Bregje de Kok

Parenting support for families with young children- a public health user-focused study undertaken in a semi-rural area of Scotland

AIMS AND OBJECTIVES To work with parents and public health nurses (health visitors), to identify and design a range of public health interventions to provide support to parents of young children. BACKGROUND In the UK, only vulnerable families are now eligible for pro-active health visiting interventions on an individual family basis beyond the early days. Public health approaches are recommended for the majority of families who are not eligible for one-to-one professional support. DESIGN Focus groups were carried out with parents of young children, health visitors and other professionals working with them. METHODS The study was carried out in a semi-rural area of Scotland, consisting of a small town, and the surrounding rural area, including one area of deprivation. The area is served by a team consisting of six health visitors and one health assistant, based in two health centres in the area. Nineteen parents, five members of the health visiting team and 11 other professionals from health, education and social work took part via an invitation to contact the research team. RESULTS The needs of parents identified by both parents and professionals could best be met by social support, with skilled facilitation and suitable resources. The resolution of tensions between caseload-based and population-based health visiting, as well as the management of the tensions inherent in these changes, seems to be vital in order to implement these approaches. Many parents would like information made available online. CONCLUSIONS Services to support families with young children need to be designed from the perspectives of parents and their needs. RELEVANCE TO CLINICAL PRACTICE Services need to be set up in partnership with parents to provide them with information and access to peer and professional support, using public health approaches. Multiagency working, including among senior managers, may be the most effective way of providing this support.

Joining-up thinking: Loss in childbearing from inter-disciplinary perspectives

This editorial provides epidemiological data on the prevalence of loss in childbearing. It underscores the need for an inter-disciplinary contextualized approach by highlighting the multi-dimensional nature of loss and identifies some of the main insights that a collection of articles offers to those seeking to improve peoples reproductive health. In addition the authors draw attention to loss in childbearing as a physical psychological social economic and public health problem intertwined with social political and economic inequities that are affronts to social justice and human rights.

Interpersonal Issues in Expressing Lay Knowledge: A Discursive Psychology Approach

This article examines lay knowledge about causes of infertility. We use discursive psychology to analyse semi-structured interviews with purposively sampled Malawians with a fertility problem. We observe that respondents deny knowledge of causes, sometimes emphatically, but this co-occurs with descriptions of potential causes. We show that these respondents thereby address problematic interpersonal issues: namely that one is not entitled to medical knowledge and that negative inferences that may be drawn about someone who knows particular causes of infertility. These findings shed new light on previous observations, and have implications for the study of lay knowledge.

'It's a very complicated issue here': understanding the limited and declining use of manual vacuum aspiration for postabortion care in Malawi: a qualitative study.

Malawi has one of the highest maternal mortality ratios in the world. Unsafe abortions are an important contributor to Malawis maternal mortality and morbidity, where abortion is illegal except to save the womans life. Postabortion care (PAC) aims to reduce adverse consequences of unsafe abortions, in part by treating incomplete abortions. Although global and national PAC policies recommend manual vacuum aspiration (MVA) for treatment of incomplete abortion, usage in Malawi is low and appears to be decreasing, with sharp curettage being used in preference. There is limited evidence regarding what influences rejection of recommended PAC innovations. Hence, drawing on Greenhalgh et al. s (2004. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Quarterly 82: 581-629.) diffusion of healthcare innovation framework, this qualitative study aimed to investigate factors contributing to the limited and declining use of MVA in Malawi. Semi-structured interviews with 17 PAC providers in a central hospital and a district hospital indicate that a range of factors coalesce and influence PAC and MVA use in Malawi. Factors pertain to four main domains: the system (shortages of material and human resources; lack of training, supervision and feedback), relationships (power dynamics; expected job roles), the health workers (attitudes towards abortion and PAC; prioritization of PAC) and the innovation (perceived risks and benefits of MVA use). Effective and sustainable PAC policy must adopt a broader people-centred health systems approach which considers all these factors, their interactions and the wider socio-cultural, legal and political context of abortion and PAC. The study showed the value of using Greenhalgh et al. s (2004. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Quarterly 82: 581-629.) framework to consider the complex interaction of factors surrounding innovation use (or lack of), but provided more insights into rejections of innovations and, particularly, a low- and middle-income country perspective.

Reproductive Desires and Disappointments

ABSTRACT In this introduction we consider how people who have difficulties achieving “natural” parenthood seek to form families, and their experiences of reproductive negotiations and losses in this pursuit. We highlight gaps in the literature on infertility and loss globally, and identify how the special edition addresses the dearth of research in this field with men, with non-elites and on loss. We consider the key insights drawn from studies conducted in divergent geographical, cultural, socioeconomic and political contexts, including perspectives from Ghana, Indonesia, Romania, Spain, the United Kingdom, and the United States. In these contexts we explore both high tech and no tech reproductive strategies, encompassing assisted reproductive technologies, third party donation, surrogacy, as well as intra-family and transnational adoption. We illuminate how people attribute meaning to their lived experiences of reproductive disappointments ranging from failed conception (primary and secondary infertility), miscarriage, stillbirths, neonatal death, and failed adoption. We reflect on both local and transnational practices embedded in family making, highlighting the complexity and dynamism of reproductive opportunities, and how these opportunities are embedded in multifarious power relations. We articulate a range of important themes for the anthropology of reproduction, including: the sociality of reproductive desires and disappointments; gender sexuality and emergent masculinities; migration, practices of belonging, and kinship; reproductive stratification and leveling; and reproduction and relationality.

Global maternal health: from women's survival to respectful care

Maternal and neonatal health advocates increasingly call for respectful maternal care that addresses women’s needs (http:// whiteribbonalliance.org/campaigns/ respectful-maternity-care/). The importance of this agenda is underscored by my recent research on loss in childbearing (maternal and perinatal deaths, miscarriage) in Malawi. Four Malawian researchers (Priscilla Matinga, Blessings Kaunda, Caro Mbeya, Fryness Phiri) and I conducted focus groups and interviews with community members and practitioners, and unstructured, ethnographic observations of antenatal, postnatal and intrapartum care in three health centres and two referral hospitals in an urban, semi-urban and rural area.Maternal and neonatal health advocates increasingly call for respectful maternal care that addresses women’s needs (http:// whiteribbonalliance.org/campaigns/ respectful-maternity-care/). The importance of this agenda is underscored by my recent research on loss in childbearing (maternal and perinatal deaths, miscarriage) in Malawi. Four Malawian researchers (Priscilla Matinga, Blessings Kaunda, Caro Mbeya, Fryness Phiri) and I conducted focus groups and interviews with community members and practitioners, and unstructured, ethnographic observations of antenatal, postnatal and intrapartum care in three health centres and two referral hospitals in an urban, semi-urban and rural area.