The Place of Traditional Birth Attendants in Global Maternal Health: Policy Retreat, Ambivalence and Return

In this chapter, I tell the story of the waxing and waning of the status of the traditional birth attendant (TBA) in global maternal health policy from the launch of the Safe Motherhood Initiative in 1987 to the present. Once promoted as part of the solution to reducing maternal mortality, the training and integration of TBAs into formal healthcare systems in the global south was deemed a failure and side-lined in the late 1990s in favour of ‘a skilled attendant at every birth’. This shift in policy has been one of the core debates in the history of the global maternal health movement and TBAs continue to be regarded with deep ambivalence by many health providers, researchers and policymakers at the national and global levels. In this chapter, I take a critical global heath perspective that scrutinises the knowledge, policy and practice of global health in order to make visible the broader social, cultural and political context of its making. In this chapter, I offer a series of critiques of global maternal health policy regarding TBAs: one, that the evidence cited to underpin the policy shift was weak and inconclusive; two, that the original TBA component itself was flawed; three, that the political and economic context of the first decade of the SMI was not taken into account to explain the failure of TBAs to reduce maternal mortality; and four, that the reorganisation of the Safe Motherhood movement at the global level demanded a new humanitarian logic that had no room for the figure of the traditional birth attendant. I close the chapter by looking at the return of TBAs in global level policy, which, I argue, is bolstered by a growing evidence base, and also by the trends towards ‘self-care’ and point-of-use technologies in global health.

Association of Antenatal Care Visit with Utilization of Institutional Delivery Care Services in Afghanistan: Intersections Between Education, Wealth, and Household Decision-Making Autonomy

Background: The importance of antenatal visits in safe motherhood and childbirth is well documented. However, less is known how social determinants of health interact with antenatal care (ANC) visits in shaping the uptake of professional delivery care services in low-income countries. This study examines the association of ANC visits with institutional delivery care utilization outcomes in Afghanistan. Further, we assess the extent to which ANC visits intersect with education, wealth, and household decision-making autonomy in predicting two outcomes of delivery care utilization- delivery at a health facility and delivery assisted by a skilled birth attendant.Methods: We used data from the Afghanistan Demographic and Health Survey (AfDHS) 2015. The analytic sample included 15,581 women of reproductive age (15-49). We assessed the associations using logistic regression models, estimated the predicted probability of delivery care outcomes using statistical interactions, and presented estimates in margins plot. Results: Regression analyses adjusted for socioeconomic and demographic covariates suggest that women who had 4 or more ANC visits were 5.7 times (95% CI= 4.78, 7.11, P<0.001) more likely to use delivery care at a health facility and 6.5 times (95% CI= 5.23, 8.03; P<0.001) more likely to have a delivery assisted by a skilled birth attendant compared to women who had no ANC visit. Estimates from models with statistical interactions between ANC, education, wealth, and decision-making autonomy suggest that women with higher social status were more advantageous in utilizing institutional delivery care services compared to women with lower levels of social status. Conclusion: Our findings suggest that the association of ANC visit with institutional delivery care services is stronger among women with higher social status. The results have implications for promoting safe motherhood and childbirth through improving women’s social status.

Perceived Needs and Barriers to Accessing Sexual Reproductive Health (SRH) Services Among the Ik Community, Kaabong District, Uganda

Background: The Ik are minority group of people in Kaabong district, Uganda. They are the most marginalized. In addition, little is known about their perceived SRH needs and barriers to accessing SRH services.Objective: To determine perceived needs and barriers to accessing SRH services by the Ik community.Material and Methods: A cross-sectional analytical design with analytical was used, both quantitative and qualitative (mixed methods). Data was collected using key informant interviews, focus group discussions and semi-structured questionnaires. Sample of 345 participants selected randomly and purposively. Qualitative analysis was thematic whereas Statistical Package for Social Scientists (SPSS) was for quantitative analysis.Results: Perceived SRH needs of the Ik were; limited access to SRH information, lack of protection from gender-based violence and lack of access to comprehensive safe motherhood programs. Access to SRH services was limited mainly by poverty, limited range of available RH services, long distances to health facilities, poor attitudes of health workers, culture, poor road networks and language barriers. Individual factors; period in marriage (p=0.047), number of sex partners (p=0.041), type of house structure one lived in (p=0.039), economic activity (p=0.009) were significantly associated with access of SRH services.Conclusion: SRH needs of the Ik community is still wanting

