Show simple item record

dc.contributor.authorAsefa, A
dc.contributor.authorMcPake, B
dc.contributor.authorLanger, A
dc.contributor.authorBohren, MA
dc.contributor.authorMorgan, A
dc.date.accessioned2021-01-18T04:30:37Z
dc.date.available2021-01-18T04:30:37Z
dc.date.issued2020-12
dc.identifier.citationAsefa, A., McPake, B., Langer, A., Bohren, M. A. & Morgan, A. (2020). Imagining maternity care as a complex adaptive system: understanding health system constraints to the promotion of respectful maternity care.. Sex Reprod Health Matters, 28 (1), pp.456-474. https://doi.org/10.1080/26410397.2020.1854153.
dc.identifier.issn2641-0397
dc.identifier.urihttp://hdl.handle.net/11343/258730
dc.description.abstractEvidence of the health system challenges to promoting respectful maternity care (RMC) is limited in Ethiopia and globally. This study investigated the health system constraints to RMC in three Southern Ethiopian hospitals. We conducted a qualitative study (7 focus group discussions (FGDs) with providers of RMC and 12 in-depth interviews with focal persons and managers) before and after the implementation of an RMC intervention. We positioned childbirth services within the health system and applied complex adaptive system theory to analyse the opportunities and constraints to the promotion of RMC. Both system "hardware" and "software" factors influencing the promotion of RMC were identified, and their interaction was complex. The "hardware" factors included bed availability, infrastructure and supplies, financing, and health workforce. "Software" factors encompassed service providers' mindset, staff motivation, and awareness of RMC. Interactions between these factors included privacy breaches for women when birth companions were admitted in labour rooms. Delayed reimbursement following the introduction of fee-exemption for maternity services resulted in depleted revenues, supply shortages, and ultimately disrespectful behaviour among providers. Other financial constraints, including the insufficient and delayed release of funds, also led to complex interactions with the motivation of staff and the availability of workforce and supplies, resulting in poor adherence to RMC guidance. Interventions aimed at improving only behavioural components fall short of mitigating the mistreatment of women. System-wide interventions are required to address the complex interactions that constraint RMC.
dc.languageeng
dc.publisherTaylor & Francis Ltd
dc.rights.urihttps://creativecommons.org/licenses/by-nc/4.0
dc.titleImagining maternity care as a complex adaptive system: understanding health system constraints to the promotion of respectful maternity care.
dc.typeJournal Article
dc.identifier.doi10.1080/26410397.2020.1854153
melbourne.affiliation.departmentMelbourne School of Population and Global Health
melbourne.source.titleSexual and Reproductive Health Matters
melbourne.source.volume28
melbourne.source.issue1
melbourne.source.pages456-474
dc.rights.licenseCC BY-NC
melbourne.elementsid1483666
melbourne.openaccess.urlhttps://www.tandfonline.com/doi/full/10.1080/26410397.2020.1854153
melbourne.openaccess.pmchttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC7888043
melbourne.openaccess.statusPublished version
melbourne.contributor.authorMorgan, Alison
melbourne.contributor.authorMcPake, Barbara
melbourne.contributor.authorBohren, Meghan
melbourne.contributor.authorMekonnen, Anteneh Asefa
dc.identifier.eissn2641-0397
melbourne.accessrightsOpen Access


Files in this item

Thumbnail

This item appears in the following Collection(s)

Show simple item record