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1.
  • Beausang, Angela, et al. (author)
  • "Möjligheten att rädda några av dessa kvinnors liv har inte vägts in"
  • 2014
  • In: Dagens Medicin. - : Dagens Medicin.
  • Journal article (pop. science, debate, etc.)abstract
    • Namnet på Socialstyrelsens vägledning lyder: Hur upptäcka våldsutsatthet? Ja, det kan man verkligen fråga sig efter att ha läst detta föga vägledande dokument, skriver ett stort antal kritiska debattörer.
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3.
  • Baroudi, Mazen, et al. (author)
  • Men and sexual and reproductive healthcare in the Nordic countries : a scoping review
  • 2021
  • In: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 11:9
  • Research review (peer-reviewed)abstract
    • Context: Men generally seek healthcare less often than women and, other than traditional gender norms, less is known about the explanation. The aim was to identify knowledge gaps and factors influencing men regarding sexual and reproductive healthcare (SRHC) in the Nordic countries.Methods: We searched PubMed and SveMed+ for peer-reviewed articles published between January 2010 and May 2020. The analyses identified factors influencing men’s experiences of and access to SRHC.Results: The majority of the 68 articles included focused on pregnancy, birth, infertility and sexually transmitted infections including HIV. During pregnancy and childbirth, men were treated as accompanying partners rather than individuals with their own needs. The knowledge and attitudes of healthcare providers were crucial for their ability to provide SRHC and for the experiences of men. Organisational obstacles, such as women-centred SRHC and no assigned healthcare profession for men’s sexual and reproductive health issues, hindered men’s access to SRHC. Lastly, the literature rarely discussed the impact of health policies on men’s access to SRHC.Conclusions: The literature lacked the perspectives of specific groups of men such as migrants, men who have sex with men and transmen, as well as the experiences of men in SRHC related to sexual function, contraceptive use and gender-based violence. These knowledge gaps, taken together with the lack of a clear entry point for men into SRHC, indicate the necessity of an improved health and medical education of healthcare providers, as well as of health system interventions.
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4.
  • Bergman, Frida, Medicine doktor, 1984-, et al. (author)
  • The ability to benefit from an intervention to encourage use of treadmill workstations : Experiences of office workers with overweight or obesity
  • 2020
  • In: PLOS ONE. - : PLOS. - 1932-6203. ; 15:1
  • Journal article (peer-reviewed)abstract
    • One way to increase physical activity in offices is to install treadmill workstations, whereoffice workers can walk on a treadmill while performing their normal tasks. However, theexperiences of people using these treadmill workstations over a long period of time is notknown. In this 13-month study, we explored the experiences of office workers with treadmillworkstations available in their offices. After completing a larger randomized controlled trialwith 80 office workers ages 40 to 67 years with overweight or obesity, we interviewed 20 participantsfrom the intervention group, using a semi-structured interview guide. Data wereanalyzed using a grounded theory approach with constant comparison of emerging codes,subcategories, and categories, followed by connecting the categories to create a core category.The core category is described as the “Ability to benefit.” Although all participants hada rather high motivational level and pre-existing knowledge about the health benefits ofincreasing physical activity at work, they had different capacities for benefiting from the intervention.The categories are described as ideal types: the Convinced, the Competitive, theResponsible, and the Vacillating. These ideal types do not represent any single participantbut suggest generalized abstractions of experiences and strategies emerging from the codingof the interviews. One participant could easily have more than one ideal type. Becauseof differences in ideal type strategies and paths used throughout the course of the study,participants had different abilities to benefit from the intervention. Knowledge regarding theideal types may be applied to facilitate the use of the treadmill workstations. Because differentideal types might require different prompts for behavior change, tailored interventionstrategies directed towards specific ideal types could be necessary.
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5.
  • Edin, Kerstin, et al. (author)
  • Between desire and rape : narratives about being intimate partners and becoming pregnant in a violent relationship
  • 2013
  • In: Global Health Action. - : Taylor & Francis. - 1654-9716 .- 1654-9880. ; 6:1
  • Journal article (peer-reviewed)abstract
    • Background: Women subjected to intimate partner violence (IPV) experience different forms of abuse. Sexual violence is often under-reported because physically abused women, in particular, might see forced sex as an obligatory part of the sexual interplay. Accordingly, abused women have less sexual autonomy and experience unplanned pregnancies more often than other women.Objective: To describe and analyse nine Swedish women's retrospective stories about IPV with a focus on power and coping strategies as intimate partners, particularly regarding experiences of sex, contraception, and becoming pregnant.Design: Nine qualitative interviews were carried out with women who had been subjected to very severe violence in their intimate relationships and during at least one pregnancy. The stories were analysed using 'Narrative method' with the emphasis on the women's lived experiences.Results: Despite the violence and many contradictory and ambivalent feelings, two of the women described having sex as desirable, reciprocal and as a respite from the rest of the relationship. The other seven women gave a negative and totally different picture, and they viewed sex either as obligatory or as a necessity to prevent or soothe aggression or referred to it as rape and as something that was physically forced upon them. The women's descriptions of their pregnancies ranged from being carefully planned and mostly wanted to completely unwelcome and including flawed contraceptive efforts with subsequent abortions.Conclusions: Women subjected to IPV have diverse and complex experiences that have effects on all parts of the relationship. Intimacy might for some turn into force and rape, but for others sex does not necessarily exclude pleasure and desire and can be a haven of rest from an otherwise violent relationship. Accordingly, women may tell stories that differ from the ones expected as 'the typical abuse story', and this complexity needs to be recognized and dealt with when women seek healthcare, especially concerning contraceptives, abortions, and pregnancies.
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6.
  • Edin, Kerstin E, 1952- (author)
  • Perspectives on intimate partner violence, focusing on the period of pregnancy
  • 2006
  • Doctoral thesis (other academic/artistic)abstract
    • Målet med denna avhandling var att undersöka partnerrelaterat våld mot kvinnor i Sverige från olika perspektiv och med ett särskilt fokus på graviditetsperioden. Syftet var: 1) att ta reda på barnmorskors erfarenheter, attityder och rutiner angående partnerrelaterat våld mot gravida kvinnor inom mödravården; 2) att utforska hur personer som arbetar inom olika program för våldsbenägna män (inom och utom kriminalvården) talar om manligt och kvinnligt och om partnerrelaterat våld, speciellt i förhållande till graviditet; och 3) att belysa kvinnors erfarenheter av att bli och vara gravid samtidigt som de var utsatta för våld i relationen, samt deras möten med barnmorskorna på mödravårdscentralen. Data för tre studier samlades in under åren 1998-2003 med kvantitativa och kvalitativa metoder. En enkät skickades till alla yrkesverksamma mödravårdsbarnmorskor i Västerbotten och analyserades statistiskt och med innehållsanalys. Forskningsintervjuerna utfördes och analyserades enligt ’grundad teori’ (för att skapa teoretiska förklaringsmodeller), ’diskursanalys’ (för att visa hur ett gemensamt språkbruk konstruerar ’sanning’) och ’narrativ metod’ (för att tolka och återberätta innebörden i personliga berättelser). Resultaten från de studier som lade grunden till denna avhandling visar på problemets komplexitet, både från de professionellas och från kvinnornas perspektiv. Barnmorskorna (artikel I) var yrkeskunniga men också kunniga om partnerrelaterat våld mot kvinnor, men utan PM eller andra riktlinjer, så blev de osäkra och ställde sällan direkta frågor eftersom ämnet ansågs vara känsligt och tabubelagt. De professionella (artikel II-III) som arbetade med våldsbenägna män i olika program (inom eller utanför kriminalvården) krävde att män skulle ta ansvar för sitt våld. De ansåg att våldsamma män var tämligen vanliga män men avvikande i särskilda avseenden såsom i samspel, kommunikation, nära relationer och i deras kvinnosyn. De professionella beskrev stereotyper om könsskillnader och hur aggressivitet kan starta på olika sätt hos olika typer av män och ansåg också att graviditet kan utlösa konflikter och våld. Likväl så ingick i programmen vanligtvis inte känsliga frågor, om t.ex. graviditet och samlevnad, och trots en god vilja och avsikt att skapa en ’ny maskulinitet’, så tycktes deras strategier och tankegångar rent av kunna motverka deras egna goda syften. De nio intervjuade kvinnorna (artikel IV) som hade varit utsatta för våld beskrev hur deras liv hade varit komplicerade och blivit till en mardröm då deras hjärtevän hade förvandlats till en förövare. Två kvinnor bröt upp från sina relationer under graviditeten på grund av livshotande våld medan de andra för det mesta höll uppe en fasad och dolde det pågående våldet inför barnmorskan och andra alltmedan de gick balansgång mellan hopp och förtvivlan eller väntade på rätt tidpunkt att ge sig av. Förutom kvinnornas berättelser om partnerrelaterat våld under graviditet (artikel IV) så presenterades två professionella grupper och deras gemensamma svårigheter gällande tabun och känsliga frågor utanför det man vanligtvis sysslade med i sin profession (artikel I-III). Barnmorskorna var yrkeskunniga men hade ingen handlingsplan för att kunna bemöta och identifiera komplexiteten i våldsutsatta gravida kvinnors situation som ofta består i att dölja och balansera. De professionella i program för män konfronterade tydligt mäns våld och hade ambitionen att utmana deras maskulinitet, men då de i samtalen exempelvis förbisåg att ta upp vissa känsliga frågor kan utfallet ifrågasättas.