Maternal health care services in Nepal: A qualitative perspective based on the socio-ecological model

Nepal has a high Maternal Mortality Rates (MMR) in the South Asian region, partly due to the poor utilization of maternal and child healthcare services. The study aims to explore the influencing factors of maternal and child healthcare services among Nepalese women. Eighteen women, who had seven-days-old-children and those recently accessed maternal and child healthcare practices, were purposively selected. The face-to-face, In-depth-Interview (IDI) was applied to collect the information. The data were thematically analyzed, where Socio-Ecological Model (SEM) was applied as a theoretical framework. The study showed that the factors such as the knowledge of women, perception, and decision-making-autonomy at individual levels influenced maternal and child healthcare-seeking behaviors. Likewise, mothers-in-law and the role of husbands at intrapersonal levels, employment at institutional levels, peers and role of neighbors at community levels, and safe motherhood program at policy levels were significant factors for the utilization of maternal and child healthcare-seeking-behaviors. The negligence of women concerning pregnancy, inadequate health facilities, lack of specialist health workers with advanced equipment, and cultural taboos and beliefs were observed as score barriers for utilization of maternal and child health-seeking behaviors. The research strongly recommends that all women be aware of maternal and child healthcare and health-seeking behaviors at their initial ages.

Son Preference in India

Through a focus on Rajasthan, this chapter analyses how government awareness campaigns for gender equality, as well as a sharp rise in institutional deliveries throughout the country in the 2000s, have affected how son preference is discussed and treated in hospitals. Drawing on 3 months of ethnographic fieldwork in a government hospital in Jaipur, this chapter shows that the condemnation of son preference has enhanced regimes of medical and moral surveillance within obstetric wards. Not only does it contribute to further castigation and self-disciplining mechanisms, but it also constitutes a new opportunity for social distinction. While condemning son preference practices, women, nurses, and doctors are constantly finding scapegoats in social classes, state, and generational differences. Thus, this chapter considers whether the public condemnation of son preference, currently jeopardizing the relationship of trust between caregivers and patients, could undermine government policies on safe motherhood.

AYURVEDA FOR PREGNANT WOMEN DURING COVID-19 ERA – A REVIEW

The Novel corona virus disease (COVID-19) is highly communicable viral infection caused by SARS-CoV 2. WHO mentions that pregnant women or recently pregnant women seem to have an increased risk of developing severe COVID-19. Due to physiological changes in the body and immune system, pregnant women can be badly affected by respiratory infections. It is therefore important that they take precautions to protect themselves against COVID-19. Overall, 10% of pregnant women suffered from COVID-19. Ayurveda mentions Garbhini paricharya (antenatal care of the pregnant) which recommends ahara (dietary regimen) and vihara (specific activity for physical, emotional and mental wellbeing) that is required for the safe motherhood and healthy progeny. Here is an attempt to understand how Garbhini paricharya helps in preventing corona. KEY WORDS: Garbhini paricharya, COVID-19, Pregnancy

MEN KNOWLEDGE/AWARENESS LEVEL ON BIRTH PREPAREDNESS AND COMPLICATION READINESS IN MAGARINI SUB COUNTY

Purpose: This study sought to find out the knowledge/awareness level of men on birth preparedness and complication readiness in Magarini Sub County. Methodology: A cross-sectional study sequential mixed methods design was used where a total of 464 men will be enrolled. Quantitative data was collected using semi structured questionnaires and interview guides were used to collect qualitative data. Quantitative data was coded, and analyzed by SPSS software. Qualitative data was analyzed using NVIVO software. Chi- square test was used to determine associations between categorical variables and Logistics regression was used to identify factors associated with birth preparedness and complication readiness. The associations between awareness and each independent variable were determined by odds ratio (OR) and 95% confidence interval (CI). Thematic content analysis was applied for qualitative data analysis. Findings: The result indicated that the odds of pregnancies resulting in a baby that was born alive were 47.306 times higher for more than two pregnancies as compared to one pregnancy(Odds=47.306,p=0.000). The odds of pregnancies resulting in a baby that was born alive were 16.25 times higher for one pregnancies as compared to no pregnancy(Odds=16.25,p=0.000). Unique contribution to theory, practice and policy Birth Preparedness and Complication Readiness (BPACR) should be endorsed as an essential component of safe motherhood programs to reduce delays for care-seeking for obstetric emergencies and this has been proven to positively impact on birth outcomes Keywords: knowledge/awareness level, birth preparedness, complication readiness, Magarini Sub County

