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Social workers in Perinatal Palliative Care (PPC) play an essential role in caring for birthing people carrying a baby with a life-limiting condition and their families. Perinatal palliative care is consistent with social work values concerning fostering quality of life and promoting social justice and access to care. Social workers play a multidimensional role in providing a holistic approach to caring for the birthing person, baby, and family. Although social workers may be part of an interdisciplinary care team, their role is not defined solely by the goals of the greater team, nor has it been discussed in depth in the perinatal palliative care literature. The purpose of this paper is to describe the knowledge, values, and skills essential to the role of the social worker in a hospital-based perinatal palliative care team. A case study will be used to illustrate the relevant practices, and implications are outlined. [ABSTRACT FROM AUTHOR]

Since the shift to legalizing recreational cannabis use in Canada in 2018, there has been increased attention on the consequences of cannabis use on women's reproductive and maternal health, with particular attention to the impact of cannabis in utero and through breastfeeding. This has resulted in an intense focus on the behaviors of individuals who consume cannabis during the perinatal period, which raises questions about the impact this has on women and mothers who have historically been under the surveillance of the Canadian public health, health and social care, and legal systems. Grounded in an intersectional feminist framework that acknowledges how race, ability, class, and other social positions impact and differentiate women's experience, this paper presents findings emerging from a participatory arts-based research approach called Photovoice with 23 mothers living throughout Canada. All participants consumed cannabis during pregnancy and breastfeeding and illustrated through photographs and individual and group discussion how their experiences of intersectional stigma and surveillance by health and social care providers resulted in barriers to accessing cannabis-related information and support. Implications arising from our inquiry suggest there is a dire need for public health, perinatal care, and social care responses that run counter to the current context where stigma and fear prevent parents from accessing cannabis information and support. [ABSTRACT FROM AUTHOR]

Internationally, politicians and practitioners have focused strongly on humanization of births, to enable fewer medicalized birth care procedures. In this paper, we explore policy efforts to support better births in order to comprehend developments in maternity care in Denmark and France, two countries previously identified as having different birth cultures. Our analysis has been fueled by the question of how birth policies have developed in both countries in an era in which medicalization of birth has been problematized internationally. Using discourse analysis, we examine the political constructions of specific problems in central policy documents. The analysis shows which problematizations around maternity care are discursively constructed, what solutions are discursively presented and on what assumptions the problematizations are based. The article supports the conclusion of other scholars that a pervading risk discourse on birth and birthing bodies constitutes how maternity care can be experienced and practiced. [ABSTRACT FROM AUTHOR]

Community engagement is gaining prominence in global health research. But communities rarely have a say in the agendas or conduct of the very health research projects that aim to help them. This paper provides new evidence on how to share power in priority-setting in ways that seek to overcome structural constraints created by the funding environment. The five strategies were identified through case study research on the Participation for Local Action project in Karnataka, India. That project was carried out by researchers in partnership with the Zilla Budakattu Girijana Abhivrudhhi Sangha, an indigenous community development organisation representing the Solega people. The paper describes each identified strategy for sharing power in priority-setting, followed by a report of the pitfalls and challenges that arose when implementing it. Thus, the study also demonstrates that even where actions and strategies are used to address power imbalances, pitfalls will arise that need to be navigated. Given those challenges, considerations to reflect upon before employing the identified strategies are suggested. Ultimately, the paper aims to communicate strategies for sharing power during and after priority-setting and lessons on how to implement them effectively that can be used by global health researchers in the current funding environment. [ABSTRACT FROM AUTHOR]

Transgender and gender non-conforming individuals have historically experienced discrimination accessing reproductive rights. This transcends into the ways in which the current systems of healthcare are structured to continue perpetuating the marginalization of this population of gender diverse persons, specifically as it relates to reproductive care. Throughout this paper, we will utilize a reproductive justice framework to explore ways in which transgender patients experience discrimination in unique ways through micro- and macroaggressions within the healthcare system based on the intersection of the reproductive healthcare services in which they are seeking, paying special attention to pregnancy and postpartum care, and their unique social identity. This paper will conclude with specific recommendations for how medical family therapists can impact healthcare systems by integrating trauma-informed care aligned with a reproductive justice framework. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to (1) determine if there are racial differences between Non-Hispanic (NH) Black and NH White women in health 'care' factors associated with low birth weight (LBW), (2) to determine if there are differences across health 'system' factors, and (3) to explore if the factors account for racial differences. Univariate and multinomial nested logit (MNL) models were performed. Whereas the LBW percentage for NH White women was 8.1%, for NH Black women, the LBW percentage was 13.6% (p <.001). NH Black women were significantly more likely to be unmarried (p <.001) and earn less income (p <.001). For level of care, NH Black women were more likely to have LBW babies in neonatal care; whereas NH White women were more likely to have LBW babies in well-baby nurseries. Results from MNL models indicated that NH Black women were 1.79 times more likely to have a LBW baby. When controlling for health 'care' factors, the racial difference between NH Black and NH White women in the likelihood of having a LBW baby increased to an odds ratio of 2.26 (p =.038). There are racial differences in factors associated with LBW. [ABSTRACT FROM AUTHOR]

The purpose of the authors in this paper is to investigate the effects of negative experiences during delivery and postpartum period on the relationship between the mother. The quantitative part of this study was conducted with 289 mothers and the qualitative part with 40 mothers. It was found that experiencing upsetting problems during delivery (p = 0.006) and in the postpartum period (p = 0.002) had an effect on separation anxiety. Based on the examination of the feelings experienced during annoying or distressing situations in the postpartum period, it was determined that there was a significant correlation between guilt (p = 0.000), fear of not being a good mother (p = 0.035), and feeling weak (p = 0.001) and separation anxiety. Blues of birth is fear and anxiety that the baby will be harmed if the mother is separated from it, and it is attributed to negative experiences during delivery and the postpartum period. [ABSTRACT FROM AUTHOR]

Effective, low-cost clinical interventions to improve facility-based care during childbirth are critical to reduce maternal and perinatal mortality and morbidity in low-resource settings. While health interventions for low- and lower-middle-income countries are often developed and implemented top-down, needs and circumstances vary greatly across locations. Our pilot study in Zanzibar improved care through locally co-created intrapartum clinical practice guidelines (CPGs) and associated training (the PartoMa intervention). This intervention was context-tailored with health-care providers in Zanzibar and now scaled up within five maternity units in Dar es Salaam, Tanzania. This PartoMa Scale-up Study thereby provides an opportunity to explore the co-creation process and modification of the intervention in another context and how scale-up might be successfully achieved. The overall protocol is presented in a separate paper. The aim of the present paper is to account for the Scale-up Study's programme theory and qualitative methodology. We introduce social practice theory and argue for its value within the programme theory and towards qualitative explorations of shifts in clinical practice. The theory recognizes that the practice we aim to strengthen – safe and respectful clinical childbirth care – is not practiced in a vacuum but embedded within a socio-material context and intertwined with other practices. Methodologically, the project draws on ethnographic and participatory methodologies to explore current childbirth care practices. In line with our programme theory, explorations will focus on meanings of childbirth care, material tools and competencies that are being drawn upon, birth attendants' motivations and relational contexts, as well as other everyday practices of childbirth care. Insights generated from this study will not only elucidate active ingredients that make the PartoMa intervention feasible (or not) but develop the knowledge foundation for scaling-up and replicability of future interventions based on the principles of co-creation and contextualisation. [ABSTRACT FROM AUTHOR]

