Parallel worlds: An ethnography of care in an Afghan maternity hospital

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

Journal: Social Science and Medicine

Volume: 216

Pages: 33-40

eISSN: 1873-5347

ISSN: 0277-9536

DOI: 10.1016/j.socscimed.2018.09.010

Abstract:

Aspirations of quality, equitable and respectful care for all women in childbirth have, so far, been unrealised. Sub-optimal care remains the norm in many settings despite decades of substantial investment, the introduction of evidence-based policies, procedures and training programmes. Improving the standard of facility-based care for childbearing women in Afghanistan is an example. This ethnography of a large public Afghan maternity hospital explored the experiences, motivations and constraints of healthcare providers. The aim was to identify barriers and facilitators in the delivery of care. Participant observation, semi-structured interviews, and focus group discussions were used to gather diverse perspectives on childbirth and care between 2010 and 2012. The influences of the sociocultural setting and political economy on facility-based care are discussed in this paper. Under the surface of this maternity hospital, social norms were in conflict with the principles of biomedicine. Contested areas included the control of knowledge, equity and the primary goal of work. The institutional culture was further complicated by pressure from powerful elites. These unseen values and pressures explain much of the disconnection between policy and implementation, education and the everyday behaviours of healthcare providers. Improving the quality of care and equity in Afghan public maternity hospitals will require political will from all stakeholders to acknowledge these issues and find culturally attuned ways to address them. Furthermore, the notion of competing world-views on healthcare has relevance beyond Afghanistan.

http://eprints.bournemouth.ac.uk/31239/

Source: Scopus

Parallel worlds: An ethnography of care in an Afghan maternity hospital.

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

Journal: Soc Sci Med

Volume: 216

Pages: 33-40

eISSN: 1873-5347

DOI: 10.1016/j.socscimed.2018.09.010

Abstract:

Aspirations of quality, equitable and respectful care for all women in childbirth have, so far, been unrealised. Sub-optimal care remains the norm in many settings despite decades of substantial investment, the introduction of evidence-based policies, procedures and training programmes. Improving the standard of facility-based care for childbearing women in Afghanistan is an example. This ethnography of a large public Afghan maternity hospital explored the experiences, motivations and constraints of healthcare providers. The aim was to identify barriers and facilitators in the delivery of care. Participant observation, semi-structured interviews, and focus group discussions were used to gather diverse perspectives on childbirth and care between 2010 and 2012. The influences of the sociocultural setting and political economy on facility-based care are discussed in this paper. Under the surface of this maternity hospital, social norms were in conflict with the principles of biomedicine. Contested areas included the control of knowledge, equity and the primary goal of work. The institutional culture was further complicated by pressure from powerful elites. These unseen values and pressures explain much of the disconnection between policy and implementation, education and the everyday behaviours of healthcare providers. Improving the quality of care and equity in Afghan public maternity hospitals will require political will from all stakeholders to acknowledge these issues and find culturally attuned ways to address them. Furthermore, the notion of competing world-views on healthcare has relevance beyond Afghanistan.

http://eprints.bournemouth.ac.uk/31239/

Source: PubMed

Parallel worlds: An ethnography of care in an Afghan maternity hospital

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

Journal: SOCIAL SCIENCE & MEDICINE

Volume: 216

Pages: 33-40

ISSN: 0277-9536

DOI: 10.1016/j.socscimed.2018.09.010

http://eprints.bournemouth.ac.uk/31239/

Source: Web of Science (Lite)

Parallel worlds: An ethnography of care in an Afghan maternity hospital

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

Journal: Social Science & Medicine

Publisher: Elsevier

ISSN: 0277-9536

DOI: 10.1016/j.socscimed.2018.09.010

Abstract:

Aspirations of quality, equitable and respectful care for all women in childbirth have, so far, been unrealised. Sub-optimal care remains the norm in many settings despite decades of substantial investment, the introduction of evidence-based policies, procedures and training programmes. Improving the standard of institutional care for childbearing women in Afghanistan is an example.

