Midwives' experiences of working conditions, perceptions of professional role and attitudes towards mothers in Mozambique

Adolphson, Katja; Axemo, Pia; Högberg, Ulf

doi:10.1016/j.midw.2016.06.012

Cited by 24 publications

(41 citation statements)

References 16 publications

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“…Because low salaries were found to be particularly demotivating in several LMICs [41], it was unexpected to find that participants’ responses implied a high Commitment to work . Indeed, this could be perceived as commitment and devotion on the part of the health providers in trying to provide empathic and responsive care despite a weak health system with a lack of resources, as has been reported in a previous study in Mozambique [42]. However, the high scores observed in the other dimensions suggest an enabling environment for the provision of maternal and neonatal health care, which is surprising.…”

Section: Discussionmentioning

confidence: 81%

Ready to deliver maternal and newborn care? Health providers’ perceptions of their work context in rural Mozambique

Mocumbi

McKee

Munguambe

et al. 2018

Global Health Action

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Background: Deficiencies in the provision of evidence-based obstetric care are common in low-income countries, including Mozambique. Constraints relate to lack of human and financial resources and weak health systems, however limited resources alone do not explain the variance. Understanding the healthcare context ahead of implementing new interventions can inform the choice of strategies to achieve a successful implementation. The Context Assessment for Community Health (COACH) tool was developed to assess modifiable aspects of the healthcare context that theoretically influence the implementation of evidence. Objectives: To investigate the comprehensibility and the internal reliability of COACH and its use to describe the healthcare context as perceived by health providers involved in maternal care in Mozambique. Methods: A response process evaluation was completed with six purposively selected health providers to uncover difficulties in understanding the tool. Internal reliability was tested using Cronbach’s α. Subsequently, a cross-sectional survey using COACH, which contains 49 items assessing eight dimensions, was administered to 175 health providers in 38 health facilities within six districts in Mozambique. Results: The content of COACH was clear and most items were understood. All dimensions were near to or exceeded the commonly accepted standard for satisfactory internal reliability (0.70). Analysis of the survey data indicated that items on all dimensions were rated highly, revealing positive perception of context. Significant differences between districts were found for the Work culture, Leadership, and Informal payment dimensions. Responses to many items had low variance and were left-skewed. Conclusions: COACH was comprehensible and demonstrated good reliability, although biases may have influenced participants’ responses. The study suggests that COACH has the potential to evaluate the healthcare context to identify shortcomings and enable the tailoring of strategies ahead of implementation. Supplementing the tool with qualitative approaches will provide an in-depth understanding of the healthcare context.

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Section: Discussionmentioning

confidence: 81%

Ready to deliver maternal and newborn care? Health providers’ perceptions of their work context in rural Mozambique

Mocumbi

McKee

Munguambe

et al. 2018

Global Health Action

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“…"If you are dealing with three patients and one has eclampsia, another needs a caesarian section and the third suddenly has a hemorrhage, for sure one will be abandoned. "(Midwife, FGD 2, age group [24][25][26][27][28][29][30] They also linked this to the stress of being accused afterwards of making medical errors.…”

Section: Resultsmentioning

confidence: 99%

“…This commitment and empathy was also described by Adolphoson et. al in 2016, interviewing midwives in different settings in Mozambique [27]. On the downside, the recent evolution of having more demanding and informed patients together with a parallel private system are factors putting pressure on midwives working in the public system.…”

Section: Discussionmentioning

confidence: 99%

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A qualitative study on midwives’ identity and perspectives on the occurrence of disrespect and abuse in Maputo city

Galle

Manaharlal

Griffin

et al. 2020

Preprint

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BACKGROUND Midwifery care plays a vital role in the reduction of preventable maternal and newborn mortality and morbidity. There is a growing concern about the quality of care during facility based childbirth and the occurrence of disrespect and abuse (D&A) worldwide. While several studies have reported a high prevalence of D&A, evidence about the drivers of D&A is scarce. AIM This study aims to explore midwives’ professional identity and perspectives on the occurrence of D&A in urban Mozambique. METHODS A qualitative study took place in the central hospital of Maputo, Mozambique. Nine focus group discussions with midwives were conducted, interviewing 56 midwives. RQDA software was used for analyzing the data by open coding and thematic analysis. RESULTS Midwives felt proud of their profession but felt they were disrespected by the institution and wider society because of their inferior status compared to doctors. Furthermore, they felt being blamed for poor health outcomes. The occurrence of D&A seemed more likely in emergency situations but midwives tended to blame this on women being “uncooperative”. The involvement of birth companions was a protective factor against D&A together with supervision. Conclusion In order to improve quality of care and reduce the occurrence of D&A midwives will need to be treated with more respect within the health system. Furthermore, they should be trained in handling obstetric emergency situations with respect and dignity for the patient. Systematic and constructive supervision might be another promising strategy for preventing D&A.

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“…"As a midwife you are responsible for two lives, which is a huge responsibility, so you want to do it with perfection." (Midwife, FGD 7, age group [31][32][33][34][35][36][37][38][39][40] However, they also revealed that in the city they are losing this unanimous appreciation and linked this to broader access to information and services.…”

Section: Resultsmentioning

confidence: 99%

Midwives’ identity and perspectives on the occurrence of disrespect and abuse in Maputo city: a qualitative study

Galle¹,

Manaharlal²,

Griffin³

et al. 2020

Preprint

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BACKGROUND: Midwifery care plays a vital role in the reduction of preventable maternal and newborn mortality and morbidity. There is a growing concern about the quality of care during facility based childbirth and the occurrence of disrespect and abuse (D&A) worldwide. While several studies have reported a high prevalence of D&A, evidence about the drivers of D&A is scarce. AIM: This study aims to explore midwives’ professional identity and perspectives on the occurrence of D&A in urban Mozambique. METHODS: A qualitative study took place in the central hospital of Maputo, Mozambique. Nine focus group discussions with midwives were conducted, interviewing 54 midwives. RQDA software was used for analysing the data by open coding and thematic analysis from a grounded theory perspective. RESULTS: Midwives felt proud of their profession but felt they were disrespected by the institution and wider society because of their inferior status compared to doctors. Furthermore, they felt blamed for poor health outcomes. The occurrence of D&A seemed more likely in emergency situations but midwives tended to blame this on women being “uncooperative”. The involvement of birth companions was a protective factor against D&A together with supervision. CONCLUSION: In order to improve quality of care and reduce the occurrence of D&A midwives will need to be treated with more respect within the health system. Furthermore, they should be trained in handling obstetric emergency situations with respect and dignity for the patient. Systematic and constructive supervision might be another promising strategy for preventing D&A.

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Midwives' experiences of working conditions, perceptions of professional role and attitudes towards mothers in Mozambique

Cited by 24 publications

References 16 publications

Ready to deliver maternal and newborn care? Health providers’ perceptions of their work context in rural Mozambique

Ready to deliver maternal and newborn care? Health providers’ perceptions of their work context in rural Mozambique

A qualitative study on midwives’ identity and perspectives on the occurrence of disrespect and abuse in Maputo city

Midwives’ identity and perspectives on the occurrence of disrespect and abuse in Maputo city: a qualitative study

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