scholarly journals Compelling Choices: Tensions in the Practice and Experience of Prenatal Screening in New Zealand

2021 ◽  
Author(s):  
◽  
Sarah Ellen Donovan
Keyword(s):  
Health Policy ◽  
New Zealand ◽  
Pregnant Women ◽  
Prenatal Screening ◽  
Risk Groups ◽  
Population Based ◽  
Ethical Practice ◽  
Policy Makers ◽  
Pregnancy Care ◽  
Recent Developments

<p>Recently there has been a shift in health policy in New Zealand, as internationally, away from prenatal screening for fetal abnormalities targeting specific 'high risk' groups of pregnant women, towards the implementation of population-based screening programmes. As a result, for the majority of pregnant women in Western countries, prenatal screening is now undertaken as part of the standard 'package' of maternity care. This thesis explores the constitution of prenatal screening as a now taken-for-granted aspect of contemporary pregnancy care. It considers tensions between popular and medical understandings of the value and purpose of this practice, in particular examining the contradictory nature of discourses which, on one hand, construct acceptance of prenatal screening as an empowering 'choice' available to pregnant women, and on the other hand, as an institutionally-endorsed, morally appropriate practice of risk management. Recent developments within the New Zealand context are presented as a 'case study' of the representational politics of prenatal screening within contemporary public health policy.  The question of informed consent for prenatal screening is a key focus within the research. It examines the extent to which the scope of women's choices and the degree of consent possible are materially shaped and constrained within the context of current clinical practice, and the broader climate of contemporary pregnancy care. Empirically, the research investigates key themes in women's experience of prenatal screening decisions within this climate, and explores the private 'moral work' undertaken by pregnant women as they navigate the contradictory imperatives which circulate in mainstream screening discourse. The findings of the research suggest a need for clinicians and policy makers to recognise prenatal screening as an ethically complex 'special case', qualitatively distinct from other projects of population-based health screening. It is argued that ethical practice in prenatal screening requires an approach which acknowledges the discursive and material factors which problematise liberal conceptions of prenatal screening as an authentic, deliberative 'choice' available to pregnant women.</p>

scholarly journals Compelling Choices: Tensions in the Practice and Experience of Prenatal Screening in New Zealand

2021 ◽  
Author(s):  
◽  
Sarah Ellen Donovan
Keyword(s):  
Health Policy ◽  
New Zealand ◽  
Pregnant Women ◽  
Prenatal Screening ◽  
Risk Groups ◽  
Population Based ◽  
Ethical Practice ◽  
Policy Makers ◽  
Pregnancy Care ◽  
Recent Developments

<p>Recently there has been a shift in health policy in New Zealand, as internationally, away from prenatal screening for fetal abnormalities targeting specific 'high risk' groups of pregnant women, towards the implementation of population-based screening programmes. As a result, for the majority of pregnant women in Western countries, prenatal screening is now undertaken as part of the standard 'package' of maternity care. This thesis explores the constitution of prenatal screening as a now taken-for-granted aspect of contemporary pregnancy care. It considers tensions between popular and medical understandings of the value and purpose of this practice, in particular examining the contradictory nature of discourses which, on one hand, construct acceptance of prenatal screening as an empowering 'choice' available to pregnant women, and on the other hand, as an institutionally-endorsed, morally appropriate practice of risk management. Recent developments within the New Zealand context are presented as a 'case study' of the representational politics of prenatal screening within contemporary public health policy.  The question of informed consent for prenatal screening is a key focus within the research. It examines the extent to which the scope of women's choices and the degree of consent possible are materially shaped and constrained within the context of current clinical practice, and the broader climate of contemporary pregnancy care. Empirically, the research investigates key themes in women's experience of prenatal screening decisions within this climate, and explores the private 'moral work' undertaken by pregnant women as they navigate the contradictory imperatives which circulate in mainstream screening discourse. The findings of the research suggest a need for clinicians and policy makers to recognise prenatal screening as an ethically complex 'special case', qualitatively distinct from other projects of population-based health screening. It is argued that ethical practice in prenatal screening requires an approach which acknowledges the discursive and material factors which problematise liberal conceptions of prenatal screening as an authentic, deliberative 'choice' available to pregnant women.</p>

scholarly journals Public health funding mechanisms in New Zealand [Commentary by Rosalie Viney, pp. 115–117]