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7.
  • Edin, Kerstin, 1952-, et al. (author)
  • "Keeping up a front" : narratives about intimate partner violence, pregnancy, and antenatal care
  • 2010
  • In: Violence against Women. - : Sage Publications. - 1077-8012 .- 1552-8448. ; 16:2, s. 189-206
  • Journal article (peer-reviewed)abstract
    • Nine women who had been subjected to severe intimate partner violence during pregnancy narrated their ambiguous and contradictory feelings and the various balancing strategies they used to overcome their complex and difficult situations. Because allowing anyone to come close posed a threat, the women mostly denied the situation and kept up a front to hide the violence from others. Three women disclosed ongoing violence to the midwives, but only one said such disclosure was helpful. This article highlights the complexity of being pregnant when living with an abusive partner and challenges antenatal care policies from the perspective of pregnant women.
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8.
  • Edin, Kerstin, et al. (author)
  • Men's violence : narratives of men attending anti-violence programmes in Sweden
  • 2014
  • In: Women's Studies. - : Elsevier BV. - 0277-5395 .- 1879-243X. ; 46, s. 96-106
  • Journal article (peer-reviewed)abstract
    • The efficacy of batterer-intervention programmes for men has frequently been questioned, inviting additional research and development. Men inclined to violence have multifaceted problems but are frequently squeezed into ‘one-size-fits-all’ programmes with high ambitions for change that often show little evidence of effectiveness. Some research even indicates that any changes in men's violent behaviour might result from factors not at all linked to the programmes.For this study, ten interviews were carried out with men who had attended anti-violence programmes within the Swedish Probation Service. The overall aim was to analyse gendered identity constructions in the narratives of men attending the programmes — how men articulate the course of violent events and in what way they talk about themselves and the programmes.According to our results, men defended themselves by making excuses, explanations and victim positions. Furthermore, the men's gendered identity constructions collided with the programmes' ambitions of changing men's conceptions and behaviour.
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10.
  • Edin, Kerstin, et al. (author)
  • Perspectives on intimate relationships among young people in rural South Africa : the logic of risk
  • 2016
  • In: Culture, Health and Sexuality. - : Informa UK Limited. - 1369-1058 .- 1464-5351. ; 18:9, s. 1010-1024
  • Journal article (peer-reviewed)abstract
    • This paper explores how young people in rural South Africa understand gender, dating, sexuality and risk-taking in adolescence. The empirical material drawn upon consists of 20 interviews with young men and women (aged 18-19) and reflects normative gender patterns characterised by compulsory heterosexuality and dating as obligatory, and representing key symbols of normality. However, different meanings of heterosexual relationships are articulated in the interviews, for example in the recurring concept of 'passing time', and these meanings show that a relationship can be something arbitrary: a way to reduce boredom and have casual sex. Such a rationale for engaging in a relationship reflects one of several other normative gender patterns, which relate to the trivialisation of dating and sexual risk-taking, and which entail making compromises and legitimising deviations from the 'ideal' life-script and the hope of a better future. However, risks do not exclusively represent something bad, dangerous or immoral, because they are also used as excuses to avoid sex, HIV acquisition and early pregnancy. In conclusion, various interrelated issues can both undermine and/or reinforce risk awareness and subsequent risk behaviour. Recognition of this tension is essential when framing policies to support young people to reduce sexual risk-taking behaviour.
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11.
  • Edin, Kerstin, et al. (author)
  • The pregnancy put the screws on : discourses of professionals working with men inclined to violence
  • 2009
  • In: Men and Masculinities. - 1097-184X .- 1552-6828. ; 11:3, s. 307-324
  • Journal article (peer-reviewed)abstract
    • Qualitative research interviews were conducted with professionals working with men inclined to violence. The aim was to explore professional discourses about intimate partner violence with special reference to gender and to the partner's period of pregnancy. Three major findings are presented. Firstly, the professionals had a rather fixed understanding of opposite gender positions as well as a split picture of the violent man as both weak and tough, thus violence may result from poor self-confidence combined with a desire for power and control and the fear of losing it. Secondly, the pregnancy was identified as a stressor that, together with other circumstances, could trigger violence. Thirdly, the topic of pregnancy and other relational topics were typically omitted from the conversations with men inclined to violence. This study discusses inconsistencies that might counteract the professionals' intentions of building an alternative masculinity in men inclined to violence.
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13.
  • Edin, Kerstin, et al. (author)
  • Violent men : ordinary and deviant.
  • 2008
  • In: Journal of Interpersonal Violence. - : SAGE Publications. - 0886-2605 .- 1552-6518. ; 23:2, s. 225-244
  • Journal article (peer-reviewed)abstract
    • This article deals with discourses of intimate partner violence and is based on interviews with professionals who meet violent men. The professionals emphasized the importance of men taking unreserved responsibility for their violent behavior. Intimate partner violence was viewed not only as “power and control” but as the result of complex situations and interplays. The discourses presented an ambivalent explanation of violent men as both ordinary and deviant. They were understood as having a strained background, but to be rather ordinary, often functioning well at work and in society. Yet, they have nonstandard views of women, act deviant in their communication and interplay with others, and cannot cope with certain situations in intimate relationships. Based on the interviews, men inclined to partner violence may be generalized as those who: attack immediately, explode unexpectedly, or ultimately become aggressive. The discussion challenges unreflected discourses as means for change when counteracting violence.
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15.
  • Gebrehiwet, Tesfay Gebregzabher, 1966- (author)
  • No woman should die while giving life : Does the Health Extension Program improveaccess to maternal health services in Tigray, Ethiopia?
  • 2015
  • Doctoral thesis (other academic/artistic)abstract
    • Introduction: Ensuring access to universal primary health care is essential to secure a safe and pleasant motherhood and to provide compassionate care for mothers and newborns.However, inequalities in the access to maternal health services still remain a prominent problem in many countries. As part of reducing inequalities, Ethiopia launched the Health Extension Program (HEP) in 2003. The HEP is a community based program designed with a defined package of essential promotive, preventive and basic curative services targeting households, particularly mothers and children. Despite the construction of over 600 health posts and deploying more than 1200 Health Extension Workers (HEWs), preliminary data suggests a low utilization of maternal health care services. This thesis explores the HEP contribution in improving women’s access to maternal health care, and the reasons for the low use of maternal health care services from the perspectives of the involved actors in the Tigray region in Ethiopia. The five dimensions of access were used as a framework to explore the access to maternal health care utilization in this setting.Methods: A total of four districts were included in the study. Both quantitative and qualitative methods were applied. In the first sub-study, we assessed the HEP and its association with change in the utilization of antenatal, delivery and postnatal care services. Retrospective longitudinal data for 10 years was extracted from three selected districts and checked for accuracy. Segmented linear regression technique was used to control the secular trends adjusted for correlation of the data. For the second sub-study, we conducted a cross sectional survey with 1115 women (aged 15-49 years who had given birth within five years prior to the survey period) to determine the prevalence of antenatal care and institutional delivery utilization and explore their determinant factors of low utilization. For the third sub-study, we conducted six focus group discussions (FGDs) with a total of 51 women to explore women’s experiences of childbirth and maternal care. An interview with eight HEWs and four midwives were carried out to capture health workers’ perspective on access to maternal health care services in the fourth sub-study. Grounded theory for the former, and thematic analysis for the latter were used for the analysis.Main findings: The finding of the first sub-study showed a statistically significant upward trend for delivery care (DC) and postnatal care (PNC) in all facilities during the HEP late implementation period (July 2008-June 2012). In addition, a substantial trend of antenatal care (ANC) service use was observed at health centres after the intervention. In the second sub-study, the determinant predictors for ANC utilization were: proximity to health facilities, to be married, ≥5 years of education and having non-farming husbands. The last three factors were also significantly associated with institutional delivery, but also lower parity, previous history of obstructed/prolonged labour and ANC counselling. Findings from the qualitative studies pointed out that elderly women influenced women’s decision making about where to give birth. Women were mostly positive about giving birth at health facilities, but were concerned about the poor quality of care, inaccessibility and unavailability of transport. From the health workers’ perspective: specialized performance of hospital services, community assistance during referral and an increased awareness among women regarding the benefits of giving birth at a health facility were perceived as facilitators for institutional deliveries. Poor perceived competence of HEWs, poor conditions of health care facilities and inaccessibility of transportation, among others, were perceived as barriers for giving birth at health facilities.Conclusion: Overall, this research revealed a considerable contribution of the HEP in improving the access and coverage of maternal health services (ANC, DC and PNC). However, cultural traditions, scattered localities, mountainous roads without adequate transportation and low quality of care are still the major obstacles to accessing the services. Mechanisms need to be designed to enable health facility access of safe delivery for women in hard to reach areas, improving the proficiency of health workers and introducing a women centered approach that enhances acceptability of the services.