Background:Evidence on effective ways of improving maternal and neonatal health outcomes is widely available. The challenge that most low-income countries grapple with is implementation at scale and sustainability. Objectives:The study aimed at improving access to quality maternal and neonatal health services in a sustainable manner by using a participatory action research approach. Methods: The  study consisted of a quasi-experimental design, with a participatory action research approach to implementation in three rural districts (Pallisa, Kibuku and Kamuli) in Eastern Uganda. The intervention had two main components; namely, community empowerment for comprehensive birth preparedness, and health provider and management capacity-building. We collected data using both quantitative and qualitative methods using household and facility-level structured surveys, record reviews, key informant interviews and focus group discussions. We purposively selected the participants for the qualitative data collection, while for the surveys we interviewed all eligible participants in the sampled households and health facilities. Descriptive statistics were used to describe the data, while the difference in difference analysis was used to measure the effect of the intervention. Qualitative data were analysed using thematic analysis. Conclusions:This study was implemented to generate evidence on how to increase access to quality maternal and newborn health services in a sustainable manner using a multisectoral participatory  approach. [ABSTRACT FROM PUBLISHER]

A growing body of research has documented disrespectful, abusive, and neglectful treatment of women in facilities during childbirth, as well as the drivers of such mistreatment. Yet, little research exists on effective interventions to improve Person-Centred Maternal Care (PCMC)—care that is respectful and responsive to individual women's preferences, needs, and values. We sought to extend knowledge on interventions to improve PCMC, with a focus on two factors – provider stress and implicit bias – that are driving poor PCMC and contributing to disparities in PCMC. In this paper we describe the process towards the development of the intervention. The intervention design was an iterative process informed by existing literature, behaviour change theory, formative research, and continuous feedback in consultation with key stakeholders. The intervention strategies were informed by the Social Cognitive Theory, Trauma Informed System framework, and the Ecological Perspective. This process resulted in the 'Caring for Providers to Improve Patient Experience (CPIPE)' intervention, which has 5 components: provider training, peer support, mentorship, embedded champions, and leadership engagement. The training includes didactic and interactive content on PCMC, stress, burnout, dealing with difficult situations, and bias, with some content integrated into emergency obstetric and neonatal care (EmONC) simulations to enable providers apply concepts in the context of managing an emergency. The other components create an enabling environment for ongoing individual behavior and facility culture change. The pilot study is being implemented in Migori County, Kenya. The CPIPE intervention is an innovative theory and evidence-based intervention that addresses key drivers of poor PCMC and centers the unique needs of vulnerable women as well as that of providers. This intervention will advance the evidence base for interventions to improve PCMC and has great potential to improve equity in PCMC and maternal and neonatal health. [ABSTRACT FROM AUTHOR]

In 2020, the New Zealand (NZ) Parliament voted to decriminalise abortion. Although NZ's abortion law formally opposes sex selective abortions, there is considerable complexity in the gender politics of 'choice' and 'agency' in multi-ethnic societies, and interpretations of reproductive rights for ethnic minority women and for the girl child, respectively. This paper explores these complexities through the perspectives of reproductive and maternity care practitioners who are situated at the interface of legal systems, health service provision, and delivery of culturally sensitive care. Thirteen practitioners were interviewed as part of this study. The analysis highlights strains in framings of 'reproductive choice' (underpinned by western liberal notions of rights) and 'gender equality' (abortion rights that acknowledge the complexity of cultural son-preference) for ethnic minority women. These tensions are played out in three aspects of the post-reform landscape: (a) everyday practice and accountability; (b) consumerism and choice; (c) custodianship and gender rights. The findings point to the limitations in operationalising choices for ethnic women in health systems wherein trust deficit prevails, and cultural dynamics render complex responses to abortion. They also highlight reconfigurations of client-expert relationships that may have implications for practitioners' abilities to advocate for ethnic women's rights against cultural influences. [ABSTRACT FROM AUTHOR]

According to the World Health Organization, intimate partner violence (IPV) affects 35% of women worldwide and 40% of pregnant women, often resulting in maternal and infant death and harm. Displaced persons are at higher risk of abuse compared to the general population. While few studies have explored IPV in Iraq, research from Erbil, Iraq showed nearly 60% of women reported experiencing IPV in their lifetime. No publications examining IPV among displaced women in Iraq exist. Considering the severe impacts of IPV in pregnancy and the associated risks for IPV among women in refugee camps, this paper presents the first analysis of prevalence and factors associated with lifetime IPV among displaced pregnant women in two Iraqi refugee camps. Thirteen percent of women reported experiencing any abuse and experiencing IPV was associated with receiving fewer years of schooling (p = 0.04), not having a private doctor (p = 0.002), attending the first prenatal visit during the third trimester (p = 0.03), feeling pressure to have a child (p = 0.003), knowing someone who was physically injured by their husband (p = 0.05), experiencing suicidal ideation (p = 0.02), and being worried about harming one's baby (p = 0.02). Policy and programme recommendations for screening and prevention of IPV in resource-limited settings are provided. [ABSTRACT FROM AUTHOR]

In Brazil, Black women are disproportionately denied access to timely care and are made vulnerable to death by avoidable obstetric causes. However, they have not been at the center of recent initiatives to improve maternal health. This paper contends that the effectiveness of Brazilian maternal and infant health policy is limited by failures to robustly address racial health inequities. Multi-sited ethnographic research on the implementation of the Rede Cegonha program in Bahia, Brazil between 2012 and 2017 reveals how anti-Blackness structures iatrogenic harms for Black women as well as their kin in maternal healthcare. Building on the work of Black Brazilian feminists, the paper shows how Afro-Brazilian women experience anti-Black racism in obstetric care, which the paper argues can be better understood through Dána-Ain Davis' concept of obstetric racism. The paper suggests that such forms of violence reveal the necropolitical facets of reproductive governance and that the framing of obstetric violence broadens the scales and temporalities of iatrogenesis. [ABSTRACT FROM AUTHOR]

