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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]

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]

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]

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]

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]

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 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]

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]

Infant well-being is intrinsically linked to maternal physical and emotional well-being. Internationally health services have implemented policies to identify women at risk of mental health problems and developed effective care pathways. The aim of this paper is to describe how perinatal and infant mental health clinicians perceive their role and the attachment-based interventions they use in their work. The study comes from a larger mixed methods study, which examined two specialist perinatal and infant mental health services in New South Wales (Australia). Two hundred and forty-four medical records were reviewed, and six perinatal and infant mental health clinicians participated in in-depth semi-structured interviews. Data were analysed by content and thematic analysis. One overarching theme, modelling a secure base and three supporting themes, enhancing reflective capacity, enhancing emotional regulation and enhancing empathy emerged from the analysis. These findings demonstrate how perinatal and infant mental health clinicians use attachment theory to inform practice by modelling "holding" and being a secure-base for women. They also provide a clearer understanding of perinatal mental health practice and can be used to inform educational programs for multidisciplinary mental health professionals particularly those working with women and infants. [ABSTRACT FROM AUTHOR]

Purpose: Little is known about the barriers and facilitators to pregnancy, birth and motherhood for disabled women within the New Zealand context. Our study explored this deficit with the aim of improving health care interventions and support for disabled mothers. Methods: This paper reports on the third phase of a mixed-methods study. The first two phases used semi-structured individual and focus group interviews with disabled women, and health professionals, involved in maternity and postnatal care and has been reported elsewhere. Phase 3 utilised a modified Delphi technique with both groups of participants to seek consensus on the prioritisation of recommendations from the study. This article focuses on the disabled women's recommendations. Results: In all, 20 disabled women took part in the Delphi phase of the study (28% of the cohort from Phase 1). In total, 11 key recommendations were identified by the disabled women, with the top seven discussed in detail here. Conclusions: Health professionals and health systems could, and arguably should, utilise a matrix of these recommendations to facilitate a review of service responsiveness to disabled women. [ABSTRACT FROM AUTHOR]

Objective:This paper examines maternal knowledge regarding perinatal and infant mental health amongst mothers in Alexandra township, Johannesburg. The applicability and utility of these Western-derived concepts in a low socio-economic South African setting is examined. Method:A concurrent mixed methods approach was used. Descriptive statistical analysis was conducted on the responses of 255 mothers on a structured questionnaire, designed to elicit levels of knowledge about the relational needs and awareness of infants and the psychosocial needs of mothers, to determine trends in mothers’ knowledge. A thematic content analysis was also conducted on the responses to determine themes and understandings within the mothers’ responses. Results:Maternal knowledge in Alexandra regarding perinatal and infant mental health correlates with maternal education levels. Cultural, contextual and psychological factors appear to influence maternal understandings of infant sentience and maternal ambivalence. Conclusions:Further research is required to determine possible contributions of the denial of negative maternal affect post-birth to elevated levels of post-natal depression found amongst South African mothers parenting in adverse circumstances. There is a need for education regarding key messages from the neuroscience of development, to give these parents opportunities to raise their children in a way that supports healthy cognitive and emotional development. [ABSTRACT FROM PUBLISHER]

Objective:This study aimed to explore health visitors’ (HVs) experiences of the assessment of women with psychological distress and mental health problems across the perinatal period in clinical practice.Background:In international contexts, there is now a firm policy remit for the assessment of psychological and mental health disorder across the perinatal period. Women are in regular contact with health professionals across this time and consultations intuitively create an ideal and appropriate context in which to assess women’s psychological health. National reports and academic literature highlight that to prevent the escalation of perinatal mental illness, significant change is needed to support health professionals in detecting, discussing and dealing with mental illnesses.Methods:In a qualitative aspect of a larger mixed-method study, data were collected from two Focus Group Discussions with HVs pre and post a training session related to assessing and managing perinatal mental health problems in practice. For the purposes of this paper, the data were explicitly examined for references to recognition and assessment.Results:Four themes emerged from the data: recognising the problem; questioning and identification; so what do I do now; the importance of support to promote effective identification and assessment.Conclusion:Findings elucidate the complexities that practitioners face in assessing women’s psychological health in real world settings. HVs’ experiences highlight that the implementation of measures into practice needs to be workable and accompanied by contemporary and appropriately contextualised knowledge, adequate service provision and clear referral pathways to ensure effective assessment of women’s psychological health. [ABSTRACT FROM PUBLISHER]

