Perspectives of Care amongst Afghan maternity healthcare providers

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

Conference: ICM 29th Triennial Congress, International Confederation of Midwives

Dates: 19-23 June 2011


The delivery of quality care through skilled attendance is considered a key factor in reducing maternal mortality globally (Freedman et al 2007). Afghanistan has one of the highest maternal mortality ratios (MMR) in the world. The Afghan Ministry of Public Health (MoPH) has made reduction of MMR a top priority. Increasing the percentage of births with skilled attendance is one strategy being implemented. The number of Afghan midwives tripled between 2003 and 2006, however engendering kindness and respect in patient care within the hospital culture remains a challenge (Currie et al 2007). Globally tools are being used to measure the quality of skilled attendance (Hussein et al 2004), but reasons why care is sometimes inadequate despite the presence of a health professional remains unclear. This self-funded, Bournemouth University PhD study aimed to analyse the culture of care within Kabul maternity hospitals. Health care providers’ perspectives, experience and values were sought to address the following questions: What barriers and facilitators do you experience in your work? What support structures are in place for you? What are your thoughts on skilled care in this hospital and how can care be improved? The experiences and values of women in the community regarding skilled attendance gave additional perspective.

This ethnographic study included participant observation, six focus groups and 20 in-depth interviews with purposively chosen health care providers in two Kabul hospitals. Six focus groups and 12 in-depth purposive interviews were held with women from three districts of Kabul. Key stakeholder interviews provided background and context. The study was ethically approved by the MoPH Institutional Review Board. Data was transcribed and coded, iterative and thematic analysis continued throughout.

Preliminary findings will be reported and discussed. They will inform policy and training within Afghan reproductive health services.

Source: Manual