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16.
  • Gebrehiwot, Tesfay Gebregzabher, et al. (author)
  • The Health Extension Program and Its Association with Change in Utilization of Selected Maternal Health Services in Tigray Region, Ethiopia : A Segmented Linear Regression Analysis
  • 2015
  • In: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; :7
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: In 2003, the Ethiopian Ministry of Health established the Health Extension Program (HEP), with the goal of improving access to health care and health promotion activities in rural areas of the country. This paper aims to assess the association of the HEP with improved utilization of maternal health services in Northern Ethiopia using institution-based retrospective data.METHODS: Average quarterly total attendances for antenatal care (ANC), delivery care (DC) and post-natal care (PNC) at health posts and health care centres were studied from 2002 to 2012. Regression analysis was applied to two models to assess whether trends were statistically significant. One model was used to estimate the level and trend changes associated with the immediate period of intervention, while changes related to the post-intervention period were estimated by the other.RESULTS: The total number of consultations for ANC, DC and PNC increased constantly, particularly after the late-intervention period. Increases were higher for ANC and PNC at health post level and for DC at health centres. A positive statistically significant upward trend was found for DC and PNC in all facilities (p<0.01). The positive trend was also present in ANC at health centres (p = 0.04), but not at health posts.CONCLUSION: Our findings revealed an increase in the use of antenatal, delivery and post-natal care after the introduction of the HEP. We are aware that other factors, that we could not control for, might be explaining that increase. The figures for DC and PNC are however low and more needs to be done in order to increase the access to the health care system as well as the demand for these services by the population. Strengthening of the health information system in the region needs also to be prioritized.
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17.
  • Gebrehiwot, Tesfay, et al. (author)
  • Health workers' perceptions of facilitators of and barriers to institutional delivery in Tigray, Northern Ethiopia
  • 2014
  • In: BMC Pregnancy and Childbirth. - : BioMed Central. - 1471-2393 .- 1471-2393. ; 14
  • Journal article (peer-reviewed)abstract
    • Background: Evidence shows that the three delays, delay in 1) deciding to seek medical care, 2) reaching health facilities and 3) receiving adequate obstetric care, are still contributing to maternal deaths in low-income countries. Ethiopia is a major contributor to the worldwide death toll of mothers with a maternal mortality ratio of 676 per 100,000 live births. The Ethiopian Ministry of Health launched a community-based health-care system in 2003, the Health Extension Programme (HEP), to tackle maternal mortality. Despite strong efforts, universal access to services remains limited, particularly skilled delivery attendance. With the help of 'the three delays' framework, this study explores health-service providers' perceptions of facilitators and barriers to the utilization of institutional delivery in Tigray, a northern region of Ethiopia.Methods: Twelve in-depth interviews were carried out with eight health extension workers (HEWs) and four midwives. Each interview lasted between 90 and 120 minutes. Data were analysed through a thematic analysis approach.Results: Three themes emerged from the analysis: the struggle between tradition and newly acquired knowledge, community willingness to deal with geographical barriers, and striving to do a good job with insufficient resources. These themes represent the three steps in the path towards receiving adequate institutional delivery care at a health facility. Of the themes, 'increased community awareness', 'organization of the community' and 'hospital with specialized staff' were recognized as facilitators. On the other hand, 'delivery as a natural event', 'cultural tradition and rituals', 'inaccessible transport', 'unmet community expectation' and 'shortage of skilled human resources' were represented as barriers to institutional delivery.Conclusions: The participants in this study gave emphasis to the major barriers to institutional delivery that are closely connected with the three delays model. Despite the initiatives being implemented by the Tigray Regional Health Bureau, much is still needed to enhance the humanization approach of delivery care on a broader level of the region. A quick solution is needed to address the major issue of lack of transport accessibility. The poor capacity of the HEWs to provide delivery services, calls for reconsidering staffing patterns of remote health posts and readdressing the issue of downgraded health facilities would address unmet community needs.
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18.
  • Gebrehiwot, Tesfay, et al. (author)
  • Making pragmatic choices : women's experiences of delivery care in Northern Ethiopia
  • 2012
  • In: BMC Pregnancy and Childbirth. - : BioMed Central Ltd.. - 1471-2393 .- 1471-2393. ; 12:113
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: In 2003, the Ethiopian Ministry of Health launched the Health Extension Programme (HEP), which was intended to increase access to reproductive health care. Despite enormous effort, utilization of maternal health services remains limited, and the reasons for the low utilization of the services offered through the HEP previously have not been explored in depth.This study explores women's experiences and perceptions regarding delivery care in Tigray, a northern region of Ethiopia, and enables us to make suggestions for better implementation of maternal health care services in this setting.METHODS: We used six focus group discussions with 51 women to explore perceptions and experiences regarding delivery care. The data were analysed by means of grounded theory.RESULTS: One core category emerged, 'making pragmatic choices', which connected the categories 'aiming for safer deliveries', 'embedded in tradition', and 'medical knowledge under constrained circumstances'. In this setting, women -- aiming for safer deliveries -- made choices pragmatically between the two available models of childbirth. On the one hand, choice of home delivery, represented by the category 'embedded in tradition', was related to their faith, the ascendancy of elderly women, the advantages of staying at home and the custom of traditional birth attendants (TBAs). On the other, institutional delivery, represented by the category 'medical knowledge under constrained circumstances', and linked to how women appreciated medical resources and the support of health extension workers (HEWs) but were uncertain about the quality of care, emphasized the barriers to transportation.In Tigray women made choices pragmatically and seemed to not feel any conflict between the two available models, being supported by traditional birth attendants, HEWs and husbands in their decision-making. Representatives of the two models were not as open to collaboration as the women themselves, however.CONCLUSIONS: Although women did not see any conflict between traditional and institutional maternal care, the gap between the models remained and revealed a need to reconcile differing views among the caregivers. The HEP would benefit from an approach that incorporates all the actors involved in maternal care, at institutional, community and family levels alike. Reconsideration is required of the role of TBAs, and a well-designed, community-inclusive, coordinated and feasible referral system should be maintained.
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19.
  • Gebremichael, Mengistu Welday, et al. (author)
  • Women suffer more from disrespectful and abusive care than from the labour pain itself : a qualitative study from Women's perspective
  • 2018
  • In: BMC Pregnancy and Childbirth. - : BioMed Central. - 1471-2393 .- 1471-2393. ; 18
  • Journal article (peer-reviewed)abstract
    • Background: Utilization of institutional delivery services could be hampered by women's experience of disrespectful and abusive care during childbirth. However, such experiences are not well documented and taken into consideration id planning maternal health services in many developing countries. The aim of this study was to describe women's experience of disrespect and abuse during giving birth at health facilities in northern Ethiopia. Methods: A qualitative phenomenological study was conducted in Tigray, Ethiopia. Focus group discussions (FGDs) with primipara and multipara women were conducted to collect the necessary information. All study participants had their last delivery at a health facility in the year preceding the study. A semi-structured discussion guide was used to elicit discussion. Discussions were audio recorded and transcribed verbatim in the local language and then translated to English. Data were analyzed using thematic analysis approach assisted by the Open Code qualitative data management software. Results: The study participants described disrespect and abuse as serious obstacles to utilization of maternal health services. Women reported experiencing feelings of being infantilized, losing self-control, being overlooked, being informed bad news without proper preparation, repeated examination without being properly communicated/ informed, disallow companions, and left unattended during labor. Facility related issues include women's perception of incompetence of professionals attending delivery, unhygienic facilities, and unavailability of basic supplies. Conclusion: Women consider health facilities not fully prepared to provide respectful maternal care. Sustainable increase in institutional delivery requires ensuring quality, compassionate and caring services in all health facilities.
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20.
  • Goicolea, Isabel, et al. (author)
  • Condemning violence without rejecting sexism? : exploring how young men understand intimate partner violence in Ecuador
  • 2012
  • In: Global Health Action. - : CoAction Publishing. - 1654-9716 .- 1654-9880. ; 5:1
  • Journal article (peer-reviewed)abstract
    • Background: This study aims to explore young men's understanding of intimate partner violence (IPV) in Ecuador, examining similarities and differences between how ordinary and activist young men conceptualize IPV against women. Methods: We conducted individual interviews and focus group discussions (FGDs) with 35 young men - five FGDs and five interviews with ordinary young men, and 11 interviews with activists - and analysed the data generated using qualitative content analysis. Results: Among the ordinary young men the theme 'too much gender equality leads to IPV' emerged, while among the activists the theme 'gender inequality is the root of IPV'. Although both groups in our study rejected IPV, their positions differed, and we claim that this is relevant. While activists considered IPV as rooted in gender inequality, ordinary young men understood it as a response to the conflicts generated by increasing gender equality and women's attempts to gain autonomy.