1999 ◽  
Vol 22 (4) ◽  
pp. 100 ◽  
Author(s):  
Gillian Durham ◽  
Bette Kill
Keyword(s):  
Public Health ◽  
Health Policy ◽  
New Zealand ◽  
Health Services ◽  
Population Based ◽  
International Literature ◽  
Public Health Services ◽  
Policy Makers ◽  
Health Funding ◽  
Funding Mechanisms

The funding of population-based public health services (health protection, health promotionand disease prevention) has received little attention in the international literature on healthreforms, and yet these services are of fundamental importance to the health of populationsand to the economy. This article provides justification for health policy-makers placing moreemphasis on the level of public health funding compared with funding on personal healthservices, and accountability arrangements for its expenditure, when considering options toimprove the performance of their health sectors. The New Zealand experience of fundingpublic health services is described within the context of the health reforms. The strengths andweaknesses of the adopted approach are analysed.

scholarly journals Comparison between Enzyme Immunoassays Performed on Samples of Dried Blood and Serum for Toxoplasmosis Prenatal Screening: Population-based Study

2021 ◽  
Vol 43 (05) ◽  
pp. 351-356
Author(s):  
Bárbara Araújo Marques ◽  
Ericka Vianna Machado Carellos ◽  
Vânia Maria Novato Silva ◽  
Fernando Henrique Pereira ◽  
Maria Regina Lage Guerra ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Prenatal Screening ◽  
Dried Blood Spots ◽  
Population Based ◽  
Minas Gerais ◽  
Immunoglobulin M ◽  
Screening Tests ◽  
Reference Test ◽  
Screening Programs ◽  
Blood Spots

Abstract Objective Most prenatal screening programs for toxoplasmosis use immunoassays in serum samples of pregnant women. Few studies assess the accuracy of screening tests in dried blood spots, which are of easy collection, storage, and transportation. The goals of the present study are to determine the performance and evaluate the agreement between an immunoassay of dried blood spots and a reference test in the serum of pregnant women from a population-based prenatal screening program for toxoplasmosis in Brazil. Methods A cross-sectional study was performed to compare the immunoassays Imunoscreen Toxoplasmose IgM and Imunoscreen Toxoplasmose IgG (Mbiolog Diagnósticos, Ltda., Contagem, Minas Gerais, Brazil)in dried blood spots with the enzyme-linked fluorescent assay (ELFA, BioMérieux S.A., Lyon, France) reference standard in the serum of pregnant women from Minas Gerais Congenital Toxoplasmosis Control Program. Results The dried blood spot test was able to discriminate positive and negative results of pregnant women when compared with the reference test, with an accuracy of 98.2% for immunoglobulin G (IgG), and of 95.8% for immunoglobulin M (IgM). Conclusion Dried blood samples are easy to collect, store, and transport, and they have a good performance, making this a promising method for prenatal toxoplasmosis screening programs in countries with continental dimensions, limited resources, and a high prevalence of toxoplasmosis, as is the case of Brazil.

“When I am with my husband, I do not feel mosquito bite”

2017 ◽  
Vol 30 (2) ◽  
pp. 148-159 ◽  
Author(s):  
Mary Anita Quist ◽  
Augustine Adomah-Afari
Keyword(s):  
Health Policy ◽  
Pregnant Women ◽  
Malaria Control ◽  
Health Professionals ◽  
Cultural Beliefs ◽  
Malaria Control Programme ◽  
Framework Analysis ◽  
Policy Makers ◽  
Content Type ◽  
Beliefs And Practices

Purpose The purpose of this paper is to explore how socio-cultural beliefs and practices could influence the knowledge, attitude and perception of insecticide-treated net (ITN) use in the control of malaria amongst pregnant women attending antenatal clinic. Design/methodology/approach Data were gathered using interviews and documentary review. Framework analysis was applied to classify emerging themes and the findings interpreted using the health belief model. Findings The findings showed that the pregnant women had appreciable knowledge, both the positive and negative attitudes and the perceptions of insecticide treated nets. To most of them, sleeping under an ITN would not affect pregnancy/cause abortion, but rather prevent mosquito bites and associated malaria. Research limitations/implications The limitations include the sample size of participants and health facilities used. Lack of application of a quantitative research method meant that the authors could not quantify the findings to ensure generalisation to the entire population. Practical implications The findings suggest that health policy makers, implementers and health professionals need to appreciate the perception and the attitude of pregnant women when designing policy guidelines for the malaria control programme. Social implications This paper helps to elucidate on how socio-cultural beliefs and practices could influence the knowledge, attitude and perception of ITN usage amongst both pregnant women and people in malaria endemic communities. Originality/value This paper suggests that health policy makers, implementers and health professionals have to devise strategies to address socio-cultural beliefs and practices in the scaling up of malaria control programmes.

