The World Health Organization (WHO) states that no region in the world is justified in having a caesarean section rate greater than 10-15 percent, calculated as the number of caesarean deliveries over the total number of live births. There is however, an international increase in the rate of caesarean section deliveries and this is a concern to midwives. The increase is evident in South Africa as well. Currently the rate of caesarean section deliveries in the private sector can be as high as 70 percent per total number of live births per year. As a result, the public often perceives giving birth surgically in South Africa as ‘normal’ and ‘safer’ than vaginal delivery, even for low-risk pregnancies. The lack of involvement of midwives in the care of pregnant women in the private sector is indicated as one of the reasons related to the high caesarean section delivery rates. This motivated the researcher to undertake a study to explore and describe the perceptions of private sector midwives and obstetricians regarding the feasibility of collaboration in maternity care. A literature review to support the study identified research done previously regarding collaborative maternity care. The study followed a qualitative, exploratory, descriptive, contextual design. The research population included midwives and obstetricians in the private sector in the Eastern Cape. Non-probability, purposive sampling was used. The researcher conducted semi-structured one-to-one interviews to collect information rich data. The researcher ensured that the study was conducted in an ethical manner by adhering to ethical principles such as autonomy, non-maleficence, beneficence and justice. The interviews were transcribed and Creswell’s’ data analysis spiral was used as a guide for the data analysis. Themes and sub-themes were identified and grouped together to form new categories. An independent coder assisted with the coding process. Data analysis results revealed the following results Participants perceived a collaborative working relationship as being beneficial to maternity care. Participants identified that there might be critical impediments that need to be faced in order to realize collaborative maternity care. The researcher ensured the validity of the study by conforming to Lincoln and Guba’s model of trustworthiness, which consists of the following four criteria namely credibility, transferability, dependability and conformability. The information obtained from this study assisted in developing guidelines to facilitate the implementation of collaborative maternity care between midwives and obstetricians in private practice in South Africa. The objective of the study was thus met.

My thesis proposes a female community and maternal health care center, run by the local Kablas themselves, that is linked to the Tangier hospital in order to provide all necessary medical supplies and offer prosperous opportunities to the local commnunities traditional birth attendants and girls.Linked to this, my thesis proposes a maintained “garden of health”, where all local medicinal species of plants are grown and nurtured and the knowledge around their healing properties is shared, in order to conserve both knowledge and species around the local realm of ethnopharmacy regarding female health.As this project is dedicated to a Muslim community, that is economically and socially lacking hope in their futures. As it is part of their spiritual practice to surround yourself with holy writings, and symbols, I dedicated the methodology of my design around the theme of Islamic pattering. By using the pattern’s infrastructure to inform the design of this building, additional meaning and profound recognition is put on to a group of people that is so far often forgotten or mistreated.

