Kagaha Alexander, Manderson Lenore
School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
Institute at Brown for Environment and Society, Brown University, Providence, RI, USA.
Health Policy Plan. 2021 Mar 26;36(2):187-195. doi: 10.1093/heapol/czaa136.
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.
不安全堕胎行为仍是乌干达孕产妇死亡的主要原因，阻碍了全民健康覆盖的实现以及孕产妇保健质量。我们采用人种志设计和批判性话语分析方法，探讨了在确定孕产妇保健优先事项时权力的运作情况，这在2018年生殖、孕产妇、新生儿、儿童和青少年健康会议上表现得很明显。我们收集了决策活动、过程和事件的观察数据，并对27名参与者进行了关键信息访谈。我们描述了新自由主义和国家治理如何通过决策的结构和组织、认知治理以及“高影响力”干预措施、基于结果的融资、成本效益和问责制的普遍概念相互融合，从而压制与不安全和有风险堕胎相关的当地情况的表达。通过沿着生育连续体定义孕产并强调分娩妇女，优先事项设定朝着促进妇女作为母亲的规范角色的干预措施倾斜，同时压制未得到满足的堕胎护理需求。最后，话语和交流材料控制着乌干达育龄妇女如何管理生育。