Lesbian mothers share mainstream existence with other mothers by virtue of their motherhood, but remain marginalised by their non-heterosexual identity. This paper will draw on the qualitative findings of a recent Australian study that examined the experiences of lesbian mothers. Using a story-sharing method, data were collected using three methods; a demographic data sheet, in-depth semi-structured interviews and journaling. The findings demonstrated that participants experienced various forms of homophobia when interfacing with healthcare services and providers and included exclusion, heterosexual assumption, inappropriate questioning and refusal of services. Strategies used to avoid homophobia included screening and crusading. [ABSTRACT FROM AUTHOR]

An interprofessional team of maternity care providers and academics developed a pilot interprofessional education (IPE) program in maternity care for undergraduate students in nursing, midwifery and medicine. There are few published studies examining IPE programs in maternity care, particularly at the undergraduate level, that examine long-term outcomes. This paper outlines findings from a case study that explored how participation in an IPE program in maternity care may enhance student knowledge, skills/attitudes, and may promote their collaborative behavior in the practice setting. The program was launched at a Canadian urban teaching hospital and consisted of six workshops and two clinical shadowing experiences. Twenty-five semi-structured, in-depth interviews were completed with nine participants at various time points up to 20 months post-program. Qualitative analysis of transcripts revealed the emergence of four themes: relationship-building, confident communication, willingness to collaborate and woman/family-centered care. Participant statements about their intentions to continue practicing interprofessional collaboration more than a year post-program lend support to its sustained effectiveness. The provision of a safe learning environment, the use of small group learning techniques with mixed teaching strategies, augmented by exposure to an interprofessional faculty, contributed to the program's perceived success. [ABSTRACT FROM AUTHOR]

Nurses and midwives play a key role in providing universal maternal, child and family health services in Australia. However, the Australian federation of states and territories has resulted in policy frameworks that differ across jurisdictions and services that are fragmented across disciplines and sectors. This paper reports the findings of a study that reviewed and synthesised current Australian service policy or frameworks for maternity and child health services in order to identify the degree of commonality across jurisdictions and the compatibility with international research on child development. Key maternity and child health service policy documents in each jurisdiction were sourced. The findings indicate that current policies were in line with international research and policy directions, emphasising prevention and early intervention, continuity of care, collaboration and integrated services. The congruence of policies suggests the time is right to consider the introduction of a national approach to universal maternal, child health services. [ABSTRACT FROM AUTHOR]