Background: In Ghana, many women die every year due to preventable causes related to pregnancy and child birth. Several national strategies have been made to improve women’s access to essential maternal health care. Still there is a significant inequality in the number of women attending to maternal health care in between different parts of the country. An important determinant that affects women’s utilization of the subsidized maternal health care is the quality of health care, including the health providers’ attitudes to their patients. Aim: The aim of this study was to describe nurses’ experiences of interacting with women in a maternal health care context within primary care in Ghana. Method: Five qualitative semi-structured interviews were conducted at three different primary health care clinics. Content analysis was used to analyse the data. Results: Three main-themes, patient compliance, building trust and nursing strategies and ten sub-themes were identified. Conclusion: Although the nurses expressed a desire to have more women attend maternal health care, they seemed unaware of how their own behaviour might contribute to the current underutilization. A hierarchical power imbalance within the nurse-patient interactions, where the patients were perceived and treated as subordinate passive receivers of the nurses’ expertise, was identified. The nurses’ lack of critical approach towards their own actions might be at the source of this underutilization. Suggestion for further research: The authors recommend further studies to explore nurses’ ability to allow self-reflective critical thinking and also how implementation of a more patient-centred approach in Ghana would affect the quality of health care. / Bakgrund: Varje år dör många kvinnor i Ghana på grund av förebyggbara komplikationer relaterade till graviditet och förlossning. Flera nationella strategier har genomförts i syfte att ge fler kvinnor tillgång till nödvändig mödrahälsovård. Trots det råder en signifikant skillnad i andel kvinnor som söker mödrahälsovård mellan olika delar av landet. En viktig faktor som påverkar utnyttjandet av den subventionerade mödrahälsovården är vårdkvaliteten, inklusive vårdpersonalens bemötande. Syfte: Syftet med denna studie var att beskriva sjuksköterskors erfarenheter av bemötande av kvinnor i en mödrahälsovårdskontext inom primärvården i Ghana. Metod: Fem kvalitativa semistrukturerade intervjuer genomfördes vid tre olika primärvårdskliniker. Innehållsanalys användes for att analysera insamlad data. Resultat: Tre huvudteman, patientföljsamhet, bygga förtroende och omvårdnadsstrategier och tio underteman hittades i resultatet. Slutsats: Trots att sjuksköterskorna uttryckte en vilja att få fler kvinnor att nyttja tillgänglig mödrahälsovård så verkade de omedvetna om hur deras eget agerande skulle kunna bidra till att kvinnorna väljer att inte söka vård. En hierarkisk maktobalans inom sjuksköterskornas vårdrelation med patienterna framträdde genom intervjuerna, där patienterna sågs och bemöttes som underordnade, passiva mottagare av sjuksköterskornas expertis. Sjuksköterskornas brist på kritiskt förhållningssätt till egna insatser kan göra att de oavsiktligt arbetar emot sina egna mål. Förslag på fortsatta studier: Ytterligare studier för att utforska sjuksköterskors förmåga att tillämpa kritiskt tänkande rekommenderas samt vilken nytta det skulle vara för kvaliteten på omvårdnaden om ett mer patientcentrerat förhållningssätt implementerades inom vården i Ghana.

Magister Philosophiae - MPhil / The importance of maternal health care services cannot be stressed enough. Maternal health services are important in reducing pregnancy-related complications as well as maternal and infant deaths. This study was concerned with investigating the relationship between maternal education and maternal health care utilization. Furthermore, the study aimed to investigate the rates of maternal health care use, the reasons for non-use of maternal health services, as well as the determinants of maternal health care use. Primary data was used from selected areas (Tsolo, Qumbu and Mqanduli), which fall within the O.R. Tambo district in the Eastern Cape Province. Simple random sampling was used (with a structured questionnaire) to study maternal health care use among the sampled women. To analyse this data, univariate, bivariate, and multivariate techniques were employed. The results indicated that maternal education was not statistically significant with antenatal and postnatal services, but the percentages were important in explaining the use of maternal health care services in relation to maternal education. Women with higher levels of education reported higher rates of antenatal and delivery care utilization, while those with lower levels of education reported higher rates of postnatal care use. Access factors, such as transport, payment and distance to health facilities, also played an important role in the use of maternal health care services. It was recommended that the Department of Health implement mobile clinics and centralize health care facilities as this will bring essential health services closer to the communities. Women in the study area also need to be educated about the importance of these services, more particularly pertaining to postnatal care.

Magister Public Health - MPH / Adolescent pregnancy holds numerous health and social risks for mother and child. Adolescent access to maternal health services is of vital importance to ensure that pregnant adolescents receive timely and effective health care. Evidence suggests that adolescents tend to seek medical care late in their pregnancies and attend fewer than the recommended four antenatal visits. This results in missed opportunities to improve maternal and newborn health due to untreated sexually transmitted diseases and uninhibited mother-to-child HIV transmission, resulting in low birth weight among other poor pregnancy outcomes. Sub-Saharan Africa has the highest rate of adolescent births worldwide, in keeping with evidence that low-to-middle income countries have the highest rates of adolescent pregnancy. Adolescent pregnancy in South Africa remains a public health concern, and the Mitchells Plain sub-district has a particularly high rate of adolescent pregnancy. The aim of this study was thus to explore the barriers to access for maternal health care services amongst pregnant adolescents in the Mitchells Plain sub-district.

