Ruth Jackson

Health Extension Workers' and Mothers' Attitudes to Maternal Health Service Utilization and Acceptance in Adwa Woreda, Tigray Region, Ethiopia.

Background The maternal health system in Ethiopia links health posts in rural communities (kebeles) with district (woreda) health centres, and health centres with primary hospitals. At each health post two Health Extension Workers (HEWs) assist women with birth preparedness, complication readiness, and mobilize communities to facilitate timely referral to mid-level service providers. This study explored HEWs’ and mother’s attitudes to maternal health services in Adwa Woreda, Tigray Region. Methods In this qualitative study, we trained 16 HEWs to interview 45 women to gain a better understanding of the social context of maternal health related behaviours. Themes included barriers to health services; women’s social status and mobility; and women’s perceptions of skilled birth attendant’s care. All data were analyzed thematically. Findings There have been substantial efforts to improve maternal health and reduce maternal mortality in Adwa Woreda. Women identified barriers to healthcare including distance and lack of transportation due to geographical factors; the absence of many husbands due to off-woreda farming; traditional factors such as zwar (some pregnant women are afraid of meeting other pregnant women), and discouragement from mothers and mothers-in-law who delivered their children at home. Some women experienced disrespectful care at the hospital. Facilitators to skilled birth attendance included: identification of pregnant women through Women’s Development Groups (WDGs), and referral by ambulance to health facilities either before a woman’s Expected Due Date (EDD) or if labour started at home. Conclusion With the support of WDGs, HEWs have increased the rate of skilled birth attendance by calling ambulances to transfer women to health centres either before their EDD or when labour starts at home. These findings add to the growing body of evidence that health workers at the community level can work with women’s groups to improve maternal health, thus reducing the need for emergency obstetric care in low-income countries.

Barriers and facilitators to accessing skilled birth attendants in Afar region, Ethiopia.

OBJECTIVE to explore barriers and facilitators that enable women to access skilled birth attendance in Afar Region, Ethiopia. DESIGN researchers used a Key Informant Research approach (KIR), whereby Health Extension Workers participated in an intensive training workshop and conducted interviews with Afar women in their communities. Data was also collected from health-care workers through questionnaires, interviews and focus groups. PARTICIPANTS fourteen health extension workers were key informants and interviewers; 33 women and eight other health-care workers with a range of experience in caring for Afar childbearing women provided data as individuals and in focus groups. FINDINGS participants identified friendly service, female skilled birth attendants (SBA) and the introduction of the ambulance service as facilitators to SBA. There are many barriers to accessing SBA, including women׳s low status and restricted opportunities for decision making, lack of confidence in health-care facilities, long distances, cost, domestic workload, and traditional practices which include a preference for birthing at home with a traditional birth attendant. KEY CONCLUSIONS many Afar men and women expressed a lack of confidence in the services provided at health-care facilities which impacts on skilled birth attendance utilisation. IMPLICATIONS FOR PRACTICE ambulance services that are free of charge to women are effective as a means to transfer women to a hospital for emergency care if required and expansion of ambulance services would be a powerful facilitator to increasing institutional birth. Skilled birth attendants working in institutions need to ensure their practice is culturally, physically and emotionally safe if more Afar women are to accept their midwifery care. Adequate equipping and staffing of institutions providing emergency obstetric and newborn care will assist in improving community perceptions of these services. Most importantly, mutual respect and collaboration between traditional birth attendants (Afar women׳s preferred caregiver), health extension workers and skilled birth attendants will help ensure timely consultation and referral and reduce delay for women if they require emergency maternity care.

Factors that hinder or enable maternal health strategies to reduce delays in rural and pastoralist areas in Ethiopia

To document factors that hinder or enable strategies to reduce the first and second delays of the Three Delays in rural and pastoralist areas in Ethiopia.

