It is essential that neonatal practitioners are able to use their theoretical knowledge in clinical practice in an appropriate manner, in order to render competent quality care to the critically ill neonate. However, theory and practice integration is also very difficult to achieve. Managers of neonatal units and neonatal students had voiced concerns regarding the integration of theory and practice in the neonatal programme offered by an Institution of Higher Education (IHE). Therefore the purpose of this research was to develop standards and criteria to facilitate the integration of theory and practice in the IHE Neonatal Programme A combined qualitative/quantitative exploratory, descriptive, contextual approach was followed, based on Muller's Model for the Development of Nursing Standards (1990:49-55). The design consisted of a development phase and a quantification phase. Standard development began with conceptualisation, that is, the definition of the research concepts and the integration of the study into existing theoretical frameworks. The legislative frameworks used for the study were those of the South African Qualifications Authority and the South African Nursing Council, that govern nursing education and nursing practice. The theoretical frameworks promote theory/practice integration. Standards and criteria were developed from the legislative and theoretical frameworks in order to facilitate the theory/practice integration of the IHE neonatal programme. Ten experts who met specific criteria for inclusion in the study were then asked to validate the standards. The quantification phase consisted of the statistical determination of the content validity of the standards, using a questionnaire. The original ten experts together with another forty participants who complied with specific inclusion criteria, were asked to evaluate the standards, using a four-point rating scale. A standard or criterion with a content validity index of 3.5 to 4. 0 was accepted as valid. The results of the data analysis for the fifty participants showed that all criteria had a mean score of over 3. 5 and thus could be considered valid and useful as a guideline for neonatal programmes. However it was evident from standard deviation scores that the expert group showed greater consensus than the additional participants regarding the validity of the standards. Further research may therefore be required in order to confirm the validity of the standards and criteria.

Background: Pregnancy is a significant period of time for individual women. Promoting optimal health behaviors and supporting individuals during critical periods of health (such as pregnancy) is an important aspect of public health research and practice. One way of supporting individuals in promoting positive health behaviors and outcomes is by increasing their health literacy. The ability to find appropriate health information is the first step in the health literacy process. This process of finding information in health contexts is called Health Information Seeking Behavior (HISB). Whereas, HISB has been extensively studied in chronic health contexts, little research has been conducted regarding maternity-related information seeking in women. Purpose: The purpose of this study is to explore the pregnancy-related health information seeking behavior (HISB) of women while they were pregnant. This objective will be achieved through the following specific aims: (1) To describe topics sought, and (2) describe the sources of information used by women during pregnancy. Methods: To achieve these aims, a multi-phase, descriptive, mixed methods, cross-sectional research design will be utilized. Phase I consisted of an online survey disseminated to collect HISB data on first-time mothers (N = 168) who delivered a child within the prior 12 months. Phase II consisted of in-depth individual interviews (n=26) with a sub-set of participants who completed the online survey assessment to check the consistency of the survey findings and further explore constructs related to HISB. Findings: Using primary data collection, pregnant women seek information on numerous pregnancy and childbirth topics (average 18.7 topics). Of information they sought, women ranked the three most important topics to them. If looking at topics deemed ‘most important’ irrespective of rank positioning, the most frequently cited topics were ‘How My Baby Grew While I was Pregnant’, ‘Complications during Pregnancy’, and ‘What NOT to Eat during Pregnancy.’ If we look at only those topics ranked as being first ‘most important’, ‘What NOT to Eat during Pregnancy’ is replaced by ‘Natural Birth’. Findings from the qualitative phase of the study indicated that topics were salient for a number of reasons, including curiosity about pregnancy as a new experience, wishing to avoid poor health outcomes, and wanting to achieve maternity-related goals. Quantitative results indicated that women used multiple sources of information during pregnancy to meet their information needs (average 9.9 sources). Of information sources they used, women ranked the three used ‘most often’. If looking at sources used ‘most often’ irrespective of rank positioning, the most frequently used information sources were ‘My Doctor(s) that Took Care of Me while Pregnant,’ ‘Pregnancy and Childbirth Books,’ and ‘Pregnancy and Childbirth Mobile Applications.’ If we look only at those information sources ranked as used ‘most often’, ‘Pregnancy and Childbirth Books’ are no longer used as often, and ‘Midwive(s) Who Took Care of Me while Pregnant’ becomes important. Qualitative interviews indicate that women use information sources for a variety of reasons including ease of access, access to the lived experiences of other pregnant women, reliance on professional expertise, and anticipatory guidance. Conclusion: This study found that pregnant women look for many different pregnancy and childbirth-related topics, using multiple sources of information to do so. There were multiple motivations driving information needs and use of information sources. Further, beliefs about the value of information sources were different given the motivation behind using them. Understanding pregnant women’s HISB may allow us to understand which translational practices better address individual information needs in ways that they are more likely to use. Further, if the motivation behind why women seek out information is understood and why they use certain information topics, better targeted and tailored health literate educational materials for pregnant and postpartum women may be created. Exploring health information seeking behavior of pregnant women is the first step in understanding and affecting health literacy in this priority population.