Background: Neonate’s health is intimately linked to maternal health. Yearly approximately 2.8 million neonatal deaths occur worldwide, counting for more than 40 % of all deaths of children less than five years. Over 70 % of these deaths happen during the first week of life (early neonatal mortality), often the first day, and 99% of these deaths occur in low- and middle-income countries with an often low quality of maternal health care services. Aim: To assess societal and household factors, and maternal health care factors delivered in Rwanda, and how these were associated with early neonatal mortality Methods: Cross-sectional data of interviewed mothers to 7726 children between 2010 to 2014, obtained from the 2014–15 Rwanda Demographic and Health Survey, were analyzed in relation to early neonatal mortality using multiple logistic regression. Results: The factors found to be associated with reduced risk of early neonatal mortality were: delivery at a health facility, delivery assisted by a skilled birth attendant, and no low birth weight neonates. After adjustment with socioeconomic and proximate determinants, the same associations were found with delivery at a health facility and no low birth weight neonates. Conclusions: Delivery at a health facility and not to be born of low birth weight were associated with risk reduction of early neonatal mortality. These findings indicate that interventions to strengthen the antenatal health care system and to increase the utilization of already existing health care services are needed, and to educate practicing professional health care workers about early neonatal mortality.

Magister Curationis - MCur / The use of health education during antenatal care of pregnant women has been a commonly used strategy in improving maternal health worldwide. However the health education strategy sometimes does not prove to be effective in promoting maternal health, especially in Sub-Sahara Africa.

Bakgrund: Övervikt och undervikt hos gravida kvinnor är kopplat till ökade risker hos mamma och barn. Mödrahälsovården erbjuder gravida kvinnor stöd för att öka deras möjligheter till en begränsad viktuppgång eller motivation för en sund viktuppgång under graviditeten. Kunskaper om vad som kan hända kvinnan och barnet vid en ohälsosam livsstil, t.ex. vid viktproblematik, finns hos barnmorskor men att prata om dessa problem är känsligt. Därför kan det vara av betydelse att ta del av hur gravida kvinnor med olika typer av viktproblematik upplever viktkontrollerna på MHV. Syfte: Syftet med studien var att belysa gravida kvinnors upplevelse av viktkontroller och samtal om vikt på mödrahälsovården. Metod: En netnografisk metod har använts. Författarna har verkat som observatörer och genomfört en dold studie på nio diskussionstrådar på internet där gravida kvinnor delar sina erfarenheter med varandra. Datan analyserades med Kozinets metod för netnografi och kvalitativ analys. Resultat: Många av kvinnorna tar illa upp när barnmorskan talar om deras vikt och upplever att barnmorskan “tjatar” och föreläser på ett nedlåtande sätt. En del kvinnor förstår varför det är viktigt att barnmorskan pratar om vikt och förstår riskerna med för högt respektive för lågt BMI. Många kvinnor tycks däremot inte förstå riskerna och blir istället kränkta av att barnmorskan pratar om vikten vid varje träff. En del kvinnor skriver att de p.g.a. barnmorskans sätt att prata om viktkontrollerna har fått återfall i sina ätstörningsbeteenden. Slutsats: De gravida kvinnorna i studien upplever att mycket fokus läggs på samtal och kontroller kring vikt samt viktuppgång. De upplever barnmorskan som upprepande och föreläsande i syfte att ge dem dåligt samvete. Att utbilda fler barnmorskor i MI och se till att det finns tillräckligt med tid för att använda sig av denna metod är av betydelse för att barnmorskan på bästa sätt kunna möta kvinnornas behov av stöd och information. / Background: Overweight and underweight in pregnant women are linked to increased risks in mother and child. Maternal health care offers pregnant women support to increase their possibilities for a limited weight gain or motivation for a healthy weight gain during pregnancy. Knowledge of what can happen to the woman and the child in an unhealthy lifestyle, eg in weight problems, is known to midwives but talking about these problems is sensitive. Therefore, it may be important to find out how pregnant women with different types of weight problems experience weight controls at maternal health care. Aim: The aim of the study was to elucidate pregnant women’s experience of weight controls and conversations about weight in maternal health care.   Method: A netnographic method has been used. The authors have acted as observers and conducted a hidden study on nine discussion threads on the internet where pregnant women share their experiences with each other. The data was analyzed using Kozinet's method for netnography and qualitative analysis. Outcome: Many of the women take offense when the midwife talks about their weight and feels that the midwife "nags" and lectures in a condescending manner. Some women understand why it is important for the midwife to talk about weight and understand the risks of too high and too low BMI. Many women, on the other hand, do not seem to understand the risks and are instead offended by the midwife talking about the weight at every visit. Some women write that because of the midwife's way of talking about the weight controls there has been a relapse in their eating disorder behaviors. Conclusion: The pregnant women in the study feel that much focus is placed on conversations and controls regarding weight and weight gain. They experience the midwife as repetitive and lecturing in order to give them a bad conscience. Educating more midwives in MI and ensuring that there is enough time to use this method is important so that the midwife can best meet women's needs for support and information.