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21.
  • Goicolea, Isabel, et al. (author)
  • Mapping and exploring health systems' response to intimate partner violence in Spain
  • 2013
  • In: BMC Public Health. - : BioMed Central. - 1471-2458. ; 13:1
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: For a comprehensive health sector response to intimate partner violence (IPV), interventions should target individual and health facility levels, along with the broader health systems level which includes issues of governance, financing, planning, service delivery, monitoring and evaluation, and demand generation. This study aims to map and explore the integration of IPV response in the Spanish national health system.METHODS: Information was collected on five key areas based on WHO recommendations: policy environment, protocols, training, monitoring and prevention. A systematic review of public documents was conducted to assess 39 indicators in each of Spain's 17 regional health systems. In addition, we performed qualitative content analysis of 26 individual interviews with key informants responsible for coordinating the health sector response to IPV in Spain.RESULTS: In 88% of the 17 autonomous regions, the laws concerning IPV included the health sector response, but the integration of IPV in regional health plans was just 41%. Despite the existence of a supportive national structure, responding to IPV still relies strongly on the will of health professionals. All seventeen regions had published comprehensive protocols to guide the health sector response to IPV, but participants recognized that responding to IPV was more complex than merely following the steps of a protocol. Published training plans existed in 43% of the regional health systems, but none had institutionalized IPV training in medical and nursing schools. Only 12% of regional health systems collected information on the quality of the IPV response, and there are many limitations to collecting information on IPV within health services, for example underreporting, fears about confidentiality, and underuse of data for monitoring purposes. Finally, preventive activities that were considered essential were not institutionalized anywhere.CONCLUSIONS: Within the Spanish health system, differences exist in terms of achievements both between regions and between the areas assessed. Progress towards integration of IPV has been notable at the level of policy, less outstanding regarding health service delivery, and very limited in terms of preventive actions.
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22.
  • Goicolea, Isabel, et al. (author)
  • When sex is hardly about mutual pleasure : Dominant and resistant discourses on sexuality and its consequences for young people's sexual health
  • 2012
  • In: International Journal of Sexual Health. - : Informa UK Limited. - 1931-7611 .- 1931-762X. ; 24:4, s. 303-317
  • Journal article (peer-reviewed)abstract
    • This study explores gendered discourses about sexuality in Ecuador, the consequences of these discourses for young people's sexual health, and the possibility of the emergence of resistance and challenge. We analyzed and compared individual interviews and focus-group discussions with: young women, youth service providers, ordinary young men, and activist young men. Five interpretative repertoires emerged: (1) becoming sexually respectable women, (2) policing young women's sexuality, (3) men threatening and protecting women, (4) sexual relations (abusing, fooling, or seducing?), and (5) emerging resistance. The repertoires constructed a hierarchy of sexualities in which heterosexual monogamous lifelong coupledom was normative and women's pleasure was absent, but resistance was emerging.
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23.
  • Hullur, Nitya, et al. (author)
  • Community perspectives on HIV, violence and health surveillance in rural South Africa : a participatory pilot study
  • 2016
  • In: Journal of Global Health. - : International Global Health Society. - 2047-2978 .- 2047-2986. ; 6:1
  • Journal article (peer-reviewed)abstract
    • Background South Africa faces a complex burden of disease consisting of infectious and non–communicable conditions, injury and interpersonal violence, and maternal and child mortality. Inequalities in income and opportunity push disease burdens towards vulnerable populations, a situation to which the health system struggles to respond. There is an urgent need for health planning to account for the needs of marginalized groups in this context. The study objectives were to develop a process to elicit the perspectives of local communities in the established Agincourt health and socio-demographic surveillance site (HDSS) in rural north–east South Africa on two leading causes of death: HIV/AIDS and violent assault, and on health surveillance as a means to generate information on health in the locality. Methods Drawing on community–based participatory research (CBPR) methods, three village–based groups of eight participants were convened, with whom a series of discussions were held to identify and define the causes of, treatments for, and problems surrounding, deaths due to HIV/AIDS and violent assault. The surveillance system was also discussed and recommendations generated. The discussion narratives were the main data source, examined using framework analysis. Results The groups identified a range of social and health systems issues including risky sexual health behaviors, entrenched traditional practices, alcohol and substance abuse, unstable relationships, and debt as causative. Participants also explained how compromised patient confidentiality in clinics, insensitive staff, and a biased judicial system were problematic for the treatment and reporting of both conditions. Views on health surveillance were positive. Recommendations to strengthen an already well–functioning system related to maintaining confidentiality and sensitivity, and extending ancillary care obligations. Conclusion The discussions provided information not available from other sources on the social and health systems processes through which access to good quality health care is constrained in this setting. On this basis, further CBPR in routine HDSS to extend partnerships between researchers, communities and health authorities to connect evidence with the means for action is underway.
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24.
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25.
  • Kinsman, John, et al. (author)
  • A model for promoting physical activity among rural South African adolescent girls
  • 2015
  • In: Global Health Action. - : Co-Action Publishing. - 1654-9716 .- 1654-9880. ; 8
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: In South Africa, the expanding epidemic of non-communicable diseases is partly fuelled by high levels of physical inactivity and sedentary behaviour. Women especially are at high risk, and interventions promoting physical activity are urgently needed for girls in their adolescence, as this is the time when many girls adopt unhealthy lifestyles.OBJECTIVE: This qualitative study aimed to identify and describe facilitating factors and barriers that are associated with physical activity among adolescent girls in rural, north-eastern South Africa and, based on these, to develop a model for promoting leisure-time physical activity within this population.DESIGN: The study was conducted in and around three secondary schools. Six focus group discussions were conducted with adolescent girls from the schools, and seven qualitative interviews were held with sports teachers and youth leaders. The data were subjected to thematic analysis.RESULTS: Seven thematic areas were identified, each of which was associated with the girls' self-reported levels of physical activity. The thematic areas are 1) poverty, 2) body image ideals, 3) gender, 4) parents and home life, 5) demographic factors, 6) perceived health effects of physical activity, and 7) human and infrastructural resources. More barriers to physical activity were reported than facilitating factors.CONCLUSIONS: Analysis of the barriers found in the different themes indicated potential remedial actions that could be taken, and these were synthesised into a model for promoting physical activity among South African adolescent girls in resource-poor environments. The model presents a series of action points, seen both from the 'supply-side' perspective (such as the provision of resources and training for the individuals, schools, and organisations which facilitate the activities) and from the 'demand-side' perspective (such as the development of empowering messages about body image for teenage girls, and encouraging more parental involvement). The development of physical activity interventions that incorporate this supply- and demand-side model would represent an additional tool for ongoing efforts aimed at tackling the expanding non-communicable disease epidemic in South Africa, and in other resource-constrained settings undergoing rapid health transitions.
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26.
  • Lusey, Hendrew, et al. (author)
  • Conflicting discourses of church youths on masculinity and sexuality in the context of HIV in Kinshasa, Democratic Republic of Congo
  • 2014
  • In: SAHARA-J. - : Informa UK Limited. - 1729-0376 .- 1813-4424. ; 11:1, s. 84-93
  • Journal article (peer-reviewed)abstract
    • Masculinity studies are fairly new and young churchgoers are an under-researched group in the current Congolese church context. In response to this knowledge gap, this paper attempts to explore discourses of young churchgoers from deprived areas of Kinshasa regarding masculinity and sexuality in the era of HIV. A series of 16 semi-structured interviews were conducted with unmarried young churchgoers from the Salvation Army, Protestant and Revival churches. The interviews were tape-recorded, transcribed verbatim and analysed using discourse analysis. Five main discourses emerged: 'we are aware of the church message on sex', 'young men need sex', 'young women need money', 'to use or not to use condoms' and 'we trust in the church message'. Although all informants knew and heard church messages against premarital sex, many of them were sexually active. The perception was that young men were engaged in sexual activities with multiple partners as a result of sexual motivations surrounding masculinity and sexual potency, while young women sought multiple partners through transactional and intergenerational sex for economic reasons. These sexual practices of young people conflicted with church messages on sexual abstinence and faithfulness. However, a small number of participants challenged current gender norms and suggested alternative ways of being a man or a woman. To elucidate these alternatives, we suggest that church youths and church leaders might take concrete actions to deconstruct misconceptions about being men. In this way, they can possibly enhance a frank and fruitful dialogue on sex, sexuality and gender to promote positive masculinities and constructive partnerships to prevent HIV.
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27.