Filhos da (in)justiça

The following article presents statements by pregnant or breastfeeding women to have been through custody hearings and criminal proceedings while released on bail, illustrating institutional responses to prenatal, childbirth, and post-natal care outside the prison environment. The aim was to document the possibilities for and difficulties of applying release measures, according to the women’s own narratives of violence. The qualitative research is based on an analysis of content and is organized according to thematic modules with an exploration of the material collected in interviews and field data. Several obstacles faced in the empirical study have been highlighted, as have the experiences of the women inside and outside the prisons, in terms of the exercise of motherhood, life with the child, the lack of state assistance, and the consequences of the imprisonment. The report from mothers to have been released on bail or placed under house arrest due to pregnancy demonstrates adequate pre-natal care and the children’s healthy development, although difficulties were still experienced during childbirth. The adoption of measures to release the women allowed for better access to healthcare, in line with the human right to safe motherhood. The satisfaction of being able to care for their children and live alongside family stood out as a positive factor. Situations of institutional violence still persist, given the insufficiency or absence of state protection.

Utilization of Skilled Birth Attendants and Associated Factors Among Women Having Children Less Than Two Years in Bench-Shako, South West of Ethiopia,2020

Introduction:-Skilled attendant delivery is considered the most critical intervention in reducing maternal death and ensuring safe motherhood. But, the level of maternal morbidity and mortality in Ethiopia is among the highest in the world: indicate the proportion of births occurring at health facilities is low. Globally, about 289,000 women die each year due to preventable causes, yielding a maternal mortality rate of 210 per 100,000 live births. In Ethiopia, institutional delivery is low 34%. From the treatable and preventable woman deaths, 16 % occurs during delivery.To mitigate maternal death by identifying the utilization of skilled birth attendants and associated factors among women children less than two years is important.Objective: Assess the utilization of skilled birth attendants and associated factors among the women children less than two years in South West, Ethiopia, 2020G.C.Methods and Materials: Community-based cross-sectional study design was employed to collect data from 294 women children less than two years in Mizan- Amen, Bench Shako zone, 2020.Structured questionnaires were to collect the data by face-to-face interviews of a systematically selected participant. The data were analysed by SPSS software version 21.Results: Among the respondents (294), 30.6% of them had utilized skilled birth attendants. The contributing factors associated with the utilization of skilled birth attendants were:-Age of the respondents (21–25), governmental employees, having antenatal care follow-up, and nearest to the health facility.Conclusions: Generally, this study has indicated the skilled birth attendance was low. Mothers with government-employed, Age in years, having antenatal care follow-up, and nearest to the health facility in less than 30minutes were predictors of skilled birth attendant.

Safe Motherhood Practices of Women in Urban and Rural Areas of Chitwan District, Nepal

Safe motherhood practices ensure all women receive the care they need to be safe and healthy throughout pregnancy and childbirth. It is one of the most important pillars for preventing maternal morbidity and mortality. A descriptive comparative study was conducted to compare the safe motherhood practices in selected VDC and Municipality of Chitwan District. The purposive sampling method was applied in which 120 respondents were married and had at least one child. Among them, 59 respondents were from Bharatpur Municipality and 61 respondents from Mangalpur VDC. Data was collected by interviewing mothers using a structured interview schedule. Descriptive statistics were used for data analysis. The results showed that the number of mothers in the rural area practicing safe motherhood is lower than the number of mothers in the urban area. The number of ANC visits/PNC visits, use of Iron tab, institutional delivery and use of extra nutritious diet or meal per day during pregnancy and after pregnancy were higher in respondents of the urban area. The main reason for not taking ANC/PNC services during their last birth was lack of knowledge and second was their poor economic conditions. This study concludes that the trend of visiting ANC services, delivery care, and PNC services properly are high in the age group 20-39 years and it is increasing with their level of education. Special awareness programmes about information regarding safe motherhood practices should be planned and launched especially targeting the women of rural areas.