PhD (Health Sciences) / Department of Advanced Nursing Science / STRACT Background: The implementation of the World Health Organisation maternal health care guidelines in African countries has resulted in the reduction of maternal deaths by half since 1990. As a result, between 1990-2013, maternal mortality ratio declined by only 2.6% per year and this is far from the annual decline of 5.5% required to achieve the Sustainable Development Goals (SDGs). Ninety percent of women are dying from preventable maternal conditions and most of them are from the low and middle-income areas. The 2011-2013 Saving Mothers Report indicates that the Limpopo Province was ranked number three on the Maternal Mortality Rate in South Africa. Hence, this study sought to assess the implementation of maternal health care guidelines by professional nurses in Limpopo Province. Method: A convergent parallel mixed-methods design study was used. Phase 1 entailed parallel collection of qualitative and quantitative data. In this approach, self-administered questionnaires were used in the quantitative research method and an in-depth interview in qualitative research method. Data were collected from Maternal Health Care Managers, Professional Nurses and Operational Managers working in Primary Health Care Facilities of the Vhembe and Mopani Districts. Systematic methods to sample managers and midwives through the Slovan formula was used. Ethical clearance for the study was obtained from the University of Venda Research Ethics Committee and permission to conduct the study at the Primary Health Care facilities was obtained from the Limpopo Province Department of Health and Health District Offices. Data analyses were done separately using the Statistical Package for Social Sciences for quantitative data and Tesch’s open-coding methods for qualitative data. Validity, reliability and trustworthiness were ensured through a pilot study and by critical appraisal and peer review of the research instruments by experts in the field of maternal health. Results: The study revealed that midwives experienced difficulty when providing care to women presenting with postpartum haemorrhage and pre-eclampsia or eclampsia. Difficulty in the management was confirmed by 36% of respondents. Some participants lacked knowledge on the management of women with postpartum haemorrhage, Pre-eclampsia and eclampsia and this was also indicated by 30% of respondents. Shortage of staff led to work overload, especially if one midwife was left alone to provide care to patients in the facility. Furthermore, midwives experienced delayed ambulance services when in need of referring women who required urgent attention to the next level. Delayed ambulance was indicated also by 80,4% of respondents ad this contributed to the midwives’ frustrations hence poor maternal outcomes. High risk women failed to return to the hospital and others hide their previous history of complications and hence experienced abrupt postpartum haemorrhage leading to poor implementation of maternal health guidelines. Phase 2 dealt with the development of the strategy to facilitate implementation of maternal health guidelines in Limpopo Province using the Strengths, Weaknesses, Opportunities and Threats analysis, identified from the collected data. Phase 3 comprised the validation of the strategy, which was conducted using a quantitative research design. Meetings were held with Maternal Health Care Managers, Midwives and Operational Managers working at Primary Health Care Facilities of Vhembe and Mopani districts. Self-administered questionnaires were distributed for respondents to complete and data were analysed using descriptive analysis. Almost all respondents (95%) agreed that the developed strategy was suitable and applicable for midwifery practice. Maternal Health Care Managers, Midwives and Operational Managers made suggestions that will enhance the developed strategy. Recommendations: Continuous education and in-service training must be done in order to capacitate midwives with knowledge of the management of women with postpartum haemorrhage, pre-eclampsia and eclampsia. The curriculum for Midwifery training must be strengthened and must include enrolled nurses. Health education to women must be strengthened and they must be encouraged to give the correct history in order to reduce maternal mortality rate. / NRF