  • Lusey, Hendrew, et al. (author)
  • Factors associated with gender equality among church-going young men in Kinshasa, Democratic Republic of Congo : a cross-sectional study
  • 2017
  • In: International Journal for Equity in Health. - : BIOMED CENTRAL LTD. - 1475-9276. ; 16
  • Journal article (peer-reviewed)abstract
    • Background: While women and girls are made vulnerable by inequitable and violent versions of masculinities, there is increasing evidence that gender equality will not be achieved without partnering with men. The aim of this study was to assess gender-equitable norms and their determinants among church-going young men in Kinshasa, the Democratic Republic of Congo.Method: A cross-sectional study was carried out among 289 church-going young men, aged 18-24 years, residing in three disadvantaged communes of Kinshasa. Variables included sociodemographic characteristics, attitudes towards gender equality and responses to issues related to the Gender-Equitable Men (GEM) scale. Logistic regression was applied to identify the associations between sociodemographic characteristics, attitudes and the GEM scale.Results: The findings provide evidence of attitudes and beliefs that act as barriers to gender equality. For instance, the majority of church-going young men (83.74%) agreed that a man is the only decision maker in the home and about half (50.87%) of the respondents supported the statement "There are times a woman deserves to be beaten". Similarly, around half of the participants agreed with the idea of men's uncontrollable sex drive (50.87%) and men's toughness (50.17%). Close to half of the participants (44.29%) agreed that it is women's responsibility to prevent pregnancy. These attitudes co-existed with a few gender-equitable norms as 82.70% agreed on the importance of joint decisions concerning family planning. An association between education, certain places of residence, being single or separated, and supportive attitudes towards gender equality was found with higher scores for the GEM.Conclusion: Our study findings indicate that a high proportion of church-going young men do not endorse gender-equitable norms. Therefore, churches urgently need comprehensive gender equality and masculinity policies and programmes to influence young men's attitudes and behaviours. The promotion of gender equality in schools and the wider community also need to be encouraged.
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28.
  • Lusey, Hendrew G., et al. (author)
  • Church representatives' perspectives on masculinities in the context of HIV : the case of the Ecumenical HIV and AIDS Initiative in Africa
  • 2016
  • In: African Journal of AIDS Research. - : NISC - National Inquiry Services Centre. - 1608-5906 .- 1727-9445. ; 15:3, s. 273-281
  • Journal article (peer-reviewed)abstract
    • Despite a growing body of literature related to church leaders challenging dominant norms of masculinities that may enable the spread of HIV, research on masculinity issues among African church representatives who are policy makers is scarce. The objectives of this study were to explore the perspectives on masculinities held by church representatives within the Ecumenical HIV and AIDS Initiative in Africa (EHAIA) and to identify strategies they used to transform masculinities in their respective churches. Qualitative interviews were carried out with 14 church representatives belonging to the EHAIA International Reference Group. These interviews were analysed using thematic analysis and four themes were identified: "barriers to challenge masculinities" may contribute to the spread of HIV; "counterproductive conservative church leadership" fails to challenge dominant forms of masculinities; "facilitators to challenge masculinities" perceived as slowly changing men and "an evolving hope for gender equality" would be perceived in certain marital relationships. The latter two were viewed as positive approaches resulting from masculinity workshops and male priests disclosing their HIV-positive status. This research highlights strategies that may help male church-goers challenge masculinities, support gender equality and, improve the lives of men and women in the context of HIV.
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29.
  • Lusey, Hendrew, et al. (author)
  • Prevalence and correlates of gender inequitable norms among young, church-going women and men in Kinshasa, Democratic Republic of Congo
  • 2018
  • In: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 18
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: Prolonged political instability may have exacerbated gender inequitable beliefs in the Democratic Republic of Congo (DRC). The aim of this study was to assess attitudes related to gender-equitable norms and its determinants among young, church-going women and men in Kinshasa, DRC.METHOD: Data were collected through a cross-sectional survey with 291 church-going women and 289 men aged 18-24 years old, residing in three disadvantaged communes of Kinshasa. Variables included sociodemographic characteristics, attitudes towards gender equality, and responses to issues related to the gender-equitable men (GEM) scale. The GEM scale is a 24 item-questionnaire developed to measure attitudes towards gender equitable norms. Logistic regression was applied to discover the associations between the independent variables and the GEM outcome.RESULTS: Our study reflected the existence of attitudes hampering gender equality that were endorsed by both women and men. For example, 91.4% of women and 83% of men agreed with the statement "a woman's most important role is to take care of her home and cook for her family". Similarly, 88.3% of women and 82.9% of men concurred with the idea that men need more sex than women. These findings coexisted with a few equitable norms, because 93.7% of women and 92.3% of men agreed that a man and a woman should decide together if they want to have children. A positive association was found in both women and men between being educated, being single and separated and having supportive attitudes towards gender equality and a higher GEM scale score. Residency in Camp Luka and Masina was also a significant social determinant associated with equitable gender norms among men whilst job status was only significant among women.CONCLUSION: While both women and men had high levels of gender inequitable norms, those with more education, single, and with supportive attitudes to gender equality had high GEM scale scores. The results highlight an urgent need for the church to challenge and change gender norms among church youths.
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30.
  • Manithip, C, et al. (author)
  • Factors associated with antenatal care utilization among rural women in Lao People's Democratic Republic
  • 2011
  • In: Maternal and Child Health Journal. - : Springer. - 1092-7875 .- 1573-6628. ; 15:8, s. 1356-1362
  • Journal article (peer-reviewed)abstract
    • This study aims at exploring factors related to the antenatal care (ANC) utilization in rural areas of Lao PDR. A quantitative, cross-sectional interview study was conducted in the Khammouane and Champasack provinces. The study population comprised all currently pregnant women 15-45 years of age with a gestational period beyond 32 weeks plus all women who had given birth during the last 12 months. With the informed consent of all eligible women, 460 respondents were included in the study and interviewed using a structured questionnaire. Multiple logistic regression analysis was applied to determine factors significantly related to ANC use. Fifty-one percent of the respondents had at least one ANC visit. Among the users, 63% had visited ANC three times or more but only 28% attended during the first trimester. After adjusting for other factors, using a 95% Confidence Interval (CI), statistically significant associations were found between ANC use and the following factors: women whose husbands were salaried employees (OR = 2.66, CI = 1.45-4.88); women younger than 18 years old at first pregnancy (OR 0.56, CI = 0.28-0.97); women perceiving ANC as somewhat useful (OR = 2.88, CI = 1.26-6.61) or very useful (OR = 7.45, CI = 3.59-15.46). Awareness of the usefulness of ANC was related to more frequent use and could be one focus of community intervention to increase utilization.
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31.
  • Manithip, Chanthanom, et al. (author)
  • Poor quality of antenatal care services : is lack of competence and support the reason? An observational and interview study in rural areas of Lao PDR
  • 2013
  • In: Midwifery. - : Elsevier. - 0266-6138 .- 1532-3099. ; 29:3, s. 195-202
  • Journal article (peer-reviewed)abstract
    • OBJECTIVE: to explore the health-care providers' performance and their own perceptions of the ANC services they provide. DESIGN, SETTING AND PARTICIPANTS: this cross-sectional exploratory survey was carried out in 2009 at four district hospitals and 18 health centres in Khammouane and Champasack provinces in rural areas of Laos. MEASUREMENTS AND FINDINGS: combinations of quantitative and qualitative methods were used: (i) 59 observations of ANC sessions (components performed and equipment used); (ii) 26 semi-structured interviews with health-care providers engaged in ANC services, interpreted through content analysis. The findings indicated an overall poor quality and performance of ANC services in rural health facilities with lack of routines, scarce or insufficient equipment and limited skills among providers. The health-care providers gave an often pessimistic picture of their competence and motivation to work with ANC. Some articulated a resignation due to lack of feedback from the patients and they expressed a need for support from health-care superiors. Compared to the district hospitals, the health centres were less well-equipped and supplied, and the providers had a heavier workload, because all activities including ANC were carried out by the same provider. The average consultation time for each woman was 5mins. CONCLUSIONS: the quality of ANC services in rural health facilities in Laos was poor due to lack of resources, the providers' limited skills concurrent with inadequate routines and insufficient backup from superiors. IMPLICATIONS FOR PRACTICE: to comply with national and international recommendations for ANC services, our suggestion is to improve the quality of the rural health facilities in Laos by providing basic equipment, support from experienced superiors and in-service training.
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32.
  • Moen, Elisabeth, 1956-, et al. (author)
  • Volatile and violent relationships among women sentenced for homicide in Sweden between 1986 and 2005
  • 2016
  • In: Victims & Offenders. - : Taylor & Francis. - 1556-4886 .- 1556-4991. ; 11:3, s. 373-391
  • Journal article (peer-reviewed)abstract
    • Data from Swedish court judgments of all 124 women convicted of homicide during 20 years was analyzed. The typical pattern was an abused woman who kills her intimate partner at home with a knife, often with alcohol involved. A subsample (n = 66) was analyzed qualitatively, with a focus on intimate partner relationships. The findings indicate that female homicides usually take place after a long progression of violence and reflect women’s subordinate gendered position. Situational triggers finally lead up to the killing event. Gender equality and the so-called woman-friendly welfare state in Sweden do not appear to reduce women’s volatility in violent relationships. 
