Power, policy and abortion care in Uganda

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Abstract

Unsafe abortion practices remain the major contributor to maternal death in Uganda, impeding the achievement of universal health coverage and quality of maternal health care. Using an ethnographic design and critical discourse analysis, we explored the operations of power in setting maternal healthcare priorities, as evident at the 2018 Reproductive, Maternal, Neonatal, Child and Adolescents Health Conference. Observational data were collected of the policy-making activities, processes and events and key informant interviews were conducted with 27 participants. We describe how neoliberal and state governance through the structure and organization of policy-making, epistemic governance and universal concepts of ‘high-impact’ interventions, results-based financing, cost-effectiveness and accountability converge to suppress the articulation of local conditions associated with unsafe and risky abortion. By defining maternity along the continuum of birth and emphasizing birthing women, priority-setting was directed towards interventions promoting women’s normative role as mothers while suppressing unmet abortion care needs. Finally, discursive and communicative materials controlled how women of reproductive age in Uganda managed reproduction.

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Global causes of maternal death: a WHO systematic analysis.

Lale Say, Doris Chou, Alison Gemmill … (2014)

Data for the causes of maternal deaths are needed to inform policies to improve maternal health. We developed and analysed global, regional, and subregional estimates of the causes of maternal death during 2003-09, with a novel method, updating the previous WHO systematic review. We searched specialised and general bibliographic databases for articles published between between Jan 1, 2003, and Dec 31, 2012, for research data, with no language restrictions, and the WHO mortality database for vital registration data. On the basis of prespecified inclusion criteria, we analysed causes of maternal death from datasets. We aggregated country level estimates to report estimates of causes of death by Millennium Development Goal regions and worldwide, for main and subcauses of death categories with a Bayesian hierarchical model. We identified 23 eligible studies (published 2003-12). We included 417 datasets from 115 countries comprising 60 799 deaths in the analysis. About 73% (1 771 000 of 2 443 000) of all maternal deaths between 2003 and 2009 were due to direct obstetric causes and deaths due to indirect causes accounted for 27·5% (672 000, 95% UI 19·7-37·5) of all deaths. Haemorrhage accounted for 27·1% (661 000, 19·9-36·2), hypertensive disorders 14·0% (343 000, 11·1-17·4), and sepsis 10·7% (261 000, 5·9-18·6) of maternal deaths. The rest of deaths were due to abortion (7·9% [193 000], 4·7-13·2), embolism (3·2% [78 000], 1·8-5·5), and all other direct causes of death (9·6% [235 000], 6·5-14·3). Regional estimates varied substantially. Between 2003 and 2009, haemorrhage, hypertensive disorders, and sepsis were responsible for more than half of maternal deaths worldwide. More than a quarter of deaths were attributable to indirect causes. These analyses should inform the prioritisation of health policies, programmes, and funding to reduce maternal deaths at regional and global levels. Further efforts are needed to improve the availability and quality of data related to maternal mortality. © 2014 World Health Organization; licensee Elsevier. This is an Open Access article published without any waiver of WHO's privileges and immunities under international law, convention, or agreement. This article should not be reproduced for use in association with the promotion of commercial products, services, or any legal entity. There should be no suggestion that WHO endorses any specific organisation or products. The use of the WHO logo is not permitted. This notice should be preserved along with the article's original URL.

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A matched case–control study of preterm birth in one hospital in Beijing, China

AiQun Huang, Xi Jin, Xiaohong Liu … (2015)

Background Preterm birth is an unresolved global health issue. The etiologies of preterm birth are complex and multifactorial. To examine risk factors related to preterm birth, a matched case–control study was conducted in a hospital in Beijing, China where little data on preterm birth have been published in the scientific literature. Methods A 1:1 matched case–control study was conducted in 172 pairs of women with preterm birth (case group) and term delivery (control group). Eligible subjects were interviewed in person by well-trained investigators using a questionnaire. Information on obstetric diagnosis and newborns were abstracted from inpatients’ medical records. Univariate and multivariate conditional logistic regression models were used to measure the associations between related factors and preterm birth. Results Univariate analysis showed that 6 of 12 factors were associated with preterm birth. Multivariate results showed that gestational hypertension (OR = 7.76), low gestational weight gain (OR = 3.02), frequent prenatal care (OR = 0.16), balanced diet (OR = 0.36), and high gestational weight gain (OR = 0.41) were associated with preterm birth. Conclusion This study provides information on preterm birth in Beijing, China, and it also lends support to existing evidence about the role of maternal nutritional status, prenatal care and gestational hypertension as risk factors for preterm birth.