This ethnography of a large public Afghan maternity hospital explored the experiences, motivations and constraints of healthcare providers. The aim was to identify barriers and facilitators in the delivery of care. Participant observation, semi-structured interviews, and focus group discussions were used to gather diverse perspectives on childbirth and care between 2010 and 2012. The influences of the sociocultural setting and political economy on facility-based care are discussed in this paper.

Under the surface of this maternity hospital, social norms were in conflict with the principles of biomedicine. Contested areas included the control of knowledge, equity and the primary goal of work. The institutional culture was further complicated by pressure from powerful elites. These unseen values and pressures explain much of the disconnection between policy and implementation, education and the everyday behaviours of healthcare providers. Improving the quality of care and equity in Afghan public maternity hospitals will require political will from all stakeholders to acknowledge these issues and find culturally attuned ways to address them. Furthermore, the notion of competing world-views on healthcare has relevance beyond Afghanistan.

http://eprints.bournemouth.ac.uk/31239/

Source: Manual

Parallel worlds: An ethnography of care in an Afghan maternity hospital.

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

Journal: Social science & medicine (1982)

Volume: 216

Pages: 33-40

eISSN: 1873-5347

ISSN: 0277-9536

DOI: 10.1016/j.socscimed.2018.09.010

Abstract:

Aspirations of quality, equitable and respectful care for all women in childbirth have, so far, been unrealised. Sub-optimal care remains the norm in many settings despite decades of substantial investment, the introduction of evidence-based policies, procedures and training programmes. Improving the standard of facility-based care for childbearing women in Afghanistan is an example. This ethnography of a large public Afghan maternity hospital explored the experiences, motivations and constraints of healthcare providers. The aim was to identify barriers and facilitators in the delivery of care. Participant observation, semi-structured interviews, and focus group discussions were used to gather diverse perspectives on childbirth and care between 2010 and 2012. The influences of the sociocultural setting and political economy on facility-based care are discussed in this paper. Under the surface of this maternity hospital, social norms were in conflict with the principles of biomedicine. Contested areas included the control of knowledge, equity and the primary goal of work. The institutional culture was further complicated by pressure from powerful elites. These unseen values and pressures explain much of the disconnection between policy and implementation, education and the everyday behaviours of healthcare providers. Improving the quality of care and equity in Afghan public maternity hospitals will require political will from all stakeholders to acknowledge these issues and find culturally attuned ways to address them. Furthermore, the notion of competing world-views on healthcare has relevance beyond Afghanistan.

http://eprints.bournemouth.ac.uk/31239/

Source: Europe PubMed Central

Parallel worlds: An ethnography of care in an Afghan maternity hospital

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

Journal: Social Science & Medicine

Volume: 216

Issue: November

Pages: 33-40

ISSN: 0277-9536

Abstract:

Aspirations of quality, equitable and respectful care for all women in childbirth have, so far, been unrealised. Sub-optimal care remains the norm in many settings despite decades of substantial investment, the introduction of evidence-based policies, procedures and training programmes. Improving the standard of institutional care for childbearing women in Afghanistan is an example.

This ethnography of a large public Afghan maternity hospital explored the experiences, motivations and constraints of healthcare providers. The aim was to identify barriers and facilitators in the delivery of care. Participant observation, semi-structured interviews, and focus group discussions were used to gather diverse perspectives on childbirth and care between 2010 and 2012. The influences of the sociocultural setting and political economy on facility-based care are discussed in this paper.

Under the surface of this maternity hospital, social norms were in conflict with the principles of biomedicine. Contested areas included the control of knowledge, equity and the primary goal of work. The institutional culture was further complicated by pressure from powerful elites. These unseen values and pressures explain much of the disconnection between policy and implementation, education and the everyday behaviours of healthcare providers. Improving the quality of care and equity in Afghan public maternity hospitals will require political will from all stakeholders to acknowledge these issues and find culturally attuned ways to address them. Furthermore, the notion of competing world-views on healthcare has relevance beyond Afghanistan.

http://eprints.bournemouth.ac.uk/31239/

Source: BURO EPrints