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33.
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34.
  • Nilsson, Bo, 1959-, et al. (author)
  • "It has seldom been so difficult to try to dress up a sound experience in words" : Technology and the Rhetoric of Sound and Music Reproduction in Hi-Fi Magazines
  • 2022
  • In: Puls. - : Svenskt visarkiv. - 2002-2972. ; 7, s. 121-140
  • Journal article (peer-reviewed)abstract
    • The aim of this paper is to explore the rhetoric of sound in high fidelity magazines, and how this rhetoric is linked to a technological discourse. Rhetoric of sound refers to the magazines’ efforts to describe sound and music experiencesin words. The aim is also to show how an identified technological discourse legitimizes a specific social order. The paper argues that the technological discourse naturalizes the link between technology and masculinity based on notions of gender differences, and that it reproduces a technological worldview in general by offering multiple positions of identification.
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35.
  • Nilsson, Bo, 1959-, et al. (author)
  • Obstacles to intergenerational communication in caregivers' narratives regarding young people's sexual and reproductive health and lifestyle in rural South Africa
  • 2020
  • In: BMC Public Health. - : BioMed Central. - 1471-2458. ; 20:1
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: Statistics from South Africa show the world's highest HIV prevalence with an estimated seven million people living with the virus. Several studies have pointed to communication about sexuality between parents/caregivers and children as a protective factor. However, communication between generations has been described as problematic, especially due to discomfort in discussing sexual matters. The aim of this study was to explore how caregivers in a poor, rural part of South Africa talked about young people in general, their sexuality, and their lifestyle practices. A particular interest was directed towards central discourses in the caregivers' narratives and how these discourses were of importance for the caregivers to function as conversation partners for young people.METHODS: In this qualitative study convenience sampling was used to select and invite participants. Information was collected from nine one-on-one interviews conducted with caregivers from rural areas within South Africa. The interview guide included nine main questions and optional probing questions. Each interview took place in an uninterrupted setting of choice associated with the caregivers' home environment. The interviews were transcribed and analyzed using discourse analysis.RESULTS: Interview narratives were characterized by three central discourses - demoralized youths in a changing society, prevailing risks and modernity and a generation gap. The youths were discursively constructed as a problematic group relating to specific prevailing risks such as early pregnancies, modern technologies, STI/HIV and contraceptives. The interview narratives illustrated that caregivers tried to impose their views of a respectable lifestyle in young people. At the same time caregivers expressed a morality of despair mirroring a generation gap which counteracted their ability to communicate with their children and grandchildren.CONCLUSIONS: The findings add to the body of earlier research illustrating that rural South African caregivers and their children/grandchildren hold different moral standards. The interview material reflected a 'clash' between generations relating to their differing perceptions of a desirable lifestyle. To overcome the generational gap, we recommend further research about how a well-founded national and community collaboration linked to school-based programs can support family participation in order to empower adults in their communication with young people.
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36.
  • Njozing, Barnabas N, 1974- (author)
  • Bridging the Gap : implementing tuberculosis and HIV/AIDS collaborative activities in the Northwest Region of Cameroon
  • 2011
  • Doctoral thesis (other academic/artistic)abstract
    • Introduction The human immunodeficiency virus (HIV) epidemic has led to the upsurge of tuberculosis (TB) infection globally, but most especially in areas with high HIV prevalence. In the past, there was lack of a coordinated global and national response between TB and HIV programmes to curb the devastating impacts of both infections. However, the ProTEST Initiative piloted in sub-Saharan Africa in 1997 demonstrated that TB and HIV programmes could collaborate successfully in delivering joint services. This prompted the development of the WHO interim policy on collaborative TB/HIV activities in 2004, aimed at reducing the burden of TB and HIV in populations affected by both infections. This thesis explores how collaborative activities between TB and HIV programmes have been established in Cameroon and implemented in the Northwest Region. It also highlights the achievements and constraints in delivering joint services to TB patients co-infected with HIV. Methods The study was conducted in the Northwest Region, one of the 10 regions of Cameroon with the highest HIV prevalence. The study uses health system research combining qualitative and quantitative methods to explore the research objectives. Qualitative methods were used to capture the perspectives of: i) the service providers; key informants from the central, regional and district levels concerned with the collaboration process and in delivering HIV services to TB patients, and ii) TB patients regarding HIV testing as an entry point to HIV services. Quantitative methods were used to ascertain TB patients’ access to HIV services provided for by the collaboration. Results The study demonstrated that although there were varying levels of collaboration between TB and HIV programmes from the central to operational level in the health system, delivering joint services was feasible. Furthermore, despite the challenges TB patients faced in testing for HIV, overall implementing TB/HIV collaborative activities increased TB patients’ acceptability and accessibility to HIV services. These were facilitated by the improved collaboration at the operational level, and enhanced service provider-patient alliance which was instrumental in building patients’ trust in the health system. Collaboration also led to cross-training and teamwork between staffs from both programmes, and improved networking between service providers and other actors involved in TB and HIV care. Nevertheless, there were health system constraints including inadequate leadership and management, shortage of human and infrastructural resources, frequent interruptions in the supply of essential drugs and laboratory materials Conclusion TB/HIV collaborative activities have improved service delivery and TB patients’ access to HIV services. Nonetheless, appropriate stewardship which guarantees joint planning, monitoring and evaluation of essential activities, and accountability at all levels in the health system is invaluable. Besides, the identified health system constraints which could adversely influence effective joint service delivery and a sustainable collaboration deserve due appraisal.    
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37.
  • Njozing, Barnabas N, et al. (author)
  • “If the patients decide not to tell what can we do?” : TB/HIV counsellors’ dilemma on partner notification for HIV
  • 2011
  • In: BMC International Health and Human Rights. - 1472-698X. ; 11
  • Journal article (peer-reviewed)abstract
    • Background: There is a global consensus towards universal access to human immunodeficiency virus (HIV) services consequent to the increasing availability of antiretroviral therapy. However, to benefit from these services, knowledge of one's HIV status is critical. Partner notification for HIV is an important component of HIV counselling because it is an effective strategy to prevent secondary transmission, and promote early diagnosis and prompt treatment of HIV patients' sexual partners. However, counsellors are often frustrated by the reluctance of HIV-positive patients to voluntarily notify their sexual partners. This study aimed to explore tuberculosis (TB)/HIV counsellors' perspectives regarding confidentiality and partner notification. Methods: Qualitative research interviews were conducted in the Northwest Region of Cameroon with 30 TB/HIV counsellors in 4 treatment centres, and 2 legal professionals between September and December 2009. Situational Analysis (positional map) was used for data analysis. Results: Confidentiality issues were perceived to be handled properly despite concerns about patients' reluctance to report cases of violation due to apprehension of reprisals from health care staffs. All the respondents encouraged voluntary partner notification, and held four varying positions when confronted with patients who refused to voluntarily notify their partners. Position one focused on absolute respect of patients' autonomy; position two balanced between the respect of patients' autonomy and their partners' safety; position three wished for protection of sexual partners at risk of HIV infection and legal protection for counsellors; and position four requested making HIV testing and partner notification routine processes. Conclusion: Counsellors regularly encounter ethical, legal and moral dilemmas between respecting patients' confidentiality and autonomy, and protecting patients' sexual partners at risk of HIV infection. This reflects the complexity of partner notification and demonstrates that no single approach is optimal, but instead certain contextual factors and a combination of different approaches should be considered. Meanwhile, adopting a human rights perspective in HIV programmes will balance the interests of both patients and their partners, and ultimately enhance universal access to HIV services.
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38.
  • Njozing, Barnabas N, et al. (author)
  • Voices from the frontline : counsellors’ perspectives on TB/HIV collaborative activities in the Northwest Region, Cameroon
  • 2011
  • In: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 11, s. 328-
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: The overlapping epidemiology of tuberculosis (TB) and human immunodeficiency virus (HIV) infections prompted the World Health Organisation in 2004 to recommend collaboration between national TB and HIV programmes. The goal of this collaboration is to decrease the burden of both infections in the population. This policy was subsequently adopted by the national TB and HIV programmes in Cameroon with TB and HIV nurses/counsellors acting as frontline implementers of the collaborative activities in the 10 regions of the country.METHODS: Qualitative research interviews were conducted with 30 nurses/counsellors in four approved treatment centres providing comprehensive TB and HIV/AIDS services in the Northwest region of Cameroon. The aim was to explore their experiences in counselling, in delivering joint TB and HIV services, and the constraints to effective collaboration between TB and HIV services. To complement the findings from the counsellors' interviews, as part of an emergent design, further interviews with 2 traditional healers and non-participant observations in two HIV support group meetings were conducted.RESULTS: According to the respondents, counselling was regarded as a call to serve humanity irrespective of the reasons for choosing the profession. In addition, the counselling training and supervision received, and the skills acquired, have altogether contributed to build patients' trust in the healthcare system. Teamwork among healthcare workers and other key stakeholders in the community involved in TB/HIV prevention and control was used as a strategy to improve joint service delivery and patients' uptake of services. Several constraints to effective collaboration between TB and HIV services were identified, including shortage of human resources, infrastructure and drug supplies, poor patients' adherence to treatment and the influence of traditional healers who relentlessly dissuade patients from seeking mainstream medical care.CONCLUSIONS: In order to achieve a sustainable collaboration between TB and HIV services, adequate planning, investment and strengthening of the health system including human resources, infrastructure and ensuring uninterrupted supplies of medicines are essential. A multidisciplinary approach to service delivery particularly focusing on harnessing the enormous potentials of traditional healers in TB/HIV prevention and control would also be indispensible.