The Coronavirus pandemic raises significant concerns about pervasive social inequities and disparate gender relations, particularly between mothers/fathers. Indeed, the pandemic engendered a general retreat into traditional parenting roles across myriad, everyday, institutional, spaces, including workplaces, homes, and welfare/healthcare services. These effects have been especially marked for couples expecting a child. Visitor-restriction policies, implemented to curb viral-spread within healthcare settings, effectively 'barred' many expectant fathers in the UK (and elsewhere) from attending antenatal appointments, and even the birth of their child; milestone moments widely regarded as significant socio-cultural 'rites-of-passage' in fathers' transition to parenthood. Many pregnant women had to face these moments alone, sparking campaigns including #ButNotMaternity. This paper critically examines how such institutional responses exhibit a complex 'welfare trade-off' effectively (re)positioning fathers as spectators, rather than participants, in pregnancy/parenthood and risk embodying a potential U-turn to recent decades' emphasis on involved, equitable fatherhood. Drawing upon the accounts of expectant mothers/fathers in the UK reported in the popular press since March 2020 and the #ButNotMaternity campaign, it employs thematic social-media analysis to explore the emotional impacts of visitor-restrictions and the gendered, emotional governance of parenting amidst the pandemic through the exclusion of particular (fathers') bodies within maternity care spaces. [ABSTRACT FROM AUTHOR]

Internally displaced women are underserved by health schemes and policies, even as they may face greater risk of violence and unplanned pregnancies, among other burdens. There are an estimated 450,000 internally displaced persons in India, but they are not formally recognised as a group. Displacement has been a common feature in India's northeast region. This paper examines reproductive and maternal health (RMH) care-seeking among Bru displaced women in India. The study employed qualitative methodology: four focus group discussions (FGDs) were held with 49 displaced Bru women aged 18–45 between June and July 2018; three follow-up interviews with FGD participants and five in-depth interviews with community health workers (Accredited Social Health Activists – ASHAs) in camps for Bru displaced people in the Indian state of Tripura. All interviewees gave written or verbal informed consent; discussions were conducted in the local dialect, recorded, and transcribed. Data were indexed deductively from a dataset coded using grounded approaches. Most women were unaware of many of the RMH services provided by health facilities; very few accessed such care. ASHAs had helped increase institutional deliveries over the years. Women were aware of temporary contraceptive methods as well as medical abortion, but lacked awareness of the full range of contraceptive options. Challenges in accessing RMH services included distance of facilities from camps, and multiple costs (for transport, medicines, and informal payments to facility staff). The study highlighted a need for comprehensive intervention to improve RMH knowledge, attitudes, and practices among displaced women and to reduce access barriers. [ABSTRACT FROM AUTHOR]

Parents with physical disabilities face challenges in their relationships with perinatal and early childhood services. This paper aims to better understand the experiences and needs of parents with physical disabilities regarding perinatal and early childhood services in the public healthcare system in Quebec, Canada. We also describe how adequately current services meet the needs of these individuals. Thirteen interviews were conducted with ten mothers and three fathers with physical disabilities. Results indicate challenges in various phases of the parental experience: the decision to have a child and conception; pregnancy follow-up; delivery; postnatal care and parental practices. The main issues reported by participants involved access to information and professionals' attitudes. Participants also emphasized the importance of keeping control over the parenting process. As there is a growing interest in the questions surrounding parents with disabilities in Quebec, this study can provide useful insights for community organizations and political stakeholders. Parents with physical disabilities report needs at various stages in their parental experience: the decision to have a child and conception, pregnancy follow-up, delivery, postnatal care and parental practices. Parents ask to be provided with appropriate information and to be part of the decision-making process during the delivery and with regards to child care. Professional services may fail to address parents' needs. Inclusive services would provide support for parents with physical disabilities surrounding both the medical, and the social aspects of their parenthood. Services of this nature could lead to positive outcomes in their parental practices. [ABSTRACT FROM AUTHOR]

This paper examines the history of infant homes for babies and toddlers in the two German states after World War II. Peak capacity of these institutions was not reached in the immediate post-war years, as one might suppose, but in the early 1960s. At that time in socialist East Germany one in forty children under the age of three lived in an infant home, while the rate was about half as high in capitalist West Germany. Thus, these institutions impacted the lives of more children than previously assumed. From a comparative perspective, divided developments become clear: In East Germany, socialist legislation and media promoted the infant home; in West Germany, the expansion took place in the shadow of the capitalistic welfare state. Criticism of the homes was articulated in both states at about the same time, following publication of British psychoanalyst John Bowlby's early attachment theory. His WHO report Maternal Care and Mental Health from the year 1951 served as a reference point for the work of several pediatricians and psychologists in both German states. It appears that Bowlby's theory – stressing the importance of exclusive maternal care and so far described as highly impactful for Western Europe and the USA – also met with approval under East German state socialism in the 1950s. However, it had different implications: In West Germany, scientific criticism of infant homes was acted on by the authorities, who quickly disbanded the institutions from the mid-1960s onwards. In East Germany, political intervention favoring maternal employment prevented this, which is why numerous places in infant homes remained available for babies and toddlers until the end of the socialist state in 1989. [ABSTRACT FROM AUTHOR]

Family Planning Services and Pregnancy Options Counseling (POC), often provided by licensed clinical social workers and registered nurses, have been a vital intervention for women and families for decades and continues to remain an important public health focus. Recent Title X Policy changes have altered service delivery of POC in many family planning clinics across the country. This paper explores Family Planning, POC, the new Title X regulations and their intersection with the evangelical, Christian faith and social worker. [ABSTRACT FROM AUTHOR]

This paper provides evidence on the predicted benefits of maternal education, in terms of reduced child malnutrition at ages 1 and 5, focusing specifically on the complementarities with early life interventions across contexts. Using data from the Young Lives Longitudinal Study for Ethiopia, India, Peru and Vietnam, results show the expected association of maternal education with reduced likelihood of malnutrition both at ages 1 and 5. However, the benefits of maternal education via access to an early life intervention (antenatal care), are found only in some countries and for some levels of maternal education. Inequalities in the risk of malnutrition between those with the highest endowments of maternal education and access to antenatal services, and those without these, are significant within countries. We conclude that programmes which aim to reduce the risks of malnutrition should consider local knowledge and realities in order to understand more fully the expected benefits. [ABSTRACT FROM AUTHOR]

Expanding access to maternal, newborn and child health (MNCH) services in traditional societies is a public health challenge, often complicated by cultural and religious beliefs about what is permitted or not permitted within a faith group. This is particularly true in the Muslim majority North of Nigeria, where deep suspicions of Western public health programmes, coupled with failing and underfunded health system, have led to the emergence of a new generation of Muslim Opinion Leaders (MOLs) with counter-narratives against family planning, immunisation and nutrition programmes. This paper reports on an innovative project implemented under the Saving Lives at Birth global partnership programme, where conservative MOLs transformed as champions were engaged as health communicators to train health providers on correct religious precepts related to MNCH. A matched subject type of study design was used to compare healthcare providers' performance in control and intervention health facilities. The result indicates a significant difference both in perception and in practices between healthcare providers in intervention and control facilities, with respect to MNCH uptake. This paper highlights the need for renewed focus on engaging faith leaders and organisations in health communication and service delivery and presents a model of sustainable engagement of champions in MNCH. [ABSTRACT FROM AUTHOR]