The private health sector in India is generally unregulated. Maharashtra is among the few states which require registration of private hospitals. This paper reports on a study of standards of care in small, private hospitals (less than 30 beds) in Maharashtra state, India, with a focus on maternity care, based on interviews with the hospitals' owners or senior staff, and observation. In the absence of reliable information on the number of private hospitals in the state, a physical listing was carried out in 11 districts and an estimate drawn up; 10% of hospitals found in each location were included in the study sample. We found poor standards of care in many cases, and few or no qualified nurses or a duty medical officer in attendance. Of the 261 hospitals visited, 146 provided maternity services yet 137 did not have a qualified midwife, and though most claimed they provided emergency care, including caesarean section, only three had a blood bank and eight had an ambulance. Government plans to promote public–private partnerships with such hospitals, including for maternity services, create concern, given our findings. The need to enforce existing regulations and collect information on health outcomes and quality of care before the state involves these hospitals further in provision of maternity care is called for. Le secteur privé est en général non réglementé en Inde. Maharashtra est l'un des rares États qui exigent l'agrément des hôpitaux privés. Cet article concerne une étude des normes de soins dans des petits hôpitaux privés (moins de 30 lits) dans l'État de Maharashtra, Inde, en particulier les soins obstétricaux, sur la base d'entretiens avec les propriétaires ou la direction de l'hôpital, et d'observations. En l'absence d'informations fiables sur le nombre d'hôpitaux privés dans l'État, une liste a été dressée dans 11 districts et une estimation a été établie ; 10% des hôpitaux recensés dans chaque site ont été inclus dans l'échantillon de l'étude. Dans beaucoup de cas, nous avons constaté des normes de soins médiocres, et peu ou pas d'infirmières qualifiées ni de médecin de garde présent. Des 261 hôpitaux visités, 146 assuraient des services de maternité, pourtant 137 n'avaient pas de sage-femme qualifiée, et même si la plupart affirmaient pratiquer des soins d'urgence, y compris des césariennes, trois seulement disposaient d'une banque du sang et huit d'une ambulance. Compte tenu de nos conclusions, la volonté du Gouvernement de promouvoir les partenariats publics-privés avec ces hôpitaux, notamment pour les services de maternité, est préoccupante. Il est nécessaire de faire appliquer la réglementation en vigueur et de recueillir des informations relatives aux effets sur la santé et à la qualité des soins avant que l'État n'implique davantage ces hôpitaux dans les soins obstétricaux. En India, el sector salud privado por lo general no es regulado. Maharashtra es uno de los pocos estados que requieren registro de hospitales privados. Este artículo informa sobre un estudio de las normas de asistencia en hospitales privados pequeños (menos de 30 camas), en el estado de Maharashtra, India, con un enfoque en la atención obstétrica, basado en entrevistas con los propietarios de los hospitales o personal de alto nivel, y en observación. En la ausencia de información fidedigna sobre el número de hospitales privados en el estado, se realizó un listado físico en 11 distritos y se calculó el número aproximado. En la muestra del estudio se incluyó el 10% de los hospitales encontrados en cada lugar. En muchos casos, se encontró calidad de atención deficiente y ninguna o pocas enfermeras calificadas o un funcionario médico de turno presente. De los 261 hospitales visitados, 146 ofrecían servicios obstétricos, pero 137 no tenían a una partera profesional calificada. Aunque la mayoría afirmaba ofrecer cuidados de emergencia, incluso cesáreas, sólo tres tenían un banco de sangre y ocho tenían ambulancia. En vista de nuestros hallazgos, los planes gubernamentales de promover alianzas entre los sectores público y privado con estos hospitales, incluso para servicios obstétricos, son preocupantes. Aún es necesario velar por el cumplimiento de los reglamentos en vigor y recopilar información sobre los resultados en salud y la calidad de la atención antes de que el estado implique aun más a estos hospitales en la prestación de servicios obstétricos. [ABSTRACT FROM AUTHOR]

The State Trait Anxiety Inventory (STAI) has been widely used in research with pregnant women. However, few studies have examined its validity for this group. In this paper the content validity of the STAI, the impact of location and consequences for further participation of higher STAI scores are investigated for 215 pregnant women who completed the STAI at hospital or community based clinics. The study participants answered the open ended question, 'How do you feel about your pregnancy?' and whether or not they would be willing to take part in further research. Results indicated that STAI state scores reflected the nature of women's spontaneous comments regarding their pregnancy, with lower anxiety related to more 'positive' comments. The state scores were also found to be sensitive to the risk level associated with the clinic where the inventory was completed; higher scores related to high-risk localities. Women with the highest levels of state or trait anxiety were also less likely to wish to take part in further research. The study concludes that the STAI does reflect the anxiety-related experiences of pregnant women and that its use with pregnant women is appropriate in this respect; however, we recommend that future research notes the issue of potential recruitment biases. [ABSTRACT FROM AUTHOR]