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39.
  • Njozing, Nwarbébé Barnabas, et al. (author)
  • "When I get better I will do the test" : facilitators and barriers to HIV testing in Northwest region of Cameroon with implications for TB and HIV/AIDS control programmes
  • 2010
  • In: SAHARA-J. - : Taylor & Francis. - 1729-0376 .- 1813-4424. ; 7:4, s. 24-32
  • Journal article (peer-reviewed)abstract
    • The World Health Organization has recommended collaborative activities between TB and HIV programmes with routine counselling and testing for HIV among TB patients in order to improve the uptake of HIV services. We carried out qualitative research interviews with 21 TB patients in four selected TB and HIV/AIDS treatment centres in the Northwest Region of Cameroon to explore the facilitators and barriers to HIV testing. The desire to be healthy and live longer from knowing one’s status inspired by the anticipated support from loved ones, faith in a supreme being, influence and trust in the medical authority, encouraged HIV testing. Men also demonstrated their masculinity by testing, thus portraying themselves as positive role models for other men. Meanwhile, the overwhelming burden of facing both TB and HIV simultaneously, influenced by the fear of disclosure of results, harmful gender norms and practices, fear of stigma and discrimination, and misconceptions surrounding HIV/AIDS deterred HIV testing. However, as a result of conflicting emotional experiences regarding to test or not to test, the decision-making process was not straightforward and this complex process needs to be acknowledged by health care providers when advocating for routine HIV testing among TB patients.
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40.
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41.
  • Pat, Puthy, et al. (author)
  • Mental health problems and suicidal expressions among young male prisoners in Cambodia : a cross-sectional study
  • 2021
  • In: Global Health Action. - : Taylor & Francis. - 1654-9716 .- 1654-9880. ; 14:1
  • Journal article (peer-reviewed)abstract
    • Background: Incarceration and mental health problems are known to have a strong empirical association. Many studies have confirmed the high prevalence of mental health problems among young prisoners in particular, yet none has been conducted in Cambodia.Objectives: This study aimed to assess the level of mental health problems and suicidal expressions, and determine the associated risk factors among young prisoners in Cambodia.Method: This was a cross-sectional study among 572 young prisoners between the ages of 15 and 24 from three prisons. Sociodemographic data and detailed information on participants’ profiles were gathered, and mental health problems and suicidal expressions were assessed using the Youth Self-Report (YSR) and the Attitude Towards Suicide (ATTS) questionnaires, respectively.Results: Mental health problems as revealed by the mean YSR scores were: 25.97 for internalizing and 18.12 for externalizing problems; 11.88 for anxiety/depression, 9.97 for aggressive behaviours and 7.53 for somatic complaints. Social problems, attention problems and rule breaking behaviour were in the range of 8.10 to 8.49. Withdrawal depression and thought problems mean scores were 6.55 and 6.66, respectively. Mental health problems were associated with younger age, lower educational background, and shorter duration of incarceration. Around 16% had thought about their own death, and 12% expressed wish to die. Suicide ideation, planning, and attempts were reported by almost 7%, 2%, and 3% of participants respectively. Prior drugs users thought about death significantly more than their counterparts while suicide ideation was significantly lower among prisoners with higher education.Conclusion: Mental health problems and suicidal expressions among young prisoners warrant well-planned mental health services that are integrated into the current prison health system. A contextualised intervention that takes into account age, education, duration of incarceration and previous drug use may contribute to improve the mental well-being of young prisoners in Cambodia.
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42.
  • Pat, Puthy, et al. (author)
  • “Overcrowded but lonely” : exploring mental health and well-being among young prisoners in Cambodia
  • 2023
  • In: International Journal of Prisoner Health. - : Emerald Group Publishing Limited. - 1744-9200 .- 1744-9219. ; 19:4, s. 628-640
  • Journal article (peer-reviewed)abstract
    • Purpose – Young prisoners are one of the most vulnerable groups in society for mental health problems and ill-being. Therefore, there is a crucial need to understand their physical, psychological and social situations. This study aims to explore young Cambodian prisoners’ experiences and perceptions of mental health and well-being, their determinants and their coping strategies.Design/methodology/approach – Six focus group discussions were carried out in three prisons with atotal of 48 young prisoners between the ages of 15 and 24 years (50% women, 50% men). Semistructured questions guided the discussions, and thematic analysis was applied to analyse the data.Findings – Young prisoners reported multifaceted experiences of mental health and well-being. The majority described adverse mental health experiences, while some revealed better well-being, partlyinfluenced by the socio-economic support from outside the prisons and previous involvement or not indrug abuse. The experience of physical overcrowding without emotional attachment among the fellow prisoners was perceived as the overarching determinant of loneliness and mental health problems, while socio-emotional support and rituals were described as the most important coping mechanisms.Originality/value – This pioneering study from Cambodia gives young prisoners an opportunity to voice their experiences and perceptions of mental health and well-being in the prison setting. The findings inthis study underline the importance of prison authorities tackling overcrowding to promote well-being andreduce mental health problems. Also, the coping mechanisms outlined by the participants should be considered when planning psychosocial interventions.
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43.
  • Sedibe, Heather M., et al. (author)
  • Qualitative study exploring healthy eating practices and physical activity among adolescent girls in rural South Africa
  • 2014
  • In: BMC Pediatrics. - : BioMed Central. - 1471-2431. ; 14
  • Journal article (peer-reviewed)abstract
    • Background: Dietary behaviours and physical activity are modifiable risk factors to address increasing levels of obesity among children and adolescents, and consequently to reduce later cardiovascular and metabolic disease. This paper explores perceptions, attitudes, barriers, and facilitators related to healthy eating and physical activity among adolescent girls in rural South Africa.Methods: A qualitative study was conducted in the rural Agincourt subdistrict, covered by a health and sociodemographic surveillance system, in Mpumalanga province, South Africa. Semistructured "duo-interviews" were carried out with 11 pairs of adolescent female friends aged 16 to 19 years. Thematic content analysis was used.Results: The majority of participants considered locally grown and traditional foods, especially fruits and vegetables, to be healthy. Their consumption was limited by availability, and these foods were often sourced from family or neighbourhood gardens. Female caregivers and school meal programmes facilitated healthy eating practices. Most participants believed in the importance of breakfast, even though for the majority, limited food within the household was a barrier to eating breakfast before going to school. The majority cited limited accessibility as a major barrier to healthy eating, and noted the increasing intake of "convenient and less healthy foods". Girls were aware of the benefits of physical activity and engaged in various physical activities within the home, community, and schools, including household chores, walking long distances to school, traditional dancing, and extramural activities such as netball and soccer.Conclusions: The findings show widespread knowledge about healthy eating and the benefits of consuming locally grown and traditional food items in a population that is undergoing nutrition transition. Limited access and food availability are strong barriers to healthy eating practices. School meal programmes are an important facilitator of healthy eating, and breakfast provision should be considered as an extension of the meal programme. Walking to school, cultural dance, and extramural activities can be encouraged and thus are useful facilitators for increasing physical activity among rural adolescent girls, where the prevalence of overweight and obesity is increasing.
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44.
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45.
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46.
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47.
  • Torres, Virgilio Mariano Salazar, et al. (author)
  • 'Expanding your mind' : the process of constructing gender-equitable masculinities in young Nicaraguan men participating in reproductive health or gender training programs
  • 2012
  • In: Global Health Action. - : CoAction Publishing. - 1654-9716 .- 1654-9880. ; 5:1
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: Traditional forms of masculinity strongly influence men's and women's wellbeing.OBJECTIVE: This study has two aims: (i) to explore notions of various forms of masculinities in young Nicaraguan men participating in programs addressing sexual health, reproductive health, and/or gender equality and (ii) to find out how these young men perceive their involvement in actions aimed at reducing violence against women (VAW).DESIGN: A qualitative grounded theory study. Data were collected through six focus groups and two in-depth interviews with altogether 62 young men.RESULTS: Our analysis showed that the informants experienced a process of change, labeled 'Expanding your mind', in which we identified four interrelated subcategories: The apprentice, The responsible/respectful man, The proactive peer educator, and 'The feminist man'. The process showed how an increased awareness of gender inequities facilitated the emergence of values (respect and responsibility) and behavior (thoughtful action) that contributed to increase the informant's critical thinking and agency at individual, social, and political levels. The process was influenced by individual and external factors.CONCLUSIONS: Multiple progressive masculinities can emerge from programs challenging patriarchy in this Latin American setting. The masculinities identified in this study show a range of attitudes and behaviors; however, all lean toward more equitable gender relations. The results suggest that learning about sexual and reproductive health does not directly imply developing more gender-equitable attitudes and behaviors or a greater willingness to prevent VAW. It is paramount that interventions to challenge machismo in this setting continue and are expanded to reach more young men.