Hospital cleaning has been shown to impact on rates of healthcare-associated infections (HCAIs) and good environmental hygiene is critical to quality care, yet those tasked with the role of ensuring a safe and clean environment often go unrecognised as members of the healthcare workforce. Sepsis is a leading cause of maternal and newborn death, a significant proportion of these cases are estimated to be due to HCAIs. Deliveries in health institutions have now reached 75% globally, and in low and middle income countries the corresponding increased pressure on facilities has impacted both quality of care provided and quality of the birth environment in terms of infection prevention and control (IPC) and HCAIs. The paper discusses the neglected role of health facility cleaners, providing evidence from the literature and from needs assessments conducted by The Soapbox Collaborative and partners in Bangladesh, India, The Gambia and Zanzibar. While not the primary focus of the assessments, common themes emerged consistently pointing to institutional neglect of cleaning and cleaners. The paper argues that low status within facilities, wider societal marginalisation, lack of training, and poor pay and working conditions contribute to the lack of prioritisation placed on health facility environmental hygiene. With increased international attention focused towards health facility water, sanitation and hygiene and a growing focus on IPC, now is the time to address the neglect of this frontline healthcare workforce. We propose that provision of and improved training can enable the recognition of the valuable role cleaning staff play, as well as equipping these staff with the tools required to perform their job to the highest standard. In addition to training, wider systems changes are necessary to establish improvements in environmental hygiene and the role of cleaning staff, including addressing resource availability, supportive supervision, and an increased emphasis on preventative healthcare. [ABSTRACT FROM AUTHOR]

Brazil is a middle-income country with universal maternity care, mostly by doctors. The experience of normal birth often includes rigid routines, aggressive interventions, and abusive, disrespectful treatment. In Brazil, this has been referred to as dehumanised care and, more recently, as obstetric violence. Since the early 1990s, social movements (SM) have struggled to change practices, public policies and provider training. The aim of this paper is to describe and analyse the role of SM in promoting change in maternity care, and in provider training. In this integrative review using a gender-oriented approach, we searched the Scielo database and the Ministry of Health’s (MofH) publications and edicts for institutional and research papers on SM initiatives addressing disrespect and abuse in the last 25 years (1993-2018) in Brazil, and their impact on public policies and training programmes. We analyse these groups of interrelated initiatives: (1) political actions of SM resulting in changes in public policies and legislation; (2) events organised by SM for diffusion of information to the public; (3) MofH policies to humanise childbirth with participation of SM; and (4) initiatives to change providers’ training, including legal actions based on obstetric violence reports. To promote real change in maternity care, the progression of policies and enabling environment of laws, regulations, and broad dissemination of information, need to go hand in hand with changes in all health providers’ training - including a solid base in ethics, gender and human rights. [ABSTRACT FROM AUTHOR]

This paper aims to describe a trend in coverage of maternal care services, and provides a detailed analysis of socio-economic correlations to the existing inequities. The paper uses data from the Vietnam Multiple Indicator Cluster Survey 2000, 2006, 2011, and 2014. In the MICS, there were 9,117 women in 2000, 9,473 women in 2006, 11,614 women in 2011, and 9,827 women in 2014 participated in. We found the coverage of antenatal care increase from 68.6% in 2000 to 95.9% in 2014. Similarly, the percentages of women who gave birth with the assistance of skilled staff increased during the studied period ( from 69.9% in 2000, 87.7% to 94.5% in 2014). However, improvements in antenatal care and skilled birth attendance in Vietnam have been uneven across different segments of the population. In all the four surveys, the proportions of women who received ANC by a skilled staff and percentages of women who gave birth with the assistance of a skilled health personnel were much higher among those with higher education, belonged to Kinh majority tribe, had better economic status, and lived in an urban area. The degrees of inequity in both antenatal and delivery care in Vietnam are likely to increase over time. [ABSTRACT FROM AUTHOR]

Foodborne illness is a major public health concern, often approached by focusing on socio-demographic groups who are considered most ‘vulnerable’ to foodborne disease such as elderly people or pregnant women. Based on a review of existing literature and original research with UK consumers, this paper proposes an alternative approach to analysing vulnerability to foodborne illness. Challenging conventional approaches that focus on the inherent vulnerability of particular socio-demographic groups, the paper emphasises the context-specific and situational nature of vulnerability and the practices and pathways through which people negotiate specific threats which may, in turn, affect their future vulnerabilities. The paper also addresses the gap between lay and expert knowledge that may increase exposure to particular food-related risks. Evidence is provided from research on the food safety and health implications of consumers’ everyday domestic practices including behaviours that do not comply with current ‘best practice’ advice. The evidence supports a turn from notions of inherent vulnerability, based on the membership of certain socio-demographic groups, towards a more nuanced understanding of situational vulnerability, based on the context and logic informing specific social practices. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this scoping review was to uncover and summarize what is known in the literature about the experiences of Indigenous women in Asia regarding access to health services. Design: The study was informed by the scoping review methodology proposed by Arksey and O'Malley [2005. "Scoping Studies: Towards a Methodological Framework." International Journal of Social Research Methodology 8 (1): 19–32. doi:10.1080/1364557032000119616]. A comprehensive search of the databases for peer-reviewed studies and grey literature was conducted between January 2000 and December 2016. The data of selected papers and abstracts were analysed by three independent researchers through a protocol of data charting, descriptive numerical summary, and thematic analysis. Results: Sixteen articles and two abstracts met the inclusion criteria for this scoping review. These 18 peer-reviewed documents consisted of eight qualitative studies, seven quantitative studies, and three mixed-method studies, which included the peer-reviewed poster and oral presentation abstracts from international conferences. The findings were sorted and grouped under the following themes: health care access for Indigenous women in Asia, facilitators to accessing healthcare services, barriers to accessing healthcare services, and cultural contexts impacting health and access. Conclusion: There is limited information about the experiences, facilitators, barriers, and cultural contexts faced by Indigenous women in Asia related to health services accessibility, and even less information related to improving health services accessibility and health outcomes. This scoping review in particular highlights the dearth of literature relating to Indigenous women's postpartum health and access to postnatal supports and services. Generally, it indicates that Indigenous women in Asia are more vulnerable to poor health in comparison to non-Indigenous women, and continue to face challenges and barriers in accessing quality and equitable health services. The barriers identified in this review are useful in explaining why inequities in health and access to health care for Indigenous women living in Asia continue to exist. Recommendations for future research directions are described. [ABSTRACT FROM AUTHOR]

This report describes the Obstetric and Neonatal Simulation (ONE-Sim) workshop run in a remote learning format for medical and midwifery students in an interprofessional setting during the COVID-19 pandemic. It explores the observation of students as participants in the online learning of using Personal Protective Equipment and simulation-based learning of perinatal emergency management. This was followed by their mutual interaction and reflections. This paper aims to understand the role of synchronous remote learning through simulation and its impact on interprofessional interactions. We describe the experience of medical and midwifery students with the ONE-Sim workshop, facilitated by medical (obstetric and neonatal) and midwifery educators. Formal thematic analysis will be performed as part of the ongoing study; however, initial direct observation demonstrated that students reacted positively to the online ONE-Sim workshop and engaged well with facilitators and peers. Students mutually interacted amongst themselves, shared their previous experiences, knowledge of roles as medical and midwifery practitioners and how they see themselves in those roles in a perinatal emergency setting. The initial observations demonstrate that interprofessional education delivered in an e-learning format can be useful and meaningful, and may be utilized across a number of specialties. [ABSTRACT FROM AUTHOR]