Making connections in a regional city: Social capital and the primary social contract

Government policy in many countries encourages migration to regional centres to relieve pressure on major cities and to boost economic development. Migrants are more likely to remain in a new location if they have meaningful work and establish social connections there. This article explores how organisations and groups in a regional city provide newcomers with access to social capital resources which migrants can use to forge social connections. Past research has shown that migrants require a mix of linking, bridging and bonding social capital to form an effective primary social contract with their new home. This research suggests that regional cities – such as Geelong, Victoria – which are proactive in assembling diverse social capital resources and making them accessible to migrants, are more likely not only to receive more newcomers but also more likely to retain migrants and a skilled workforce. The findings have relevance to other regional centres.

Utilisation of maternal health services in Ethiopia: a key informant research project

ABSTRACT This article explores the application of key informant research to examine barriers and facilitators to maternal health services in rural and pastoralist Ethiopia. The key informants were health extension workers (HEWs) who assist women with birth preparedness and facilitate timely referral to health centres for birth. While women encounter many barriers to giving birth in health facilities, where HEWs are supported by their communities and health centre staff, they can effectively encourage women to travel to health centres to give birth with skilled birth attendants rather than at home with unskilled relatives or traditional birth attendants.

The Place of Birth in Kafa Zone, Ethiopia

In this qualitative study, I used an ethnographic approach to provide an understanding about the place of birth in rural and semiurban Kafa Zone, Ethiopia. I interviewed women about birth at home and asked what would happen if there were serious problems and a woman was taken to a health facility. The development of health services aimed at reducing maternal mortality implies that the place of birth must change from home to health facility, but the distance from international policy to its implementation is vast and the pathway is not a direct, linear route.

Using birthing kits to promote clean birth practices in Ethiopia

This article explores three NGO projects that assemble and distribute clean birthing kits in Ethiopia. It contrasts the governments health strategy that aims to increase skilled birth attendance, with local realities as most women in rural and remote settings give birth at home, often in unhygienic conditions, and without skilled assistance. Many health facilities are also unable to provide hygienic conditions for birthing women. The findings indicate that clean birth kits have assisted the NGOs to effectively promote clean delivery at home or in health facilities, and to encourage antenatal care, and early referral to emergency obstetric and new-born care.

Women Researching in Africa: The Impact of Gender

This chapter introduces a collection of stories exploring the lives, consequences and motivations of female researchers in Africa. Each subsequent chapter gives unprecedented insights into how the author’s gender—and sometimes their ethnicity and age—impacted on their research experiences, and how doing research in Africa affected them as women. Gender may not have been an underlying theme during the research period, but by being reflexive, the authors re-explore research experiences and re-examine things that may have been overlooked at the time of the research. Three broad themes are discussed: (1) gender and identity as a female researcher in Africa; (2) relationships with ‘others’; and (3) methodological challenges for female researchers in Africa.

Women Researching Africa: Linking Experience to Practice

This chapter draws key lessons from the diverse contributions to this volume on women researching Africa. It reviews the methodological challenges, issues of power, access and representation, as well as privilege and identity. The differential experiences of researchers based on a complex and interrelated range of factors, primarily: gender, ethnicity, age and social position, highlight the need for critical reflection within research on positionality, engaging clearly and explicitly with gender as part of this process. Our conclusions draw attention to gender in researcher positionality in researching Africa (and elsewhere), and for women to do research differently by breaking away from the colonial knowledge frames which traditionally enforce gender anonymity.

On Walking Alone and Walking with Others: Framing Research Activities by Time and Distance in Kafa Zone, Ethiopia

In rural Kafa Zone southwest Ethiopia, walking is the ‘normal’ way to move from one place to another: the ‘walking woman’ links activities between the home, the field, visiting neighbours, going to church and going to the market. As these activities are framed by time and distance, insights gained through walking alone or with others, allowed Jackson to gain an intuitive understanding of her qualitative research about maternal health. Moving back and forth between personal experiences of walking, and critically thinking about women’s experiences of birth at home or in a health facility, walking is also a way to explore ‘the mystery of presence,’ as Frederic Gros writes, ‘to the world, to others and to yourself.’ By examining women’s participation in social networks, friendship and mobility as empowering factors, Jackson suggests that paying attention to context and the gendered self as researcher can help gain deeper insights into fieldwork experiences.