Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, 60 College St, New Haven, CT, 06510, USA; Center for Methods in Implementation and Prevention Sciences, Yale University, New Haven, CT, USA.
Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr., Chapel Hill, NC, 27599, USA.
Soc Sci Med. 2023 Aug;331:116073. doi: 10.1016/j.socscimed.2023.116073. Epub 2023 Jul 7.
Access to maternal health services has increased in Ethiopia during the past decades. However, increasing the demand for government birthing facility use remains challenging. In Ethiopia's Afar Region, these challenges are amplified given the poorly developed infrastructure, pastoral nature of communities, distinct cultural traditions, and the more nascent health system. This paper features semi-structured interviews with 22 women who were purposively sampled to explore their experiences giving birth in government health facilities in Afar. We used thematic analysis informed by a cultural safety framework to interpret findings. Our findings highlight how women understand, wield, and relinquish power and agency in the delivery room in government health facilities in Afar, Ethiopia. We found that Afari women are treated as 'others', that they manipulate their care as they negotiate 'cultural safety' in the health system, and that they use trust as a pathway towards more cultural safety. As the cultural safety framework calls for recognizing and navigating the diverse and fluid power dynamics of healthcare settings, the onus of negotiating power dynamics cannot be placed on Afari women, who are already multiply marginalized due to their ethnicity and gender. Health systems must adopt cultural safety in order to ensure health quality. Providers, particularly in regions with rich cultural diversity, must be trained in the cultural safety framework in order to be aware of and challenge the multidimensional power dynamics present in health encounters.
在过去几十年中，埃塞俄比亚的孕产妇保健服务有所增加。然而，增加对政府分娩设施的需求仍然具有挑战性。在埃塞俄比亚的阿法尔地区，由于基础设施不完善、社区的游牧性质、独特的文化传统以及更为新生的卫生系统，这些挑战更加突出。本文通过半结构化访谈，对 22 名妇女进行了有针对性的抽样，以探讨她们在阿法尔政府卫生设施分娩的经验。我们使用文化安全框架指导的主题分析来解释研究结果。我们的研究结果强调了阿法尔妇女如何在埃塞俄比亚阿法尔政府卫生设施的分娩室中理解、行使和放弃权力和代理权。我们发现，阿法尔妇女被视为“他者”，她们在卫生系统中通过“文化安全”进行协商时，会操纵自己的护理，并且她们信任是实现更多文化安全的途径。由于文化安全框架要求认识和驾驭医疗环境中多样化和流动的权力动态，因此，谈判权力动态的责任不能落在由于种族和性别而已经处于多重边缘地位的阿法尔妇女身上。卫生系统必须采用文化安全，以确保医疗质量。特别是在文化多样性丰富的地区，提供者必须接受文化安全框架的培训，以便意识到并挑战卫生接触中存在的多维权力动态。