Expanding access to sexual and reproductive health (SRH) services is one of the key targets of the Sustainable Development Goals. The extent to which sexual and reproductive health and rights (SRHR) targets will be achieved largely depends on how well they are integrated within Universal Health Coverage (UHC) initiatives. This paper examines challenges and facilitators to the effective provision of three SRHR services (maternal health, gender-based violence (GBV) and safe abortion/post-abortion care) in Ghana. The analysis triangulates evidence from document review with in-depth qualitative stakeholder interviews and adopts the Donabedian framework in evaluating provision of these services. Critical among the challenges identified are inadequate funding, non-inclusion of some SRHR services including family planning and abortion/post-abortion services within the health benefits package and hidden charges for maternal services. Other issues are poor supervision, maldistribution of logistics and health personnel, fragmentation of support services for GBV victims across agencies, and socio-cultural and religious beliefs and practices affecting service delivery and utilisation. Facilitators that hold promise for effective SRH service delivery include stakeholder collaboration and support, health system structure that supports continuum of care, availability of data for monitoring progress and setting priorities, and an effective process for sharing lessons and accountability through frequent review meetings. We propose the development of a national master plan for SRHR integration within UHC initiatives in the country. Addressing the financial, logistical and health worker shortages and maldistribution will go a long way to propel Ghana's efforts to expand population coverage, service coverage and financial risk protection in accessing essential SRH services. [ABSTRACT FROM AUTHOR]

This paper describes findings from an institutional ethnography that arose out of the concerns of women living with HIV in Ontario, Canada, regarding the disclosure of their HIV status while accessing perinatal care. The enquiry traces the connections between women's experiences of perinatal care, the activities of healthcare providers delivering such care and the ruling relations that organise women's experiences and healthcare providers' activities. Focusing on HIV disclosure as a concern expressed by women, the findings make visible the day-to-day, routinised practices of healthcare providers working in perinatal care for women living with HIV, as well as the ideological discourses of 'fear of contagion' and 'AIDS hysteria' that contributed to producing the kinds of care experiences that were articulated by women. Opportunities to strengthen perinatal care policies and practices for women living with HIV are discussed. [ABSTRACT FROM AUTHOR]

In Nigeria, two maternal and neonatal health Networks of Care (NOC) focus on extending the reach and quality of routine and emergency maternal and neonatal health services tailored to the different contexts. This paper uses the four domains of the NOC framework—Agreements and Enabling Environment, Operational Standards, Quality, Efficiency and Responsibility, and Learning and Adaptation—to describe the NOC, highlighting how each developed to address specific local needs. In Northern Nigeria, the NOC were established in collaboration among Clinton Health Access Initiative and the government to reduce maternal and neonatal morbidity and mortality. Health centers and communities in the network were supported to be better prepared to provide maternal and neonatal care, while birth attendants at all levels were empowered and equipped to stabilize and treat complications. The approach brought services closer to the community and facilitated rapid referrals. The NOC in Lagos State extended the reach of routine and emergency maternal and neonatal health services through organically developed linkages among registered traditional birth attendant clinics, private and public sector facilities, the Primary Healthcare Board, and the Traditional Medicine Board. Traditional birth attendants are registered, trained, and monitored by Apex Community Health Officers, whose responsibilities include collection and review of data and ensuring linkages to postpartum services, such as family planning and immunizations. While differing in their approaches, both NOC provide locally appropriate, pragmatic approaches to supporting women birthing in the community and encouraging institutional delivery to ensure that women and their babies have access to timely, appropriate, and safe services. [ABSTRACT FROM AUTHOR]

This paper presents an institutional ethnography that explored how risk discourse organised the experiences of pregnant women living with HIV and was reproduced in the work of healthcare providers operating in a 'high risk' prenatal clinic in Ontario, Canada. This inquiry began from the standpoint of pregnant women living with HIV, and made connections between women's experiences, the work of healthcare providers delivering prenatal care, and the ruling relations that organised women's experiences and healthcare providers' activities. The study revealed how risk was an omnipresent discourse in women's lives and became visible through the treatments women were prescribed, the prenatal clinic appointment schedule women were expected to follow, and the application of medical interventions. The discourse of risk coordinated the work of healthcare providers and was inextricably linked to practices that prioritised foetal health. Women's daily realities and experiences were overshadowed by the healthcare providers' focus on the foetus and mitigating perinatal risks. As a result, the work women did to organise their lives to participate in care, and the physical and emotional costs they experienced when attending their appointments, taking their medicines, and following clinical procedures were overshadowed within an institutional context where the primary goal was to reduce risks to their babies – even if women shared concerns and aspirations about preventing perinatal HIV transmission. Women's experiences reveal some important consequences regarding the current organisation of prenatal care that emphasises risk and possible ways to enhance prenatal care policies and practices. [ABSTRACT FROM AUTHOR]

The 3-Delays Model has helped in the identification of access barriers to obstetric care in low and middle-income countries by highlighting the responsibilities at household, community and health system levels. Critiques of the Model include its one-dimensionality and its limited utility in triggering preventative interventions. Such limitations have prompted a review of the evidence to establish the usefulness of the Model in optimising timely access to intrapartum care. To determine the current utility of the 3-Delays Model and its potential for supporting a solution-based approach to accessing intrapartum care. We conducted a qualitative evidence synthesis across several databases and included qualitative findings from stand-alone studies, mixed-methods research and literature reviews using the Model to present their findings. Papers published between 1994 and 2019 were included with no language restrictions. Twenty-seven studies were quality appraised. Qualitative accounts were analysed using the 'best-fit framework approach'. This synthesis included twenty-five studies conducted in Africa, Asia, Latin America and the Caribbean. Five studies adhered to the original 3-Delays Model's structure by identifying the same factors responsible for the delays. The remaining studies proposed modifications to the Model including alterations of the delay's definition, adding of new factors explaining the delays, and inclusion of a fourth delay. Only two studies reported women's individual contributions to the delays. All studies applied the Model retrospectively, thus adopting a problem-identification approach. This synthesis unveils the need for an individual perspective, for prospective identification of potential issues. This has resulted in the development of a new framework, the Women's Health Empowerment Model, incorporating the 3 delays. As a basis for discussion at every pregnancy, this framework promotes a solution-based approach to childbirth, which could prevent delays and support women's empowerment during pregnancy and childbirth. [ABSTRACT FROM AUTHOR]

