Maternal health care professionals perspective on the provision and use of antenatal and delivery care : a qualitative descriptive study in rural Vietnam

Background. High quality maternal health care is an important tool to reduce maternal and neonatal mortality. Services offered should be evidence based and adapted to the local setting. This qualitative descriptive study explored the perspectives and experiences of midwives, assistant physicians and medical doctors on the content and quality of maternal health care in rural Vietnam. Method. The study was performed in a rural district in northern Vietnam. Four focus group discussions with health care professionals at primary health care level were conducted. The data was analysed using qualitative manifest and latent content analysis. Result. Two main themes emerged: "Contextual conditions for maternal health care" and "Balancing between possibilities and constraints". Contextual conditions influenced both pregnant women's use of maternal health care and health care professionals' performance. The study participants stated that women's uses of maternal health care were influenced by economical constraints and cultural norms that impeded their autonomy in relation to childbearing. Structural constraints within the health care system included inadequate financing of the primary health care, resulting in lack of human resources, professional re-training and adequate equipment. Conclusion. Contextual conditions strongly influenced the performance and interaction between pregnant women and health care professionals within antenatal care and delivery care in a rural district of Vietnam. Although Vietnam is performing comparatively well in terms of low maternal and child mortality figures, this study revealed midwives' and other health care professionals' perceived difficulties in their daily work. It seemed maternal health care was under-resourced in terms of staff, equipment and continuing education activities. The cultural setting in Vietnam constituting a strong patriarchal society and prevailing Confucian norms limits women's autonomy and reduce their possibility to make independent decisions about their own reproductive health. This issue should be further addressed by policy-makers. Strategies to reduce inequities in maternal health care for pregnant women are needed. The quality of client-provider interaction and management of pregnancy may be strengthened by education, human resources, re-training and provision of essential equipment.

Beroende eller oberoende? : En kvalitativ studie av hur äldre hjälptagare ser på att ha hjälp och stöd

Dependency or independence? A qualitative study of how elderly home-help recipients regard having help and support Knowledge on elderly people’s understandings of dependence and independence is relatively scarce even though there is plenty of gerontological research on related topics. Although we know how to define and measure different types of dependency, we know, in fact, very little about how elderly home-help recipients themselves regard their situation in terms of dependency, independence and autonomy. This article aims to shed light on home-help recipients’ understandings of these constructs and on how they make sense of their situation. The analysis is based on 29 semi-structured interviews with people between the ages of 77 and 93. The findings show how these home help recipients differentiate between having help and support and being dependent on other people. Through the separation of aspects of these understandings, such as the reason why they accept help and support and how they regard the situation of being helped and assisted, three ways of regarding the situation have been identified, which stress the variability of the social construction of dependency and independence that these elders uphold. Some home-help recipients construct themselves as independent, others as autonomous and able selves, while a third group construct themselves as powerless.