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The Struggle to Provide Culturally-Appropriate Maternity Care

first_imgPosted on September 28, 2017October 6, 2017By: Sarah Hodin, Project Coordinator II, Women and Health Initiative, Harvard T.H. Chan School of Public HealthClick to share on Facebook (Opens in new window)Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Reddit (Opens in new window)Click to email this to a friend (Opens in new window)Click to print (Opens in new window)A core component of high quality health care is ensuring that services are people-centered—that providers incorporate the “preferences and aspirations of individual service users and the culture of their community.” The World Health Organization’s “Standards for improving quality of maternal and newborn care in health facilities” released in 2016 recommend that practitioners participate in regular in-service trainings to improve their interpersonal communication, counseling skills and cultural competence to encourage the provision of respectful maternity care. Organizations such as the Joint Commission, the National Institutes of Health, the International Confederation of Midwives and the International Federation of Gynecology and Obstetrics have also emphasized the importance of cultivating cultural competence in health care and offered practical guidance.How have program implementers, clinicians and researchers approached the issue of providing culturally-appropriate maternity care, and what challenges have they encountered?A recent paper in BMC Pregnancy and Childbirth aimed to answer these questions. This paper was a secondary analysis of a previous systematic review that the authors published in 2014 as part of the MHTF-PLOS Collection, “Integrating Health Care to Meet the Needs of the Mother-Infant Pair.” The authors reviewed 15 studies to examine how interventions to provide culturally-appropriate maternal health services—specifically related to patients’ ethnicity, language and religion—affected utilization of skilled antenatal, intrapartum and postnatal care.Ten of the 15 studies found that the intervention had positive effects on skilled maternity care utilization, especially antenatal care attendance.Keys to successThe following four themes illustrate barriers and facilitators to ensuring that women receive culturally-appropriate maternity care:AccessResearchers noted that financial and geographic barriers often inhibit women of certain cultural groups from seeking maternal health services, even if those services are culturally-appropriate. In some settings, gender-based restrictions on travel, low levels of education or literacy, limited knowledge of health services and a lack of social support or child care were also barriers to access. Facility-based interventions cannot be effective if the target population cannot access services.Community participationCreating mutual respect through coordination and communication among health workers and communities was essential for the success of interventions. Some program implementers highlighted the importance of establishing community ownership over interventions. Community-based participatory research is a promising approach that involves communities in program design from the beginning.Person-centered carePoor interactions between patients and providers was a common issue, with many women reporting caretakers’ unfriendliness, discrimination and negative attitudes. These experiences of disrespect and abuse decreased women’s self-worth and caused feelings of anxiety and shame. The most common strategy to combat these issues was employing staff with similar cultural or linguistic backgrounds to those of the women seeking care.Continuum of careSeveral interventions focused on a specific aspect of maternity care such as antenatal visits, but addressing issues of cultural appropriateness across the entire continuum of care was an important success factor. Collaboration among different care providers was essential to ensuring culturally-appropriate services to women at every encounter with health workers during pregnancy, delivery and postpartum.The stakes are highRespectful maternity care is a human right, and failing to guarantee culturally-appropriate care has serious implications. For example, women who do not receive respectful and culturally sensitive care at a health facility are less likely to seek facility-based maternity care in the future, which can have long-term consequences for both mother and baby.It is important to note that the 15 studies included in this review were conducted in Australia, Peru, the United States and the United Kingdom. Given how critical local contexts are in evaluating interventions to provide culturally-appropriate care, further research in other regions is needed to ensure that no woman is left behind.—Read the full, open access paper, “Interventions to provide culturally-appropriate maternity care services: Factors affecting implementation.”Learn more about respectful maternity care.Check out related posts from the MHTF blog:Respecting Choice in Childbirth: Preferred Delivery Positions Among Ethnic Minorities in VietnamIntegrating Culture Into Maternity Care Programs: A Systematic Mapping of InterventionsShare this: ShareEmailPrint To learn more, read:last_img read more


first_img 5 Comments   Share   Grace expects Greinke trade to have emotional impact Derrick Hall satisfied with D-backs’ buying and selling Bidwill added Wilks, who spent the past six seasons with the Carolina Panthers, is quick to adapt how he coaches each individual player. Some may need to be pushed more than others. Some are self-motivated, and perhaps a hands-off approach is better.It’s certainly not an easy task to reach an entire 90-man roster, but the Cardinals believe they found that unique individual who can be a leader of men, which is so vital in the National Football League.“Across the board,” Bidwill said Tuesday, “his players at all the teams he’s coached at in the NFL, not only did we seek their input but many of them — unsolicited — reached out to us to tell us what a great coach he is. He’s a terrific communicator, which is a key part of being a terrific leader.”The decision to hire Wilks was made on Saturday, Bidwill said, following a second interview.And though Wilks has never been an NFL head coach, he’s been in the league for 12 years with a pair of Super Bowl appearances on his resume.Wilks checks all the boxes Bidwill laid out when Bruce Arians announced his retirement on Jan. 1.The Cardinals wanted 1) a great leader, 2) someone with a track record of success and 3) “continue this great culture of accountability that’s been around this organization for a number of years thanks to Coach Bruce Arians,” Bidwill said. New Arizona Cardinals NFL football head coach Steve Wilks speaks, Tuesday, Jan. 23, 2018, after being introduced at the teams’ training facility in Tempe, Ariz. (AP Photo/Matt York) TEMPE, Ariz. – Once again, the Arizona Cardinals waited. And waited. And then waited some more.But, in the end, they hired whom team president Michael Bidwill called, “a great leader.” And that, first and foremost, was what Bidwill and general manager Steve Keim set out to find in their new head coach, regardless the time it took.The person they found was Steve Wilks.“Not just a leader with a high football IQ, but also a high football EQ (emotional quotient). He just doesn’t coach football players, he coaches people,” Bidwill said. “He knows where the players are 15 minutes after they walk into the training facility and makes sure where they are as people, because they aren’t going to be ready to learn and be well-coached if they’ve got any issues outside of the organization.”center_img Top Stories The Cardinals were the last of the seven teams with head coaching vacancies to target an individual, just as they were five years earlier when they named Arians, who ended his tenure as the winningest head coach in franchise history.It was a three-week search, one that included “thousands and thousands of miles” of travel and “hundreds of hours worth of interviews, conversations, text messages (and) emails,” Bidwill said.In total, nine candidates were interviewed.The Cardinals “cast a wide net” according to Keim, and they caught Wilks.“From Day 1, his infectious personality, his passion for the game, his ability to relate to players (and) on top of that, his ability to hold players accountable,” Keim said.“In the coaching ranks, you can become a better coach through experience but to have leadership, to me, there’s an innate part of that; and when you get to know Steve Wilks, you can tell that he has that innate leadership skill that very few people have.” Former Cardinals kicker Phil Dawson retires The 5: Takeaways from the Coyotes’ introduction of Alex Meruelolast_img read more