Background: Ever since Ghana embraced the 1978 Alma-Ata Declaration, it has consigned priority to achieving 'Health for All.' The Community-based Health Planning and Services (CHPS) Initiative was established to close gaps in geographic access to services and health equity. CHPS is Ghana's flagship Universal Health Coverage (UHC) Initiative and will soon completely cover the country with community-located services. Objectives: This paper aims to identify community perceptions of gaps in CHPS maternal and child health services that detract from its UHC goals and to elicit advice on how the contribution of CHPS to UHC can be improved. Method: Three dimensions of access to CHPS care were investigated: geographic, social, and financial. Focus group data were collected in 40 sessions conducted in eight communities located in two districts each of the Northern and Volta Regions. Groups were comprised of 327 participants representing four types of potential clientele: mothers and fathers of children under 5, young men and young women ages 15–24. Results: Posting trained primary health-care nurses to community locations as a means of improving primary health-care access is emphatically supported by focus group participants, even in localities where CHPS is not yet functioning. Despite this consensus, comments on CHPS activities suggest that CHPS services are often compromised by cultural, financial, and familial constraints to women's health-seeking autonomy and by programmatic lapses constrain implementation of key components of care. Respondents seek improvements in the quality of care, community engagement activities, expansion of the range of services to include emergency referral services, and enhancement of clinical health insurance coverage to include preventive health services. Conclusion: Improving geographic and financial access to CHPS facilities is essential to UHC, but responding to community need for improved outreach, and service quality is equivalently critical to achieving this goal. [ABSTRACT FROM AUTHOR]

Despite youth constituting a large portion of the population in Uganda, their involvement in improving maternal health in their communities has been minimal. This paper explores the potential role of youth in contributing to maternal health in rural communities in Wakiso district, Uganda using photovoice. Photovoice was used as a community-based participatory research method among 10 youth (5 males and 5 females) over a period of 5 months. The photos taken by the youth were discussed in monthly meetings, and emerging data was analysed using thematic content analysis. Four themes emerged regarding how youth can contribute to improving maternal health in their communities. These themes were: community health education; advocacy for health improvement; community voluntary work; and being exemplary. The fifth and final theme provides the avenues, including drama and sports, that the youth suggested they could use for conveying messages to the community concerning maternal and general health. Health education on topics such as the importance of delivering at health facilities was emphasised. Regarding advocacy, the youth said they can be involved in reaching out to various stakeholders to raise concerns affecting maternal health. Voluntary work such as construction of energy stoves for pregnant women emerged. The youth also highlighted that they could be exemplary for instance by males accompanying their spouses during antenatal visits. With the need to continuously engage community actors in health initiatives, youth should be considered and supported as important stakeholders so they may engage in activities to improve health within their communities. [ABSTRACT FROM AUTHOR]

Episiotomy is an enlargement of the vaginal orifice made by a surgical incision of the perineum. This review aimed to provide a socio-historical retrospective on the practice or episiotomy. Using the criteria from the PRISMA guidelines, the authors conducted a literature review, browsing twenty databases and several papers available in the gray literature. Sixty-four articles, seven reports, and fifteen books were selected. Through this study, four eras with different approaches to episiotomy practice could be identified: 1792–1920, 1920–1980, 1980–1996, and 1996–2018. This review shows that institutionalization and medicalization of birth lead to a systematic practice of episiotomy in many westernized countries until 1996. Lay questioning and evidence-based medicine may have reversed this trend into a restrictive practice. After making an inventory of the factors associated with the evolution of change in the rate of episiotomies, the review finally revealed that evolution of the practice of episiotomy has also been influenced by ideological, political, and social factors. [ABSTRACT FROM AUTHOR]

Existing scholarship on the Emergency’s sterilisation programme largely excludes women’s experiences, echoing the Shah Commission of Inquiry’s focus on men’s complaints against the government in its published reports. This paper re-orients historical understandings of this programme to account for female sterilisation during 1975–1977. By reading the Commission’s extensive collection of archived files against the grain, I use the male-dominated archive to illuminate the gendered nature of this policy and its effects on India’s women. Against dominant perceptions that the Emergency’s sterilisation programme focused entirely on vasectomy, this paper discusses instances where women were critical in families’ attempts to negotiate the regime’s coercive measures. It also analyses the negative impacts of coercion on the ‘girl child’ and the consequences of the Emergency’s single minded focus on sterilisation for the Mother and Child Health programme. Through these discussions I argue that such measures exacerbated existing gendered biases. In doing so, this paper challenges dominant understandings of the Emergency’s sterilisation programme and explores women’s experiences. [ABSTRACT FROM AUTHOR]

Early interactions between infants and their caregivers are fundamental to child development, and the parent–infant relationship is believed to provide the foundation for healthy and secure attachment relationships and for infant mental health. Over time, these secure attachment relationships become the backbone for positive child outcomes across development. Abundant research to date confirms that parental mental illness, including depression and PTSD following trauma exposure, may have a detrimental impact on parenting quality and subsequent early child relationship formations. This review paper summarizes the literature on the role of sensitive parenting and a healthy mother–infant relationship in establishing a secure mother–infant attachment bond, which in turn is critical for the child's healthy socioemotional and cognitive development. The review also highlights the roles of maternal perinatal depression, PTSD, and/or exposure to interpersonal violence or childhood maltreatment onto parenting, bonding, and child attachment style towards the caregiver. The final section discusses existing therapeutic interventions and approaches that bolster early parenting practices and early maternal–child relationships. Specific emphasis is placed on relational interventions that address bonding and attachment disturbances in the context of maternal perinatal mental health risk and trauma. [ABSTRACT FROM AUTHOR]

To achieve Millennium Development Goal 5 on maternal health, many countries have focused on marginalized women who lack access to care. Promoting facility-based deliveries to ensure skilled birth attendance and emergency obstetric care has become a main measure for preventing maternal deaths, so women who opt for home births are often considered 'marginal' and in need of targeted intervention. Drawing upon ethnographic data from Nicaragua, this paper critically examines the concept of marginality in the context of official efforts to increase institutional delivery amongst the rural poor, and discusses lack of access to health services among women living in peripheral areas as a process of marginalization. The promotion of facility birth as the new norm, in turn, generates a process of 're-marginalization', whereby public health officials morally disapprove of women who give birth at home, viewing them as non-compliers and a problem to the system. In rural Nicaragua, there is a discrepancy between the public health norm and women's own preferences and desires for home birth. These women live at the margins also in spatial and societal terms, and must relate to a health system they find incapable of providing good, appropriate care. Strong public pressure for institutional delivery makes them feel distressed and pressured. Paradoxically then, the aim of including marginal groups in maternal health programmes engenders resistance to facility birth. [ABSTRACT FROM AUTHOR]

Objective: Review primary research regarding PTSD Post-Childbirth (PTSD-PC) that focussed on Quality of Provider Interaction (QPI) from the perspective of women who developed PTSD-PC, or midwives. Background: Up to 45% of women find childbirth traumatic. PTSD-PC develops in 4% of women (18% in high-risk groups). Women's subjective experiences of childbirth are the most important risk factor in the development of PTSD-PC, with perceived QPI being key. Methods: A systematic search was performed for PTSD-PC literature. Reviewed papers focussed on either women's subjective childbirth experiences, particularly QPI, or midwives' perspectives on QPI. Study quality was assessed using the Critical Appraisal Skills Programme (CASP) tools, and a narrative synthesis of findings produced. Results: Fourteen studies were included. Three features of QPI contribute towards developing PTSD-PC: interpersonal factors; midwifery care factors; and lack of support. Conclusion: QPI is a significant factor in the development of PTSD-PC and the identified key features of QPI have potential to be modified by midwives. The development of guidelines for midwives should be grounded on evidence highlighted in this review, along with further high-quality qualitative research exploring QPI from the perspective of women with PTSD-PC, but also midwives' knowledge and needs regarding their role within QPI. [ABSTRACT FROM AUTHOR]

