'They would never receive you without a husband' : Paradoxical barriers to antenatal care scale-up in Rwanda

OBJECTIVE: to explore perspectives and experiences of antenatal care and partner involvement among women who nearly died during pregnancy ('near-miss'). DESIGN: a study guided by naturalistic inquiry was conducted, and included extended in-community participant observation, semi-structured interviews, and focus group discussions. Qualitative data were collected between March 2013 and April 2014 in Kigali, Rwanda. FINDINGS: all informants were aware of the recommendations of male involvement for HIV-testing at the first antenatal care visit. However, this recommendation was seen as a clear link in the chain of delays and led to severe consequences, especially for women without engaged partners. The overall quality of antenatal services was experienced as suboptimal, potentially missing the opportunity to provide preventive measures and essential health education intended for both parents. This seemed to contribute to women's disincentive to complete all four recommended visits and men's interest in attending to ensure their partners' reception of care. However, the participants experienced a restriction of men's access during subsequent antenatal visits, which made men feel denied to their increased involvement during pregnancy. CONCLUSIONS: 'near-miss' women and their partners face paradoxical barriers to actualise the recommended antenatal care visits. The well-intended initiative of male partner involvement counterproductively causes delays or excludes women whereas supportive men are turned away from further health consultations. Currently, the suboptimal quality of antenatal care misses the opportunity to provide health education for the expectant couple or to identify and address early signs of complications IMPLICATIONS FOR PRACTICE: these findings suggest a need for increased flexibility in the antenatal care recommendations to encourage women to attend care with or without their partner, and to create open health communication about women's and men's real needs within the context of their social situations. Supportive partners should not be denied involvement at any stage of pregnancy, but should be received only upon consent of the expectant mother.

The world of the Sumerian mother goddess : an interpretation of her myths

The present study is an interpretation of the two myths copied in the Old Babylonian period in which the Sumerian mother goddess is one of the main actors. The first myth is commonly called “Enki and Ninḫursaĝa”, and the second “Enki and Ninmaḫ”. The theoretical point of departure is that myths have society as their referents, i.e. they are “talking about” society, and that this is done in an ideological way. This study aims at investigating on the one hand which contexts in the Mesopotamian society each section of the myths refers to, and on the other hand which ideological aspects that the myths express in terms of power relations. The myths are contextualized in relation to their historical and social setting. If the myth for example deals with working men, male work in the area during the relevant period is discussed. The same method of contextualization is used regarding marriage, geographical points of reference and so on. Also constellations of mythical ideas are contextualized, through comparison with similar constellations in other Mesopotamian myths. Besides the method of contextualization, the power relations in the myths are investigated. According to this latter method, the categories at issue, their ranking, as well as their changed ranking, are noted. The topics of the myths are issues important for the kingship and the country, such as irrigation, trade, health and healing, birth, collective work, artisanry and rivalry. All these aspects are used in order to express what the power relations between the goddess Ninḫursaĝa/Ninmaḫ and the god Enki look like. The relations are negotiated and recalibrated, which leads to the goddess getting a lowered status. Part of the negotiations and recalibrations is gender behavior, which is related to historical developments in society. The present work points to the function of these myths as tools of recalibrating not only deities, but also men and women in society.

Kangaroo Mother Care in a Mozambican perinatal ward : a clinical case study

Kangaroo mother care (KMC) was first introduced in Mozambique in 1984. The aim of this study was to describe Mozambican mothers’ experiences of going through admission, passing from an intensive care ward to a nursery ward with their premature baby, undergoing KMC training before early discharge. A clinical case study was conducted, involving naturalistic observations and a face-to-face interview with 41 mothers participating to complete a questionnaire. Descriptive statistics and manifest content analysis were used in this study. The results show that the mothers were of low socio-economic standing and felt that they did not have enough information on KMC. The hierarchical organization within the hospital setting as well as communalistic behaviours influenced the mothers’ support of KMC, including information, communication, relationships and actions. The conclusion is that there is an important challenge for trained neonatal nurses to improve the guidelines for KMC and to empower mothers and their families to adopt KMC.