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48.
  • Tsegay, Yalem, et al. (author)
  • Determinants of antenatal and delivery care utilization in Tigray region, Ethiopia : a cross-sectional study
  • 2013
  • In: International Journal for Equity in Health. - : BioMed Central. - 1475-9276. ; 12:30
  • Journal article (peer-reviewed)abstract
    • INTRODUCTION: Despite the international emphasis in the last few years on the need to address the unmet health needs of pregnant women and children, progress in reducing maternal mortality has been slow. This is particularly worrying in sub-Saharan Africa where over 162,000 women still die each year during pregnancy and childbirth, most of them because of the lack of access to skilled delivery attendance and emergency care. With a maternal mortality ratio of 673 per 100,000 live births and 19,000 maternal deaths annually, Ethiopia is a major contributor to the worldwide death toll of mothers. While some studies have looked at different risk factors for antenatal care (ANC) and delivery service utilisation in the country, information coming from community-based studies related to the Health Extension Programme (HEP) in rural areas is limited. This study aims to determine the prevalence of maternal health care utilisation and explore its determinants among rural women aged 15-49 years in Tigray, Ethiopia.METHODS: The study was a community-based cross-sectional survey using a structured questionnaire. A cluster sampling technique was used to select women who had given birth at least once in the five years prior to the survey period. Univariable and multivariable logistic regression analyses were carried out to elicit the impact of each factor on ANC and institutional delivery service utilisation.RESULTS: The response rate was 99% (n=1113). The mean age of the participants was 30.4 years. The proportion of women who received ANC for their recent births was 54%; only 46 (4.1%) of women gave birth at a health facility. Factors associated with ANC utilisation were marital status, education, proximity of health facility to the village, and husband's occupation, while use of institutional delivery was mainly associated with parity, education, having received ANC advice, a history of difficult/prolonged labour, and husbands' occupation.CONCLUSIONS: A relatively acceptable utilisation of ANC services but extremely low institutional delivery was observed. Classical socio-demographic factors were associated with both ANC and institutional delivery attendance. ANC advice can contribute to increase institutional delivery use. Different aspects of HEP need to be strengthened to improve maternal health in Tigray.
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49.
  • Westergren, Agneta, et al. (author)
  • Autonomous and dependent–The dichotomy of birth : a feminist analysis of birth plans in Sweden
  • 2019
  • In: Midwifery. - : Elsevier. - 0266-6138 .- 1532-3099. ; 68, s. 56-64
  • Journal article (peer-reviewed)abstract
    • OBJECTIVE: To elicit pregnant women's perceptions of childbirth as expressed in their birth plans, and through a feminist lens analyse their wishes, fears, values, and beliefs about childbirth, as well as their expectations on partner and midwife.DESIGN: This study used qualitative content analysis, identifying subcategories, categories, and an overall theme in data gathered from women's written birth plans. A feminist theoretical framework underpinned the research.SETTING: A middle-sized city in northern Sweden.PARTICIPANTS: 132 women who gave birth in an obstetrician-led hospital labour ward between March and June 2016 and consented to grant access to their birth plans and antenatal and intrapartum electronic medical records.FINDINGS: Three categories emerged: 'Keeping integrity intact through specific requests and continuous dialogue with the midwife', 'A preference towards a midwife-supported birth regardless of method of pain relief", and '"Help my partner help me" - Women anticipating partner involvement.' The overall theme linking the categories together was: 'Autonomous and dependent - The dichotomy of birth', portraying women's ambiguity before birth -expressing a wish to remain in control while simultaneously letting go of control by entrusting partner and midwifewith decision-making regarding their own bodies.KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Women primarily desired a natural, midwife-supported birth and favoured a relationship-based, woman-centred model of care, based on the close interaction between woman, partner, and midwife. Midwives need to be aware of women's ambiguous reliance on them and the power they have to influence women's birth choices and birth experiences. Feminist theory and values in midwifery practice may be useful to inspire a maternity care based on women's wishes and expectations, acknowledging and valuing women's voices, and embracing the sanctity of birth and of the birthing woman's body.
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50.
  • Westergren, Agneta, 1970- (author)
  • Deficient bodies and divine interventions : women, midwives, and the medicalisation of childbirth - a gender perspective
  • 2021
  • Doctoral thesis (other academic/artistic)abstract
    • Background In Sweden, one of the safest countries to give birth and to be born in, there is a trend towards increasing interventions during childbirth, and fewer women than ever give birth without having their labours induced or augmented, epidural analgesia, or caesarean section. While interventions at times are vital for a safe birth, there is a growing body of evidence demonstrating that an overuse of medical and technological interventions may have adverse effects on woman and child. Furthermore, intervention rates vary widely between different hospitals, suggesting varying local practices and in some places, poor adherence to national recommendations. In addition, the ‘Swedish maternity care crisis’ continues to attract media attention, with recurrent reports of overcrowded labour wards, overworked midwives, and of women feeling mistreated during labour and birth.Aim The overall aim of this research project was to explore the implications of a medicalised birth culture for birthing women and midwives in a Swedish context. Through a mixed-methods approach, combining qualitative and quantitative methods, focus was placed on women’s expectations before birth; their preferences for and actual use of pain relief; rates of intrapartum interventions; women’s level of satisfaction with the birth experience; their written evaluations of the birth experience; and interactions between women and midwives in the birth room. The project was informed by a gender perspective, aiming to illuminate the impact of gender on childbirth experiences and practices.Methods The thesis is based on four papers. Data collection for Papers I, II, and III consisted of birth plans, data from medical records, and written birth evaluations. Four hundred women were invited to participate, of which 259 consented. Out of these, participants were selected according to the specific aims of each study. Thus, Study I included women with birth plans (n=132), and data was analysed through qualitative content analysis. Study II was a cross-sectional study analysed by means of descriptive statistics and logistic regression, and included women with a birth plan (n=129) and without a birth plan (n=110). Study III included women with written birth evaluations (n=190), and the analysis consisted of word frequency and thematic analysis. Finally, Study IV was a focused ethnography, gathering data through participant observation during eight births, as well as interviews with the women who gave birth and with the midwives who assisted them (n=16). Data was analysed by thematic analysis. Results Women and midwives alike had similar ideals of childbirth, many valorising natural childbirth and a woman-centred, relational care, based on trust and reciprocity. When comparing women’s expectations and wishes for pain relief as expressed in their birth plans, with actual pain relief used, first-time mothers with birth plans used more pharmacological pain relief than intended, and 93.6% of them had some form of intrapartum intervention, such as induction or augmentation of labour, internal foetal monitoring, or urinary catheterisation. Regardless of having a birth plan or not, primiparas used more pain relief, had more interventions, and were slightly less satisfied with their birth experiences than multiparas: VAS 7.4 vs 8.4 respectively. In their written birth evaluations, written within 48 h of birth, women were mostly satisfied with the support they had from the midwife. In a manner that is suggested to affect their birth experiences, women displayed examples of a gender-normative behaviour, being thankful, sympathetic, and belittling of their own feelings or requests, despite the fact that some women felt that they had not had the support or overall birth experience they had hoped for. In the interaction between women and midwives in the birth room, the midwives continuously bridged the gap between the medical and the social models of care, integrating medicalised practices into midwifery care. Although very passionate about their work, low staffing, hospital hierarchies, and working against their ideological convictions came with a price, at times leaving midwives with feelings of inadequacy and a bad conscience, when trying to meet the needs of the birthing women and colleagues, as well as the demands of the work place.Conclusion Women’s birth choices and experiences and midwives’ working conditions are closely intertwined, and mirror contemporary discourses not only on childbirth, but also on women’s rights and position in society. The present work illustrates that women’s and midwives’ birth ideals, i.e. relational, one-to-one care, incidentally supported by a growing body of evidence, is in conflict with a medicalised and efficiency-driven labour care organisation, leading to job strain for midwives, and a fragmented and interventionist birth care for women. More attention needs to be drawn to the impact of societal and cultural gender norms on contemporary birth practices. There is also the need to recognise birth as existential, emotional, and potentially empowering experiences for women. To achieve this, women need to be informed of, and offered, choices in the way they give birth. At the same time, midwives must be given the time and the support of the organisation to be able to practice ‘watchful attendance’, acknowledging the values of relational care and emotional support.
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