence from the midwives. Moreover, disapproval from relatives, shame and problems with transport and security were important obstacles to women giving birth in the clinics. Conclusions Local recruitment and professional education of midwives as promoted by Afghan authorities and applied in the project seem successful in promoting utilization and satisfaction with maternal and newborn health services in rural Afghanistan. Nevertheless, the quality of the services is still wanting, with some women complaining of disrespectful care. There seems to be a need to focus more on communication issues during the education of midwives. An increased focus on in-service training and factors promoting quality care and respectful communication is necessary and should be prioritized.

scholarly journals Status of Emergency Obstetric Care in Six Developing Countries Five Years before the MDG Targets for Maternal and Newborn Health

PLoS ONE ◽  
2012 ◽  
Vol 7 (12) ◽  
pp. e49938 ◽  
Author(s):  
Charles Ameh ◽  
Sia Msuya ◽  
Jan Hofman ◽  
Joanna Raven ◽  
Matthews Mathai ◽  
...  
Keyword(s):  
Developing Countries ◽  
Emergency Obstetric Care ◽  
Newborn Health ◽  
Obstetric Care ◽  
Maternal And Newborn Health ◽  
Maternal And Newborn

scholarly journals Using evidence to drive action: A “revolution in accountability” to implement quality care for better maternal and newborn health in Africa

2014 ◽  
Vol 127 (1) ◽  
pp. 96-101 ◽  
Author(s):  
Louise Hulton ◽  
Zoe Matthews ◽  
Adriane Martin-Hilber ◽  
Richard Adanu ◽  
Craig Ferla ◽  
...  
Keyword(s):  
Quality Care ◽  
Newborn Health ◽  
Maternal And Newborn Health ◽  
Maternal And Newborn

scholarly journals Can programmatic inputs improve adolescent mothers’ access to care in rural Bangladesh? Nine-years of evidence from a cohort study

2020 ◽  
Author(s):  
Aminur Rahman ◽  
Tahmina Begum ◽  
Anne Austin ◽  
Md. Hasan ◽  
Nurul Alam ◽  
...  
Keyword(s):  
Adolescent Mothers ◽  
Quality Care ◽  
Binary Logistic Regression ◽  
Newborn Health ◽  
Final Analysis ◽  
Adolescent Mother ◽  
Maternal And Newborn Health ◽  
P Value ◽  
Service Areas ◽  
Maternal And Newborn

Abstract Background Adolescent mothers (Girls aged 15-19) constitute 8% of annual global births, but account for 10% of annual maternal deaths. WHO recommended 4-8 Antenatal Care (ANC) visits, in addition to quality care and facility-based deliveries, are well-documented interventions to reduce maternal and child morbidity and mortality. Determinants of maternal and child health care in Bangladesh have received considerable attention, but less attention has been focused on adolescent mothers. This study explores the factors associated with 4 or more (4+) ANC visits and facility-based delivery among adolescent mothers in one rural area of Bangladesh, Methods This study uses Health and Demographic Surveillance System (HDSS) data. We conducted a comparative study on trends in 4+ ANC visits and facility-based deliveries among adolescent mothers (10-19 years) residing in an intervention area (icddr,b service area, ISA) against a comparison area (government service areas, GSA) of HDSS between 2007 and 2015. 4,996 adolescent mothers were included in the final analysis. Binary logistic regression was used to document the statistical difference on outcome indicators in the two study areas. Results Trends in 4+ANC visits and facility-based deliveries were higher in the ISA relative to the GSA. The adjusted odds of an adolescent mother accessing 4+ ANC visits in the GSA, relative to ISA was 0.57 (95% CI: 0.49 – 0.66, p-value <0.05); the adjusted odds of an adolescent mother accessing facility-based delivery in the ISA, relative to GSA was 6.63 (95% CI: 5.85 – 7.52, p-value <0.05). Increasing numbers of ANC visits were associated with increases in facility-based births in both the ISA and GSA. Conclusion This study documented that both 4+ ANC visits and facility delivery rates among adolescent mothers are much higher in the ISA than GSA. Increasing 4+ ANC visits and facility deliveries over the years, particularly in the ISA, coincide with programmatic efforts to improve the quality and availability of maternal and newborn health services. Learning from existing interventions in ISA and applying them to other areas will strengthen Bangladesh’s efforts to improve maternal and newborn health outcomes and achieve the sustainable development goal 3 (SDG 3).

scholarly journals The roles of community health workers who provide maternal and newborn health services: case studies from Africa and Asia

2019 ◽  
Vol 4 (4) ◽  
pp. e001388 ◽  
Author(s):  
Abimbola Olaniran ◽  
Barbara Madaj ◽  
Sarah Bar-Zev ◽  
Nynke van den Broek
Keyword(s):  
Community Health ◽  
Community Health Workers ◽  
Low Income ◽  
Health Workers ◽  
Newborn Health ◽  
Skilled Birth Attendance ◽  
Scope Of Practice ◽  
Maternal And Newborn Health ◽  
Birth Attendance ◽  
Maternal And Newborn

