Afghan women: a qualitative study of the culture of care in a Kabul maternity hospital.

Authors: Arnold, R., van Teijlingen, E., Ryan, K. and Holloway, I.

Start date: 1 November 2013

Central to the provision of respectful care for women having their babies in health care facilities are doctors, midwives and care assistants. We can increase the numbers and skills of health care providers, and include training in professional ethics but how can we ensure respectful care? What is the motivation of health care providers, the context in which they work, and the factors that affect their ability to care? This qualitative, ethnographic PhD study explored the culture of care of one maternity hospital in Kabul Afghanistan. The aim was to understand the barriers and facilitators to quality care, how the Afghan health care providers saw their role, care within the hospital, working conditions and their motivation and values.

Participant observation, in-depth semi-structured interviews with hospital staff, focus group discussions with women in the community and background interviews with key informants were used to collect data from diverse perspectives. Kabul Ministry of Public Health Institutional Review Board provided ethical approval.

Findings highlighted extreme pressures on this almost exclusively female workforce, issues of power and powerlessness in the workplace and in wider society, a hospital culture of blaming, fear of what will happen if a patient dies in their care, and excessive workloads. Of paramount importance for carers was the need to fulfil family obligations and to survive. Afghan women spoke of general dissatisfaction with care practices in hospitals.

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