scholarly journals Pregnant women’s and healthcare professionals’ preferences in decision-making process for prenatal screening: world experience

2019 ◽  
pp. 3-10
Author(s):  
Е.Е. Заяева ◽  
Е.Е. Баранова ◽  
Л.А. Жученко ◽  
Л.Ю. Иванова ◽  
В.Л. Ижевская
Keyword(s):  
Pregnant Women ◽  
Healthcare Professionals ◽  
Prenatal Screening ◽  
Chromosomal Abnormalities ◽  
Risk Groups ◽  
Routine Practice ◽  
Sociological Research ◽  
Local Health ◽  
Local Health Policy ◽  
Prenatal Test

Многие страны внедряют неинвазивное пренатальное тестирование (НИПТ) в систему общественного здравоохранения в качестве контингентного скрининга для беременных, что позволяет повысить эффективность выявления хромосомных аномалий (ХА) у плода и снизить количество необоснованных инвазивных процедур. Анализ литературных источников показал, что большинство врачей и беременных из групп высокого и промежуточного рисков готовы воспользоваться НИПТ в качестве дополнительного скрининга в связи с его безопасностью, высокой чувствительностью и возможностью раннего получения результатов. Однако обнаружены различия в выборе метода раннего пренатального скрининга ХА между странами, которые зависели от этнических, социо-демографических и религиозных характеристик опрошенных, а также от особенностей политики местного здравоохранения, связанных с необходимостью частичной или полной оплаты пренатального теста и доступностью прерывания беременности. Сделан вывод, что для каждой страны необходимы свои руководства, разработанные с учетом социального контекста, а вопрос о внедрении НИПТ в рутинную практику должен решаться по результатам социологических исследований в больших группах беременных и врачей страны. Many countries are introducing a non-invasive prenatal test, NIPT, into the public health system as a contingent screening for pregnant women, which improves the detection of chromosomal abnormalities of the fetus and reduces the number of unwarranted invasive procedures. Analysis of the literature showed that the majority of doctors and pregnant women from the high and intermediate risk groups are ready to use NIPT as an additional screening due to its safety, high sensitivity and the possibility of early reception of results. However, there were found differences between countries in choosing the method of prenatal screening for chromosomal abnormalities of the fetus, which depend on the ethnic, sociodemographic and religious characteristics of the respondents, as well as on the peculiarities of the local health policy related to the need for partial or full payment of the prenatal test and the availability of abortion. It was concluded that each country needs its own guidelines, developed with taking into account the social context, and the issue of introducing NIPT into routine practice should be decided by the results of sociological research among large groups of pregnant women and healthcare professionals in the country.

Using population-level incidence of hepatitis C virus and immigration status for data-driven screening policies: a case study in Israel

2020 ◽  
Author(s):  
Maya Leventer-Roberts ◽  
Noa Dagan ◽  
Jenna M Berent ◽  
Ilan Brufman ◽  
Moshe Hoshen ◽  
...  
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Population Level ◽  
Risk Groups ◽  
Study Groups ◽  
Population Based ◽  
Policy Makers ◽  
New Diagnosis ◽  
Incident Cases

Abstract Background Most studies estimate hepatitis C virus (HCV) disease prevalence from convenience samples. Consequently, screening policies may not include those at the highest risk for a new diagnosis. Methods Clalit Health Services members aged 25–74 as of 31 December 2009 were included in the study. Rates of testing and new diagnoses of HCV were calculated, and potential risk groups were examined. Results Of the 2 029 501 included members, those aged 45–54 and immigrants had lower rates of testing (12.5% and 15.6%, respectively), higher rates of testing positive (0.8% and 1.1%, respectively), as well as the highest rates of testing positive among tested (6.1% and 6.9%, respectively). Discussion In this population-level study, groups more likely to test positive for HCV also had lower rates of testing. Policy makers and clinicians worldwide should consider creating screening policies using on population-based data to maximize the ability to detect and treat incident cases.