IntroductionA variety of community health workers (CHWs) provide maternal and newborn health (MNH) services in low-income and middle-income settings. However, there is a need for a better understanding of the diversity in type of CHW in each setting and responsibility, role, training duration and type of remuneration.MethodsWe identified CHWs providing MNH services in Bangladesh, India, Kenya, Malawi and Nigeria by reviewing 23 policy documents and conducting 36 focus group discussions and 131 key informant interviews. We analysed the data using thematic analysis.ResultsIrrespective of training duration (8 days to 3 years), all CHWs identify pregnant women, provide health education and screen for health conditions that require a referral to a higher level of care. Therapeutic care, antenatal care and skilled birth attendance, and provision of long-acting reversible contraceptives are within the exclusive remit of CHWs with training greater than 3 months. In contrast, community mobilisation and patient tracking are often done by CHWs with training shorter than 3 months. Challenges CHWs face include pressure to provide MNH services beyond their scope of practice during emergencies, and a tendency in some settings to focus CHWs on facility-based roles at the expense of their traditional community-based roles.ConclusionCHWs are well positioned geographically and socially to deliver some aspects of MNH care. However, there is a need to review and revise their scope of practice to reflect the varied duration of training and in-country legislation.

scholarly journals “If there are no female nurses to attend to me, I will just go and deliver at home”: a qualitative study in Garissa, Kenya

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Coralie N’Gbichi ◽  
Abdhalah Kasiira Ziraba ◽  
David Wainaina Wambui ◽  
Pauline Bakibinga ◽  
Isaac Kisiangani ◽  
...  
Keyword(s):  
Health Facility ◽  
Newborn Health ◽  
Skilled Birth Attendance ◽  
Facility Delivery ◽  
Maternal And Newborn Health ◽  
Health Facility Delivery ◽  
Community Members ◽  
Birth Attendance ◽  
Female Nurses ◽  
Maternal And Newborn

Abstract Background The North Eastern region in Kenya experiences challenges in the utilization of maternal and newborn health services. In this region, culture and religion play a major role in influencing healthcare seeking behaviour of the community. This study was conducted to (i) understand key inherent barriers to health facility delivery in the Somali community of North Eastern Kenya and (ii) inform interventions on specific needs of this community. Methods The study was conducted among community members of Garissa sub-County as part of a baseline assessment before the implementation of an intervention package aimed at creating demand and increasing utilization of maternal and newborn services. Focus group discussions and key informant interviews were conducted with clan leaders, Imams, health managers, member of the county assembly, and service users (women and men) in three locations of Garissa sub-County. Data were analysed through content analysis, by coding recurrent themes and pre-established themes. Results Using health facility for delivery was widely acceptable and most respondents acknowledged the advantages and benefits of skilled birth delivery. However, a commonly cited barrier in using health facility delivery was the issue of male nurses and doctors attending to women in labour. According to participants, it is against their culture and thus a key disincentive to using maternity services. Living far from the health facility and lack of a proper and reliable means of transportation was also highlighted as a reason for home delivery. At the health facility level, respondents complained about the poor attitude of health care providers, especially female nurses being disrespectful; and the limited availability of healthcare workers, equipment and supplies. Lack of awareness and information on the importance of skilled birth attendance was also noted. Conclusion To increase health facility delivery, interventions need to offer services that take into consideration the sociocultural aspect of the recipients. Culturally acceptable and sensitive services, and awareness on the benefits of skilled birth attendance among the community members are likely to attract more women to use maternity services and thus reduce adverse maternal and newborn health outcomes.

scholarly journals ‘Who assisted with the delivery of (NAME)?’ Issues in estimating skilled birth attendant coverage through population-based surveys and implications for improving global tracking

2019 ◽  
Vol 4 (2) ◽  
pp. e001367 ◽  
Author(s):  
Emma Radovich ◽  
Lenka Benova ◽  
Loveday Penn-Kekana ◽  
Kerry Wong ◽  
Oona Maeve Renee Campbell
Keyword(s):  
Low Income ◽  
Newborn Health ◽  
Skilled Birth Attendant ◽  
Population Based ◽  
Maternal And Newborn Health ◽  
Demographic And Health Surveys ◽  
High Coverage ◽  
Middle Income ◽  
Definition Of ◽  
Maternal And Newborn

The percentage of live births attended by a skilled birth attendant (SBA) is a key global indicator and proxy for monitoring progress in maternal and newborn health. Yet, the discrepancy between rising SBA coverage and non-commensurate declines in maternal and neonatal mortality in many low-income and middle-income countries has brought increasing attention to the challenge of what the indicator of SBA coverage actually measures, and whether the indicator can be improved. In response to the 2018 revised definition of SBA and the push for improved measurement of progress in maternal and newborn health, this paper examines the evidence on what women can tell us about who assisted them during childbirth and methodological issues in estimating SBA coverage via population-based surveys. We present analyses based on Demographic and Health Surveys and Multiple Indicator Cluster Surveys conducted since 2015 for 23 countries. Our findings show SBA coverage can be reasonably estimated from population-based surveys in settings of high coverage, though women have difficulty reporting specific cadres. We propose improvements in how skilled cadres are classified and documented, how linkages can be made to facility-based data to examine the enabling environment and further ways data can be disaggregated to understand the complexity of delivery care. We also reflect on the limitations of what SBA coverage reveals about the quality and circumstances of childbirth care. While improvements to the indicator are possible, we call for the use of multiple indicators to inform local efforts to improve the health of women and newborns.

Sign in / Sign up

Export Citation Format

Share Document