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The social determinants of chronic disease management: perspectives of elderly patients with hypertension from low socio-economic background in Singapore

Sok Teng Tan, Rina Quek, Victoria Haldane … (2019)

Background In Singapore, the burden of hypertension disproportionately falls on the elderly population of low socio-economic status. Despite availability of effective treatment, studies have shown high prevalence of sub-optimal blood pressure control in this group. Poor hypertension management can be attributed to a number of personal factors including awareness, management skills and overall adherence to treatment. However, these factors are also closely linked to a broader range of community and policy factors. This paper explores the perceived social and physical environments of low socio-economic status and elderly patients with hypertension; and how the interplay of factors within these environments influences their ability to mobilise resources for hypertension management. Methods In-depth interviews were conducted in English, Chinese, Chinese dialects and Malay with 20 hypertensive patients of various ethnic backgrounds. Purposive sampling was adopted for recruitment of participants from a previous community health screening campaign. Interviews were translated into English and transcribed verbatim. We deductively analysed leveraging on the Social Model of Health to identify key themes, while inductive analysis was used simultaneously to allow sub-themes to emerge. Results and discussion Our finding shows that financing is an overarching topic embedded in most themes. Despite the availability of multiple safety nets, some patients were left out and lacked capital to navigate systems effectively, which resulted in delayed treatment or debt. The built environment played a significant role in enabling patients to access care easily and lead a more active lifestyle. A closer look is needed to enhance the capacity of patients with mobility challenges to enjoy equitable access. Furthermore, the establishment of community based elderly centres has enabled patients to engage in meaningful and healthy social activities. In contrast, participants’ descriptions showed that their communication with healthcare professionals remained brief, and that personalised and meaningful interactions that are context and culturally specific are essential to advocate for patients’ overall treatment adherence and lifestyle modification. Conclusion Elderly patients with hypertension from lower socio-economic background have various unmet needs in managing their hypertension and other comorbidities. These needs are closely related to broader societal factors such as socio-demographic characteristics, support systems, urban planning and public policies, and health systems factors. Policy decisions to address these needs require an integrated multi-sectoral approach grounded in the principles of health equity.

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Author and article information

Journal

Journal ID (nlm-ta): Health Policy Plan

Journal ID (iso-abbrev): Health Policy Plan

Journal ID (publisher-id): heapol

Title: Health Policy and Planning

Publisher: Oxford University Press

ISSN (Print): 0268-1080

ISSN (Electronic): 1460-2237

Publication date Collection: March 2021

Publication date (Electronic): 21 December 2020

Publication date PMC-release: 21 December 2020

Volume: 36

Issue: 2

Pages: 187-195

Affiliations

[1 ] School of Public Health, University of the Witwatersrand , Johannesburg, South Africa

[2 ] Institute at Brown for Environment and Society, Brown University , Providence, RI, USA

[3 ] Department of Anthropology, School of Social Sciences, Menzies Building 20 Chancellors Walk, Monash University , Clayton VIC 3800, Australia

Author notes

Corresponding author. School of Public Health, University of the Witwatersrand, Johannesburg, South Africa. E-mail: akagaha@ 123456gmail.com , akagaha@ 123456cartafrica.org

Article

Publisher ID: czaa136

DOI: 10.1093/heapol/czaa136

PMC ID: 7996642

PubMed ID: 33347559

SO-VID: 61073e33-785d-48a3-b0bc-553222be3787

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date accepted : 20 September 2020

Page count

Pages: 9

Funding

Funded by: Consortium for Advanced Research Training in Africa (CARTA);

Funded by: African Population and Health Research Center and the University of the Witwatersrand and funded by the Carnegie Corporation of New York;

Award ID: B 8606.R02

Funded by: Sida, DOI 10.13039/100004441;

Award ID: 54100113

Funded by: DELTAS Africa Initiative;

Award ID: 107768/Z/15/Z

Funded by: Deutscher Akademischer Austauschdienst (DAAD);

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Power, policy and abortion care in Uganda

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Most cited references 47

Global causes of maternal death: a WHO systematic analysis.

A matched case–control study of preterm birth in one hospital in Beijing, China

The social determinants of chronic disease management: perspectives of elderly patients with hypertension from low socio-economic background in Singapore

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