Bakgrund: När Corona pandemin bröt ut år 2020 kom restriktioner med syfte att minska smittspridningen. Restriktionerna utgjorde ett hinder för partners till gravida att kunna närvara vid besöken på mödrahälsovården.   Syfte: Syftet med studien var att beskriva barnmorskors erfarenhet av att hantera situationen vid en fysisk frånvarande partner under besöken på mödrahälsovården under Corona pandemin.  Metod: Studien är en fokusgruppstudie. Datainsamlingen bestod av tre fokusgruppsintervjuer med barnmorskor inom mödrahälsovården vilka valdes ut genom ett bekvämlighetsurval. Vid analys av materialet användes en kvalitativ empiriskansats med ett induktivt förhållningssätt.   Resultat: I resultatet framkom tre huvudkategorier: Det normala nya, Familjefokusering och Nya arbetssätt. Barnmorskorna upplevde en normalisering av partnerns frånvaro. Barnmorskorna påtalade att de försökt lägga fokus på att paret är ett team som ska gå igenom graviditeten tillsammans och därför uppmuntrat paret att läsa på och diskutera tillsammans om graviditet, förlossning och föräldraskap. Barnmorskorna var öppna för att utveckla digitala alternativ, men uppgav också att det krävdes nytt material, verktyg, rutiner och utbildning för att implementera detta.   Slutsats: Det är viktigt att dra lärdom av situationen under Corona pandemin och tänka nytt. Utveckling av alternativa möten på mödrahälsovården bör bli högprioriterat både under och efter pandemin. En utveckling av digitala kommunikationsalternativ möjliggör för partners även i andra sammanhang, till exempel arbete på annan ort, att kunna delta i vården runt graviditeten. / Background: When the Corona pandemic broke out in 2020, restrictions were introduced with the aim of reducing the spread of infection. The restrictions constituted an obstacle for partners of pregnant women to be able to attend the visits to the maternal health care.  Purpose: The purpose of the study was to describe midwives' experience of dealing with the situation of a physically absent partner during visits to maternal health care during the Corona pandemic.  Method: The study was a focus group study. The data collection consisted of three focus group interviews with midwives in maternal health care, which were selected through a convenience sample. When analyzing the material, a qualitative empirical approach with an inductive approach was used.  Result: The results revealed three main categories: The normal new, Family focus and New ways of working. The midwives experienced a normalization of the partner's absence. The midwives pointed out that they tried to focus on the couple being a team that will go through the pregnancy together and therefore encouraged the couple to read and discuss together about pregnancy, childbirth and parenthood. The midwives were open to developing digital alternatives, but also stated that new material, tools, routines and training were required to implement this.  Conclusion: It is important to learn from the situation during the Corona pandemic and think new. Development of alternative meetings in maternal health care should be a high priority both during and after the pandemic. The development of digital communication alternatives enables partners in other contexts, such as work in other places, to be able to participate in care around pregnancy.