Women’s rights: the impact of management systems, managers’ practice & attitudes on midwives’
Start date: 18 June 2017
Background: In Afghanistan the number of midwives and their skills have increased through a competency-based training that includes professional ethics. There is a disconnect, however, between midwifery training and the quality of clinical and interpersonal care received by women in childbirth.
Purpose/Objective: This study explored the culture of care in a Kabul maternity hospital. The aims were to understand the experiences and values of Afghan healthcare providers, perspectives on care and the barriers and facilitators to quality care.
Method: This qualitative ethnographic research took place between 2010 and 2012. Six weeks of participant observation, 23 interviews with hospital staff, two focus groups with women in the community and 41 background interviews provided diverse perspectives on care in Kabul maternity hospitals. Thematic analysis was applied and ethical approval was granted in Afghanistan.
Key Findings: Management practices and attitudes dominated the midwives’ interviews. Staff talked of extreme pressures from an ‘impossible’ workload, a high proportion of complications and the lack of a shift system. They were ‘unable to care as they would like to’. Midwives described a punitive working environment where they did not feel respected, valued, or treated fairly by management. As a consequence many lost interest in their work, or had left the profession. This presentation highlights the pivotal role of management in (a) providing systems that enable care; and (b) developing caring, equitable and respectful staff policies.
Discussion: Working environments and management practices contribute directly to poor quality care. Therefore strategies to prevent the neglect or mistreatment of women in childbirth and support the rights of women must include the structural and interpersonal support needs and rights of healthcare providers.
 White Ribbon Alliance (2011). Respectful Maternity Care: The Universal Rights of Childbearing Women. White Ribbon Alliance.
 United Nations Population Fund (2014). State of Afghanistan's Midwifery 2014. Kabul, United Nations Population Fund.
 Rahmani Z., Brekke M (2013). Antenatal and obstetric care in Afghanistan – a qualitative study among health care receivers and health care providers. BMC Health Services Res 13: 166-166.