Background: Improving maternal health is a major development goal, with ambitious targets set for high-mortality countries like Bangladesh. Following a steep decline in the maternal mortality ratio over the past decade in Bangladesh, progress has plateaued at 196/100,000 live births. A voucher scheme was initiated in 2007 to reduce financial, geographical and institutional barriers to access for the poorest. Objective: The current paper reports the effect of vouchers on the use of continuum of maternal care. Methods: Cross-sectional surveys were carried out in the Chattogram and Sylhet divisions of Bangladesh in 2017 among 2400 women with children aged 0–23 months. Using Cluster analysis utilisation groups for antenatal care, facility delivery and postnatal care were formed. Clusters were regressed on voucher receipt to identify the underlying relationship between voucher receipt and utilisation of care while controlling for possible confounders. Results: Four clusters with varying levels of utilisation were identified. A significantly higher proportion of voucher-recipients belonged to the high-utilisation cluster compared to non-voucher recipients (43.5% vs. 15.4%). For the poor voucher recipients, the probability of belonging to the high-utilisation cluster was higher compared to poor non-voucher recipients (33.3% vs. 6.8%) and the probability of being in the low-utilisation cluster was lower than poor non-voucher recipients (13.3% vs. 55.4%). Conclusion: The voucher programme enhanced uptake of the complete continuum of maternal care and the benefits extended to the most vulnerable women. However, a lack of continued transition through the continuum of maternal care was identified. This insight can assist in designing effective interventions to prevent intermittent or interrupted care-seeking. Programmes that improve access to quality healthcare in pregnancy, childbirth and the postnatal period can have wide-ranging benefits. A coherent continuum-based approach to understanding maternal care-seeking behaviour is thus expected to have a greater impact on maternal, newborn and child health outcomes. [ABSTRACT FROM AUTHOR]

Background: Community participation can provide increased understanding and more effective implementation of strategies that seek to improve outcomes for women and newborns. There is limited knowledge on how participatory processes take place and how this affects the results of an intervention. Objective: This paper presents the results of two years of implementing (2013–2015) community groups for maternal health care in Magu District, Tanzania. Method: A total of 102 community groups were established, and 77 completed the four phases of the participatory learning and action cycle. The four phases included identification of problems during pregnancy and childbirth (phase 1), deciding on solutions and planning strategies (phase 2), implementation of strategies (phase 3) and evaluation of impact (phase 4). Community group meetings were facilitated by 15 trained facilitators and groups met monthly in their respective villages. Data was collected as an ongoing process from facilitator and meeting reports, through interviews with facilitators and local leaders and from focus group discussions with community group participants. Results: The majority of groups prioritized problems related to the availability of and accessibility to health services. The most commonly actioned solution was the provision of health education to the community. Almost all groups (95%) experienced a positive impact on the community as results of their actions, including increased maternal health knowledge and positive behaviour changes among health care workers. Facilitators were positive about the community groups, stating that they were grateful for the gained knowledge on maternal health, and positively regarded the involvement of men in community groups, which are traditionally women-only. Conclusion: The process of establishing and undertaking community groups in itself appeared to have a positive perceived impact on the community. However, sustained behaviour change, power dynamics and financial incentives need to be carefully considered during implementation and sustaining the community groups. [ABSTRACT FROM AUTHOR]

Reducing barriers to use maternal health care is one of the critical components to improving maternal health. Rwanda is among the countries that have made tremendous efforts to reduce maternal mortality. However, the current maternal mortality ratio is still high which calls for further efforts to be considered. This study used a qualitative approach to understand mothers' perceptions and experiences of using maternal health care in Rwanda. Using in-depth interviews and focus group discussions, data were collected in the Western and Eastern provinces of the country where forty-five women participated in the study from June to August 2014. This paper highlights perceptions of these participants regarding issues that contribute to suboptimal use of maternal health-care services. The geographical, financial, and social-cultural barriers that emerged in this study highlight the need to understand mothers' experiences and perceptions when using maternal health care as Rwanda and other countries strive to reduce negative maternal health outcomes. [ABSTRACT FROM AUTHOR]

Structural barriers such as a restrictive legal environment, limited medical resources, and highcosts inhibit access to safe abortion in the Democratic Republic of the Congo (DRC); these barriers are exacerbated by two decades of conflict. Socio-normative barriers further complicate access to safe abortion and post-abortion care (PAC) in DRC, where fear of abortion-related stigma may lead women to avoid PAC services. Programme partners support the Ministry of Health to provide good quality contraceptive and PAC services in North and South Kivu, DRC. This paper presents results from focus group discussions that explored community members' attitudes towards women who induce abortion and their care-seeking behaviour in programme areas. Results indicate that while abortion stigma was widespread, community members' attitudes towards women who induced abortions were not one-dimensional. Although they initially expressed negative opinions regarding women who induced abortion, beliefs became more nuanced as discussion shifted to the specific situations that could motivate a woman to do so. For example, many considered it understandable that a woman would induce abortion after rape: perhaps unsurprising, given the prevalence of conflict-related sexual violence in this area. While community members believed that fear of stigma or associated negative social consequences dissuaded women from seeking PAC, a majority believed that all women should have access to life-saving PAC. This commitment to ensuring that women who induced abortion have access to PAC, in addition to the professed acceptability of induced abortion in certain situations, indicates that there could be an opening to destigmatise abortion access in this context. [ABSTRACT FROM AUTHOR]

In this paper, we examine the perceptions and experiences of childbirth among a group of wealthier women in Dhaka through in-depth interviews. We find that a number of factors including preference for Caesarean Section (CS), socio-economic position, family structure, and perceptions of modern childbirth contributed to the women's overuse of medical childbirth services. Furthermore, women's capacity to purchase modern maternal health care in the private sector did not necessarily ensure high quality care in a health system which approaches maternal healthcare as a profit-making enterprise rather than as an essential human right. [ABSTRACT FROM AUTHOR]