Introducing critical Tiriti policy analysis through a retrospective review of the New Zealand Primary Health Care Strategy

Ethnicities ◽  
2020 ◽  
Vol 20 (3) ◽  
pp. 434-456 ◽  
Author(s):  
Heather Came ◽  
D O’Sullivan ◽  
T McCreanor
Keyword(s):  
Health Care ◽  
Health Policy ◽  
Primary Health Care ◽  
New Zealand ◽  
Policy Analysis ◽  
Policy Development ◽  
Policy Makers ◽  
Aotearoa New Zealand ◽  
Primary Health ◽  
Maori Health

Background Te Tiriti o Waitangi was negotiated between the British Crown and Indigenous Māori leaders of Aotearoa New Zealand in 1840. Māori understood the agreement as an affirmation of political authority and a guarantee of British protection of their lands and resources. The Crown understood it as a cession of sovereignty. The tension remains, though legal and political developments in the last 35 years, have established that the agreement places a mandatory obligation on the Crown to protect and promote Māori health. It also requires that Māori may exercise rangatiratanga, or responsibility and authority, in relation to health policy development and implementation. Methods Te Tiriti is, then, an instrument against which health policy is justly and efficaciously evaluated. This paper introduces critical Tiriti analysis as such an evaluative method. Critical Tiriti analysis involves reviewing policy documents against the Preamble and the Articles of te Tiriti o Waitangi. The review process has five defined phases: (i) orientation; (ii) close reading; (iii) determination; (iv) strengthening practice and (v) Māori final word. Results We present a working example of critical Tiriti analysis using the New Zealand Government’s Primary Health Care Strategy published in 2001. This policy analysis found poor alignment with te Tiriti overall and the indicators of its implementation that we propose. Conclusion This paper provides direction to policy makers wanting to improve Māori health outcomes and ensure Māori engagement, leadership and substantive authority in the policy process. It offers an approach to analysing policy that is simple to use and, inherently, a tool for advancing social justice.

scholarly journals Booking systems for elective services: The New Zealand experience

1999 ◽  
Vol 22 (4) ◽  
pp. 61 ◽  
Author(s):  
Benedict Hefford ◽  
Andrew Holmes
Keyword(s):  
New Zealand ◽  
Waiting Lists ◽  
Public Hospitals ◽  
Policy Makers ◽  
Major Improvement ◽  
Recent Developments ◽  
Basic Features

This article provides a brief overview of New Zealand's experience in implementing booking systems for elective services in public hospitals. It identifies the basic features of the booking systems policy and explores the rationale and objectives for these policy settings. Progress with implementation of booking systems is explored and some of the challenges and recent developments are also outlined. The authors argue that booking systems represent a major improvement on waiting lists for patients, providers, purchasers and policy-makers.

scholarly journals Surveillance of antimicrobial resistance in low- and middle-income countries: a scattered picture

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Katia Iskandar ◽  
Laurent Molinier ◽  
Souheil Hallit ◽  
Massimo Sartelli ◽  
Timothy Craig Hardcastle ◽  
...  
Keyword(s):  
Health Policy ◽  
Antimicrobial Resistance ◽  
Social Dilemma ◽  
Population Based ◽  
Quality Data ◽  
Middle Income ◽  
Policy Makers ◽  
Middle Income Countries ◽  
Laboratory Capacity ◽  
Low And Middle Income

AbstractData on comprehensive population-based surveillance of antimicrobial resistance is lacking. In low- and middle-income countries, the challenges are high due to weak laboratory capacity, poor health systems governance, lack of health information systems, and limited resources. Developing countries struggle with political and social dilemma, and bear a high health and economic burden of communicable diseases. Available data are fragmented and lack representativeness which limits their use to advice health policy makers and orientate the efficient allocation of funding and financial resources on programs to mitigate resistance. Low-quality data means soaring rates of antimicrobial resistance and the inability to track and map the spread of resistance, detect early outbreaks, and set national health policy to tackle resistance. Here, we review the barriers and limitations of conducting effective antimicrobial resistance surveillance, and we highlight multiple incremental approaches that may offer opportunities to strengthen population-based surveillance if tailored to the context of each country.

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