The challenge of high-quality respectful care

全球，许多生育妇女有很少的机会to make autonomous childbirth decisions themselves and经验较差的关心。这涉及妇女在社会中的总体状况，更具体地涉及产妇服务未能为所有人提供最佳和有尊严的护理。后者是一个问题报告了high-income countries as well as low- and middle-income countries,在cludingAfghanistan。

Healthcare providers are the vital link between evidence-based policies and women receiving high-quality respectful maternity care.Explanations在次优护理的文献中，通常包括员工的工作条件不佳和缺乏基本供应。其他explanations建议that doctors, midwives and care assistants might lack vital skills or be unaware of the rights of the women for whom they care.

我们做了什么

我们的研究examined the everyday lives of maternal healthcare providers working in a tertiary maternity hospital in Kabul, Afghanistan, between 2010 and 2012. The aim was to understand the staff’s notions of care, their varying levels of commitment to providing care for women in childbirth, and the obstacles and dilemmas that affected standards, and thereby gain insight into their contributions to respectful maternity care, whether as ‘villains’ or as ‘victims.’

We employed an ethnographic approach to qualitatively explore the culture of care. Dr. Arnold spent six weeks observing care and interacting with staff. She then conducted 23 semi-structured interviews with doctors, midwives and care assistants, as well as 41 background interviews. In addition, focus groups were held with two diverse groups of women in community settings to understand their experiences and how they wished to be cared for.

我们发现的

本文的主要发现是，妇女将许多忽视，口头虐待和对员工贿赂的要求介绍了许多实例。医生和助产士同意他们没有提供护理，因为他们被教导并指责工作量，缺乏班次系统，不足的供应以及管理层的支持不足。仔细检查发现了一个复杂的现实，在供应短缺并进一步减少盗窃案引起的供应和药物的较低水平和药物阻碍的情况下；一些员工受到管理层不公平的指责，而另一些员工则不受惩罚地违反了规则；在积极进取的工作人员努力工作的地方，但是当工作量不知所措时，承认他们失去了耐心并向分娩的妇女大喊大​​叫。此外，还有极端的虐待和弱势员工的例子。

建议

我们得出结论,提供有礼貌,垫质量ernity care for women in Afghanistan requires multifaceted initiatives because the factors leading to suboptimal care or mistreatment are complex and interrelated. Standards need to be enforced and abusive practices need to be confronted in order to provide a supportive, facilitating environment for both staff and birthing women. Polarized perspectives such as ‘villain’ or ‘victim’ are unhelpful as they exclude the complex realities of human behavior and consequently limit the scope of problem solving.