Eleri Jones

Maternity care services and culture: a systematic global mapping of interventions.

Background A vast body of global research shows that cultural factors affect the use of skilled maternity care services in diverse contexts. While interventions have sought to address this issue, the literature on these efforts has not been synthesised. This paper presents a systematic mapping of interventions that have been implemented to address cultural factors that affect womens use of skilled maternity care. It identifies and develops a map of the literature; describes the range of interventions, types of literature and study designs; and identifies knowledge gaps. Methods and Findings Searches conducted systematically in ten electronic databases and two websites for literature published between 01/01/1990 and 28/02/2013 were combined with expert-recommended references. Potentially eligible literature included journal articles and grey literature published in English, French or Spanish. Items were screened against inclusion and exclusion criteria, yielding 96 items in the final map. Data extracted from the full text documents are presented in tables and a narrative synthesis. The results show that a diverse range of interventions has been implemented in 35 countries to address cultural factors that affect the use of skilled maternity care. Items are classified as follows: (1) service delivery models; (2) service provider interventions; (3) health education interventions; (4) participatory approaches; and (5) mental health interventions. Conclusions The map provides a rich source of information on interventions attempted in diverse settings that might have relevance elsewhere. A range of literature was identified, from narrative descriptions of interventions to studies using randomised controlled trials to evaluate impact. Only 23 items describe studies that aim to measure intervention impact through the use of experimental or observational-analytic designs. Based on the findings, we identify avenues for further research in order to better document and measure the impact of interventions to address cultural factors that affect use of skilled maternity care.

Poverty and postnatal depression: a systematic mapping of the evidence from low and lower middle income countries

This study systematically maps, assesses and aggregates research relating to postnatal depression (PND) and poverty in low and lower middle income countries (LLMICs). Our search of 12 databases yielded 2202 articles, of which 47 items from 17 countries were included in our mapping. We highlight mechanisms for the relationships between poverty and PND in LLMICs. The research base on the relationships between poverty and PND in LLMIC is limited, but has recently expanded. It is dominated by studies that consider whether poverty is a risk factor for PND. Income, socio-economic status and education are all inconsistent risk factors for PND. Clues to better ways of framing and capturing economic stress in PND research is found in the qualitative studies included in our mapping. Evidence focuses overwhelmingly on individual-level analyses. To understand the scale and implications of PND in LLMICs, research has to take account of neighbourhoods, communities, and localities.

Social relationships and postpartum depression in South Asia: a systematic review

Background: Evidence suggests a much higher prevalence of postpartum depression in South Asia than in ‘western’ contexts. Aim: To conduct a rapid systematic review of evidence on the association between social relationships and postpartum depression in South Asia. Methods: Five databases were searched to identify relevant studies. Studies meeting the selection and quality criteria were analysed and integrated in a narrative review. Results: Nine mostly quantitative studies were included in the review. Low support and poor relationships with the husband and parents-in-law were associated with postpartum depression, although associations were weakened in multivariate analyses. The different dimensions of support have not yet been systematically investigated and the likely complex interrelationships between social relationship risk factors are not yet well understood. Conclusions: Findings mirror those from ‘western’ contexts, showing the key role of social relationships in the aetiology of postpartum depression. Yet, they also reinforce the hypothesis that the social and cultural context influences the association. The importance of relationships with the extended family, as well as the husband, in South Asia is highlighted. Further research is recommended to develop an understanding of these relationships to better inform interventions.

Urban Migration of Adolescent Girls: Quantitative Results from Developing Countries

This chapter assembles a quantitative portrait of the adolescent girls who migrate to the cities and towns of poor countries, drawing mainly on a large collection of data from demographic surveys and census micro-samples. For adolescent girls and young women, migration puts important urban resources within reach, in the form of access to higher levels of schooling, more varied labor markets and employment opportunities, and multiple levels of health-care institutions. But while the move is underway and until she locates a safe home in her new location, an adolescent girl can confront a range of social and sexual risks that can threaten her well-being and thwart hopes for advancement. Much of the literature on adolescent migration is focused on these risks but neglects the potential benefits. We find that in many countries, significant percentages of urban adolescent girls are recent in-migrants. In characterizing their life-circumstances, we give special attention to indicators of social isolation, the conditions of housing and neighborhood, and school enrollment. We show that adolescent girl migrants are a highly diverse group, advantaged in some respects and disadvantaged in others. Field studies in urban India shed light on the difficulties with which girls must cope as they strive to adapt to urban life.

Bridging the hospitality and tourism university–industry research gap in developing countries: The case of Egypt

This paper explores university–industry collaboration in developing countries through a case study of university–industry research collaboration in support of the Egyptian hospitality and tourism industry. The perceptions of four key Egyptian stakeholder groups – industry, university, government and non-governmental organisations – were identified via in-depth semi-structured one-to-one interviews. The research gap between Egyptian universities and the hospitality and tourism industry is wider than suggested in the literature on university–industry collaboration. There was consensus of the absence of a research culture in faculties of tourism and hotels where social science research was perceived as having little/no value except as a part of academic degrees or for promotional purposes, rather than for knowledge creation or to inform industry’s practices. Egyptian faculties of tourism and hotels had not undergone the first academic revolution experienced in the US and Europe in the late 19th century. There was no evidence of government interventions to drive university–industry research collaboration for the tourism and hospitality industry, despite its undoubted importance to the Egyptian economy. The study sends a message to policy-makers, particularly government, that unless serious attention is paid to hospitality and tourism education and research, the impact on economic and social development will be negative.

