With one in two women delivering surgically, Iran has one of the highest rates of cesarean section (CS) worldwide. CS overuse in low-risk pregnancies potentially exposes women to Maternal Near-Miss (MNM) morbidity with minimal health benefits. This thesis studied obstetric care quality and MNM at hospitals with high rates of CS in Tehran, Iran. In Study I, we investigated whether audits of CS indications and feedback influenced CS rates at a general hospital. Subsequent to the audit, a 27% reduction in the risk of primary CS was found. In Study II, characteristics of MNM were investigated at university hospitals between 2012 and 2014. During a 26-month period, 82 MNM cases were identified using the WHO MNM approach. Severe postpartum hemorrhage (35%), severe preeclampsia (32%), and placenta previa including abnormally invasive placenta (10%) were the main three causes of MNM. Iran has a huge influx of migrants from Afghanistan. Women with antepartum CS and those who lacked health insurance, almost all Afghans, had increased risk of MNM. In Study III, audits examined whether MNM care quality differed between 54 Iranians and 22 Afghans and whether near-miss events were preventable. A majority of MNM cases (62%) arrived at hospital in a moribund state and obstetric care was more suboptimal for Afghans than Iranians (adjusted odds ratio 5.1, 95% confidence interval 1.2–22.6). Moreover, MNM was commonly (71%) potentially preventable and professionals with suboptimal practice were involved in 85% of preventable cases. In Study IV, a qualitative interview study was conducted to explore care experiences of Afghan MNM survivors. Discrimination, insufficient medical attention, and ineffective counseling were the main experiences. To a lesser extent, poverty and low education were perceived as contributing factors to delays in accessing care. This thesis emphasizes the importance of high-quality care for preventing undesirable maternal outcomes. The audit method along with interviews was useful to determine quality and equity gaps in care provision. Policymakers and professionals should consider these gaps when structuring programs to reduce adverse maternal outcomes.

This thesis seeks to account for diversity in the migratory decisions of Afghan migrants who have recently arrived in Turkey. It proposes that social theories on risk provide a framework that rectifies a theoretical gap in the migration literature with respect to intra-group heterogeneity in the decision-making processes of migrants. The thesis adopts Rosa’s (1998: 28) definition of risk as: ‘a situation or event where something of human value (including humans themselves) has been put at stake and where the outcome is uncertain.' I argue that variation in what migrants view as being ‘at stake’ and in how they evaluate the associated uncertainties— in other words, how migrants perceive risk— accounts for the diversity in the migration decisions of similarly situated migrants. Risk is therefore an analytical tool for understanding decision-making in its subjective and socio-cultural context. The thesis offers a typology as an analytical device for categorising the ways in which informants managed the risks associated with migration decisions. I identify three modes of managing risk, defined as resigned, restless and resilient, on the basis of migrants’ engagements with their social environment, their efforts at advocating for themselves and others, and their ability to gather and disseminate information. The thesis also explores subsidiary themes concerning migrants’ legal consciousness with regard to irregular immigration status, and the process of embodying the physical and emotional consequences of migration. Most of the ethnographic fieldwork for this project was conducted in the cities of Istanbul, Van, Kayseri and Sivas from February 2011 until December 2012.