First Nations women who live on reserves receive maternity care from a variety of government health care systems: Federal, provincial, and municipal. At first glance, this seems like an abundant amount of health care; however, the lack of coordination has led to poorer outcomes as demonstrated for example by the twofold IMR for First Nations on reserves compared to that of non-Aboriginal populations. To inform discussions and changes to health care policy and programming for maternity care for First Nations on reserves, my dissertation focuses on Health Canada’s evacuation policy within the province of Manitoba. It describes how First Nations women journey among these three health care systems in the provision of that care. This federal policy instructs federally employed nurses to arrange for the transfer of pregnant First Nations women who live on rural and remote reserves to an urban – and usually southern – location so that the women can receive labour and birthing services. Women are evacuated out of their home communities between 36 and 38 weeks gestational age and wait in the city, often alone, for labour to start. While there is a general understanding of how different elements of this federal policy work, there is no literature that describes its execution in detail nor in full. To address this critical knowledge gap, my dissertation consists of three stand-alone papers. For the first paper, “‘This Policy Sucks and It’s Stupid:’ Mapping Maternity Care for First Nations Women on Reserves in Manitoba,” I used intersectionality, institutional ethnography, and semi-structured interviews to produce a descriptive and visual map of the evacuation policy. Using intersectionality and a case study approach, the second paper, “Health Canada’s Evacuation Policy for Pregnant First Nations Women in Manitoba: Resignation, Resilience, and Resistance,” semi-structured interview data are analyzed through a thematic analysis to understand the experiences and perspectives of First Nations women, family, and community members. I argue for the development of a specific theoretical framework that makes explicit the specific legal and policy influences particular to First Nations women who live on reserves in the third paper, “The Legal Categorization of First Nations Women in Health: The Need for a First Nations Feminist Theory.” Taken as a whole, these three papers address some of the knowledge gaps related to maternity care services for First Nations women once they are evacuated. They also situate these gaps within the legal context of health care for First Nations women so that tangible improvements can be made.

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Magister Public Health - MPH / In recent years, the Chipata district has been making progress in promoting Respectful Maternity Care (RMC) implementation, with great emphasis on its underlying principles of ethics and psycho-sociocultural aspects as critical ingredients of care. RMC approach is individual-oriented and is based solely on the understanding of ethics and respect for human rights. Additionally, this approach utilizes evidence-based practices that recognize the needs and preferences of women and that of their newborns. Unfortunately, disrespectful and abusive care during childbirth has been found to discourage women from having their babies delivered by qualified health care workers, a practice that is essential in reducing maternal and neonatal mortalities. However, lacking are studies in the Chipata district that describe the prevalence of disrespectful and abusive maternity care.

This thesis investigates how a closure of a maternity ward affects the moves intoand out of a municipality. The policy focus of a centralization of maternal care in Sweden may bring unseen consequences that matter for society in a larger sense than only births. By treating closeness to a maternity ward as a positive amenity for a municipality, these closures introduce an exogenous variation that is used to estimate how moves change over time. With the lack of data availability, utilizing Sweden’s administrative areas, the lack of data over amenities as well as other factors such as employment possibilities are compensated for, revealing the possibility of using similar areas as potential substitutes for amenities. The results indicate that closures are likely to introduce a lower mobility for the regions as both fewer moves in and fewer moves out are revealed in the estimates. The results are strongly significant, a one minute increase of travel time would be associated with a decrease of around 3 moves in and 2.7 moves out. These results are mostly robust, and findings suggest north and south of Sweden are fundamentally different.

The purpose of this thesis is to investigate how a public health crisis affects the pregnancy decisions and experiences of Canadians, how pregnancy history impacts these experiences, and whether the delivery of pregnancy care has been impacted or changed by the COVID-19 pandemic. This thesis surveyed women from across the country about their experiences during pregnancy with prenatal care and social support, as well as their birth experiences and perceptions of new motherhood during the pandemic. Interviews were conducted with perinatal care providers from Ontario about their personal experiences providing perinatal healthcare services, as well as their perceptions of their patients’ experiences. This thesis aims to identify prenatal, birth and postpartum experiences described by Canadians, and quality of perinatal health services during the COVID-19 pandemic.

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In Ontario, supporting "a system of care that provides women and their families with equitable choice in birth environment and provider," (PCMCH & MOHLTC, 2017, p.33) has been identified as one of the central objectives of the Provincial Council for Maternal and Child Health's Low Risk Maternal Newborn Strategy. In theory, pregnant people in Ontario can choose to seek maternity care from a midwife, a family physician, or an obstetrician; however, in practice, pregnant people's choice of provider remains constrained. Extant literature suggests that in order to afford pregnant people the opportunity to exercise autonomous choice of provider, health systems must ensure that an acceptable range of provider options is available and accessible within the local organization of maternity care, that pregnant people are made aware of and knowledgeable about the available provider options, and that pregnant people have the ability and resources to navigate access to their provider of choice (Mackenzie, 2014; Sutherns, 2004). As a result, I designed this thesis to fill a gap in the evidence base to determine whether or not provincial policies had translated into the levels of access, awareness, and resourcing required to afford pregnant people the opportunity, ability and propensity to exercise autonomous choice of provider within the local maternity care system in Ontario's Champlain Region. I sought to elicit the structural conditions that would be necessary to equitably support pregnant people's access to and choice of a maternity care provider. In the pursuit of these objectives, I adopted an integrated knowledge translation approach (Bowen & Graham, 2013), using an explanatory sequential mixed methods design (Creswell, 2014), which encompassed two complementary stages: (1) quantitative geospatial mapping to assess pregnant people's access to the full range of maternity care providers across the Champlain Region; and (2) qualitative focus groups and individual interviews with parents, providers, and policy-makers to explore the individual, organizational, and system-level factors that are enabling or restricting access and autonomy. Using a systems approach to the investigation of this locally-identified issue, I demonstrate in this thesis that pregnant people within the Champlain Region have inequitable opportunities to exercise autonomous choice of maternity care provider due to (1) system and organizational-level factors that are creating imbalances in the supply, distribution and mix of maternity care provider options, and (2) pregnant people's differential access to the enabling information and resources required to exercise autonomous choice of provider and to navigate access to their services.