Migrant Adolescent Girls in Urban Slums India: Aspirations, Opportunities and Challenges

Migrant adolescent girls in India’s fast-growing urban-slum population face multiple intersecting vulnerabilities, including gender, poverty and migrant-status. The study aims to understand the opportunities and challenges for migrant adolescent girls in low-income urban slum settings. Qualitative data were collected through interviews with girls aged 12-19 who migrated during the past two years and non-migrant adolescent girls for comparison to explore their experiences in fast-growing Indore. A group-interview with slum women’s group members discussed ways to address challenges. Push/pull factors linked with different employment/educational opportunities between rural and urban areas motivated families of unmarried girls to migrate. Recently married girls joined city-based families or accompanied husbands who were labor migrants. Neither married nor unmarried girls played decision-making roles in migration. Married migrant adolescent girls faced challenges in accessing education, employment, social opportunities and services owing to restrictions on freedom of movement, weak social networks, and little awareness of opportunities and services. Childbearing migrant girls faced particular risks. Contact with their natal families being limited, the quality of relationship with husbands and marital families was crucial for married girls’ well-being. Unmarried girls attending schools were positive about the migration experience, perceiving the city to offer greater educational opportunities. Through school, they accessed opportunities for new relationships and social activities. Not all unmarried adolescent-girls were able to access opportunities owing to family restrictions and economic circumstances. These girls’ worlds remained small despite moving to a large city. Where girls’ economic and/or family and social circumstances allowed, migration entailed a positive change that enhanced their opportunities. Specific challenges of this population segment need focus in policies and programs, prioritizing three particularly vulnerable groups: girls who are neither in education nor employment, pregnant girls or new mothers, and those with difficult relationships in marital homes. Proactive outreach to raise awareness about opportunities and services and fostering social networks through frontline workers and slum-women’s groups are recommended.

Effectiveness of interventions to provide culturally appropriate maternity care in increasing uptake of skilled maternity care: a systematic review

Addressing cultural factors that affect uptake of skilled maternity care is recognized as an important step in improving maternal and newborn health. This article describes a systematic review to examine the evidence available on the effects of interventions to provide culturally appropriate maternity care on the use of skilled maternity care during pregnancy, for birth or in the postpartum period. Items published in English, French and/or Spanish between 1 January 1990 and 31 March 2014 were considered. Fifteen studies describing a range of interventions met the inclusion criteria. Data were extracted on population and intervention characteristics; study design; definitions and data for relevant outcomes; and the contexts and conditions in which interventions occurred. Because most of the included studies focus on antenatal care outcomes, evidence of impact is particularly limited for care seeking for birth and after birth. Evidence in this review is clustered within a small number of countries, and evidence from low- and middle-income countries is notably lacking. Interventions largely had positive effects on uptake of skilled maternity care. Cultural factors are often not the sole factor affecting populations’ use of maternity care services. Broader social, economic, geographical and political factors interacted with cultural factors to affect targeted populations’ access to services in included studies. Programmes and policies should seek to establish an enabling environment and support respectful dialogue with communities to improve use of skilled maternity care. Whilst issues of culture are being recognized by programmes and researchers as being important, interventions that explicitly incorporate issues of culture are rarely evaluated.

Interventions to provide culturally-appropriate maternity care services: factors affecting implementation

BackgroundThe World Health Organization recently made a recommendation supporting ‘culturally-appropriate’ maternity care services to improve maternal and newborn health. This recommendation results, in part, from a systematic review we conducted, which showed that interventions to provide culturally-appropriate maternity care have largely improved women’s use of skilled maternity care. Factors relating to the implementation of these interventions can have implications for their success. This paper examines stakeholders’ perspectives and experiences of these interventions, and facilitators and barriers to implementation; and concludes with how they relate to the effects of the interventions on care-seeking outcomes.MethodsWe based our analysis on 15 papers included in the systematic review. To extract, collate and organise data on the context and conditions from each paper, we adapted the SURE (Supporting the Use of Research Evidence) framework that lists categories of factors that could influence implementation. We considered information from the background and discussion sections of papers included in the systematic review, as well as cost data and qualitative data when included.ResultsWomen’s and other stakeholders’ perspectives on the interventions were generally positive. Four key themes emerged in our analysis of facilitators and barriers to implementation. Firstly, interventions must consider broader economic, geographical and social factors that affect ethnic minority groups’ access to services, alongside providing culturally-appropriate care. Secondly, community participation is important in understanding problems with existing services and potential solutions from the community perspective, and in the development and implementation of interventions. Thirdly, respectful, person-centred care should be at the core of these interventions. Finally, cohesiveness is essential between the culturally-appropriate service and other health care providers encountered by women and their families along the continuum of care through pregnancy until after birth.ConclusionSeveral important factors should be considered and addressed when implementing interventions to provide culturally-appropriate care. These factors reflect more general goals on the international agenda of improving access to skilled maternity care; providing high-quality, respectful care; and community participation.

Ascorbyl palmitate as a source of tissue ascorbic acid

Abstract Ascorbyl palmitate prevented the appearance of scurvy in guinea-pigs given a scorbutogenic diet. There was no significant difference between the tissue concentrations of ascorbic acid in two groups of male guineapigs given equimolar amounts of ascorbic acid and ascorbyl palmitate, respectively, as a dietary supplement.