The caste system is a complex social stratification system which has been abolished, but remains deeply ingrained in India. Scheduled Caste (SC) women are one of the historically deprived groups, as reflected in poor maternal health outcomes and low utilisation of maternal healthcare services. Key government schemes introduced in 2005 mean healthcare-associated costs should now be far less of a deterrent. This paper examines the factors contributing to this low use of maternal health services by investigating the perceptions, health-seeking behaviours and access of SC women to maternal healthcare services in Bihar, India. Eighteen in-depth, semi-structured interviews were conducted with SC women in Bihar. Data were analysed using Framework Analysis and presented using the AAAQ Toolbox. Main facilitating factors included the introduction of accredited social health activists (ASHAs), free maternal health services, the Janani Shishu Suraksha Karyakram (JSSK), and changes in the cultural acceptability of institutional delivery. Main barriers included inadequate ASHA coverage, poor information access, transport costs and unauthorised charges to SC women from healthcare staff. SC women in Bihar may be inequitably served by maternal health services, and in some cases may face specific discrimination. Recommendations to improve SC service utilisation include research into the improvement of postnatal care, reducing unauthorised payments to healthcare staff and improvements to the ASHA programme. [ABSTRACT FROM AUTHOR]

Mistreatment of women during childbirth at health facilities violates their human rights and autonomy and may be associated with preventable maternal and newborn mortality and morbidity. In this paper, we explore women’s perspectives on mistreatment during facility-based childbirth as part of a bigger World Health Organization (WHO) multi-country study for developing consensus definitions, and validating indicators and tools for measuring the burden of the phenomenon. Focus group discussions (FGDs) and in-depth interviews (IDIs) were used to explore experiences of mistreatment from women who have ever given birth in a health facility in Koforidua and Nsawam, Ghana. Interviews were audio-recorded, transcribed and thematic analysis conducted. A total of 39 IDIs and 10 FGDs involving 110 women in total were conducted. The major types of mistreatment identified were: verbal abuse (shouting, insults, and derogatory remarks), physical abuse (pinching, slapping) and abandonment and lack of support. Mistreatment was commonly experienced during the second stage of labour, especially amongst adolescents. Inability to push well during the second stage, disobedience to instructions from birth attendants, and not bringing prescribed items for childbirth (mama kit) often preceded mistreatment. Most women indicated that slapping and pinching were acceptable means to “correct” disobedient behaviours and encourage pushing. Women may avoid giving birth in health facilities in the future because of their own experiences of mistreatment, or hearing about another woman’s experience of mistreatment. Consensus definitions, validated indicators and tools for measuring mistreatment are needed to measure prevalence and identify drivers and potential entry points to minimise the phenomenon and improve respectful care during childbirth. [ABSTRACT FROM AUTHOR]

Concerns about disrespect and abuse (D&A) experienced by women during institutional birth have become critical to the discourse on maternal health. The rapid growth of the field from diverse points of origin has given rise to multiple and, at times, confusing interpretations of D&A, pointing to the need for greater clarity in the concepts themselves. Furthermore, attention to measurement of the problem has been excessive when viewed in relation to the small amount of work on critical drivers of disrespect and abuse. This paper raises some key issues of conceptualisation and measurement for the field, puts forward a working definition, and explores two critical drivers of D&A - intersecting social and economic inequality, and the institutional structures and processes that frame the practice of obstetric care. By identifying gaps and raising questions about the deeper causes of D&A, we point to potentially fruitful directions for research and action. [ABSTRACT FROM AUTHOR]

Human rights has been a vital tool in the global movement to reduce maternal mortality and to expose the disrespect and abuse that women experience during childbirth in facilities around the world. Yet to truly transform the relationship between women and providers, human rights-based approaches (HRBAs) will need to go beyond articulation, dissemination and even legal enforcement of formal norms of respectful maternity care. HRBAs must also develop a deeper, more nuanced understanding of how power operates in health systems under particular social, cultural and political conditions, if they are to effectively challenge settled patterns of behaviour and health systems structures that marginalise and abuse. In this paper, we report results from a mixed methods study in two hospitals in the Tanga region of Tanzania, comparing the prevalence of disrespect and abuse during childbirth as measured through observation by trained nurses stationed in maternity wards to prevalence as measured by the self-report upon discharge of the same women who had been observed. The huge disparity between these two measures (baseline: 69.83% observation vs. 9.91% self-report; endline: 32.91% observation vs. 7.59% self-report) suggests that disrespect and abuse is both internalised and normalised by users and providers alike. Building on qualitative research conducted in the study sites, we explore the mechanisms by which hidden and invisible power enforces internalisation and normalisation, and describe the implications for the development of HRBAs in maternal health. [ABSTRACT FROM AUTHOR]

This paper shores up the overdetermined web of fear-desire-helplessness-aspiration that impinges on the birthing experiences of women at the economic periphery of urbanity, i.e. the urban poor, positioned at the borders of the urban and its outside, affluence and its lack. The urban poor (pregnant) woman, by dint of being physically located in the city remains unable to be part of the state healthcare network in rural areas; at the same time she is marked by an inability to purchase healthcare from high-end urban private providers. Consequently, she is positioned in an in-between space of access and care, aspirations and resistance, occasionally getting (even physically) trapped in a limbo between the hospital/institution and its outside. For this woman, the materiality of the hospital symbolises development-modernity; in accessing the hospital, the urban poor woman accesses an ontology that is “like the well-off people,” the “legitimate” claimants of the city. Between her dreams of approximating the space of urbanity and development, and an experience of being pushed back to the city's periphery—locationally and metaphorically, the urban poor woman gets inscribed by conflicting and counterpoised experiences of birthing, which is what this paper maps. [ABSTRACT FROM PUBLISHER]

Information and Communications Technology (ICT) offers enormous opportunity and innovation to improve public health and health systems.This paper explores the intersections between mHealth and sexual and reproductive health and rights in both policy and practice. It is a qualitative study, informed by policy review and key informant interviews. Three case studies provide evidence of what is happening on the ground in relation to ICTs and reproductive health and rights. We argue that in terms of policy, there is little overlap between health rights and communication technology. In the area of practice, however, significant interventions address aspects of reproductive health. At present, the extent to which mHealth addresses the full range of reproductive justice and sexual and reproductive health and rights is limited, particularly in terms of government initiatives. The paper argues that mHealth projects tend to avoid contentious aspects of sexual health, while addressing favourable topics such as pregnancy and motherhood. The ways in which information is framed in mHealth mirrors current gaps within sexual and reproductive health and rights, where a limited and conservative lens predominates, and which may result in narrow programming and implementation of services. [ABSTRACT FROM AUTHOR]

The papers and commentaries in this special issue illuminate progress made by low- and middle-income countries towards implementation of the Programme of Action (PoA) agreed by 179 countries during the International Conference on Population and Development in Cairo in 1994. The PoA presents a path-breaking sexual and reproductive health and rights (SRHR) framework for global and national population and health policies. While progress towards implementation has been made at global, regional and national levels, continuing and new challenges require that high priority be given to SRHR for all, particularly women and girls, during the remaining months of the millennium development goals and in the United Nations post-2015 development agenda. This paper highlights three critical gaps, raised in other papers: inequalities in access to sexual and reproductive health (SRH) information and services; the widespread need to improve SRH services to meet public health, human rights and medical ethics standards for quality of care; and the absence or inadequate use of accountability mechanisms to track and remedy the other two. We discuss priority actions to achieve equality, quality and accountability in SRHR policies, programmes and services, especially those that should be included in the post-2015 development agenda. [ABSTRACT FROM AUTHOR]