Meeting targets or saving lives: maternal health policy and Millennium Development Goal 5 in Nicaragua

Kvernflaten, Birgit

doi:10.1016/s0968-8080(13)42728-3

Cited by 20 publications

(22 citation statements)

References 13 publications

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“…In part, this is a result of top down, globally-driven policy making, not just in India but also in other countries where maternal health programming to institutionalize child births has been unsuited to local realities. Kvernflaten [32], for instance, describes the impact of the target oriented narrowing of the maternal health agenda to skilled birth attendance and institutional delivery in Nicaragua, and how this has resulted in stunting the role of community health workers and traditional birth attendants, and straining relationships between the community, the health workers and the health system. Tracing the shifts in global advocacy for improving maternal health, Storeng argues that there has been a growing influence of quantitative evidence in evidence-based advocacy in maternal health over the past two decades, which “reinforces an oversimplified “master-narrative” circumscribed by technical solutions to health problems” [33].…”

Section: Discussionmentioning

confidence: 99%

Beyond the template: the needs of tribal women and their experiences with maternity services in Odisha, India

Contractor

Das

Dasgupta³

et al. 2018

Int J Equity Health

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BackgroundOver the past 15 years, several efforts have been made by the Government of India to improve maternal health, primarily through providing cash incentives to increase institutional child birth and strengthen services in the public health system. The result has been a definite but unequal increase in the proportion of institutional deliveries, across geographical areas and social groups. Tribal (indigenous) communities are one such group in which the proportion of institutional deliveries is low. The persistence of these inequities indicates that a different approach is required to address the maternal health challenges in these communities.MethodsThis paper describes an exploratory study in Rayagada District of Odisha which aimed to understand tribal women’s experiences with pregnancy and childbirth and their interactions with the formal health system. Methods included in-depth interviews with women, traditional healers and formal health care providers and outreach workers, observations in the community and health facilities.ResultsThe exploration of traditional practices shows that in this community, pregnancy and childbirth is treated as part of a natural process, not requiring external intervention. There is a well-established practice of birthing in the community which also recognizes the need for health system interventions in case of high-risk births or complications. However, there has been no effort by the health system to build on this traditional understanding of safety of woman and child. Instead, the system continues to rely on incentives and disincentives to motivate women. Traditional health providers who are important stakeholders have not been integrated into the health system. Despite the immense difficulties that women face, however, they do access health facilities, but barriers of distance, language, cultural inappropriateness of services, and experiences of gross violations have further compounded their distrust.ConclusionsThe results of the study suggest a re-examining of the very approach to addressing maternal health in this community. The study calls for reorienting maternal health services, to be responsive to the requirements of tribal women, cater to their cultural needs, provide support to domiciliary deliveries, invest in building trust with the community, and preserve beneficial traditional practices.

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Section: Discussionmentioning

confidence: 99%

Beyond the template: the needs of tribal women and their experiences with maternity services in Odisha, India

Contractor

Das

Dasgupta³

et al. 2018

Int J Equity Health

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“…Importantly, however, there is an inherent paradox in public health. Public health is primarily concerned with the health of the whole population, rather than with the health of the individual (Childress et al, 2002;Kass, 2001). As Childress and colleagues (2002, p. 170) put it, 'public health activities are generally understood to be teleological (end-oriented) and consequentialistthe health of the public is the primary end that is sought and the primary outcome for measuring success.'…”

Section: Participatory Spaces In Healthmentioning

confidence: 99%

Conflicting Health Interventions: Participation in Health in Rural Nicaragua

Kvernflaten

2017

Forum for Development Studies

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Word count: 10238 Birgit Kvernflaten is a PhD candidate at the Centre for Development and the Environment (SUM), at the University of Oslo, Norway. Her research has focused on reproductive health and maternal health in Guatemala and Nicaragua, exploring local perspectives in the context of policies and interventions. Her current PhD research concerns maternal health among rural women in Nicaragua, in particular the policies and practices in relation to maternal healthcare, and how maternal health interventions encounter local socio-cultural realities. Abstract Nicaragua has a long history of health activism and government policies aimed at achieving various models of participation in health. Drawing on ethnographic research in rural Nicaragua, this article situates contemporary participation within this larger historical and political context and critically explores how participation in health is understood and practised. Contemporary health interventions focus on compliance in their endeavour to improve maternal health. This focus, I argue, creates a productive tension between health seekers' and health workers' understanding of themselves as citizens and the government's attempt at achieving public health aims. My empirical focus is on the brigadistas (community health workers), women, and expectant mothers. I describe how brigadistas work as interlocutors between the government and the people. In this relation, women and brigadistas express expectations of and dissatisfaction with the healthcare services offered. Drawing upon an extensive literature on participation, I suggest that within this particular relational space a new political space may appear where demands for improved healthcare services can be articulated and recognized.

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“…As one UK-based NGO worker commented 'the women and girls agenda in global health does not necessarily reflect all we know about gender inequality' (cited in Gideon and Porter, 2015: 10). Empirical studies have also reported that a narrow focus on maternal health has directed attention away from broader understandings of women's health and that other aspects of women's sexual and reproductive health are consequently neglected (Kvernflaten, 2013;Mishra, 2015). They also felt that it offered new opportunities to address the healthcare needs of women and girls, however narrowly these are conceptualized.…”

Section: 'Perverse Outcomes' On the Ground: Ngos Hiv/aids And Maternmentioning

confidence: 99%

“…They acknowledged the role of donors in shaping the wider agenda and were clear that the opportunity to pursue funding through further corporate partnerships, whether directly or via a PPP, frequently undermined how far they were able to integrate a more complex gender analysis of women's health. Empirical studies have also reported that a narrow focus on maternal health has directed attention away from broader understandings of women's health and that other aspects of women's sexual and reproductive health are consequently neglected (Kvernflaten, 2013;Mishra, 2015).…”

Section: 'Perverse Outcomes' On the Ground: Ngos Hiv/aids And Maternmentioning

confidence: 99%

Challenging Gendered Inequalities in Global Health: Dilemmas for NGOs

Gideon¹,

Porter²

2016

Development and Change

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This article considers the implications of the changing funding landscape in global health for NGOs in the health sector, particularly where they have aspired to promote gender equality and justice through their health work. The article reflects on the tensions that arise as a result of the growing influence of business norms within health funding alongside what critics have termed the 'scientization' of global health, and it considers the gendered implications of these developments. It is argued that it is due to the under-valuation and marginalization of community-based work that provides spaces for women's voices in the design and delivery of health interventions that large-scale 'technical' interventions receive priority. The article examines what this means in terms of NGOs' ability to work towards producing transformative change around gender -and indeed racial -equality.The authors would like to thank the anonymous reviewers for their comments on an earlier draft of this article. Development and Change 47(4): 782-797.

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Meeting targets or saving lives: maternal health policy and Millennium Development Goal 5 in Nicaragua

Cited by 20 publications

References 13 publications

Beyond the template: the needs of tribal women and their experiences with maternity services in Odisha, India

Beyond the template: the needs of tribal women and their experiences with maternity services in Odisha, India

Conflicting Health Interventions: Participation in Health in Rural Nicaragua

Challenging Gendered Inequalities in Global Health: Dilemmas for NGOs

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