Barriers to delivering quality midwifery education programmes in the Democratic Republic of Congo — An interview study with educators and clinical preceptors

BackgroundIn the Democratic Republic of Congo, the education of midwives at a higher education level has recently been introduced as a strategy to improve maternal and neonatal health. However, little is known about the preconditions for such an education.AimTo explore the barriers to delivering high-quality midwifery education programmes in the DRC and reflect on potential areas for improvement.MethodData was collected through 14 focus group discussions with 85 midwifery educators and clinical preceptors, at four higher education institutions delivering midwifery education programmes. Transcribed discussions were inductively analysed using content analysis.FindingsOverall, the teaching environment was insufficient. Most midwifery educators and clinical preceptors had deficient competencies, and there was a shortage of didactic resources and equipment as well as poor communication routines between the education institutions and clinical education sites. The barriers varied between locations; for instance, the institution in the country’s capital was overall well equipped.ConclusionThe identified barriers constitute major risks undermining the quality of future midwives in the DRC. Reforming the education of midwives, together with general higher education reform, will be critical for achieving the Sustainable Development Goal on health in the country. We therefore suggest that (i) midwifery educators have at least one academic level above the programme in which they teach, (ii) continuing education be available for midwifery educators and clinical preceptors, (iii) education institutes and clinical sites are fit for purpose, and (vi) routines for clear communication links between education and clinical sites be used.     

Subversive acts and everyday midwifery: Feminism in content and context

BackgroundMidwives are often at the forefront of political campaigns for women's empowerment, overtly advocating for women's rights and reproductive justice. However, midwives can also be found engaging in inadvertent activism on a daily basis within routine care. When casting a feminist lens over both the content and context of midwifery practice in Australia, subversive acts and opportunities for feminist reform can be found.AimTo interrogate the significance of feminism in midwifery practice, identifying feminist successes and further opportunities for implementation including: analysis of the Midwifery Standards for Practice; the primary tenets of woman-centred care; the content versus context of midwifery in Australia; and feminist opportunities for enhanced practice. This paper will discuss the importance of feminism in midwifery practice and its significance in informing optimal midwifery care.DiscussionIncorporating women's voice and respecting women's bodies and agency in the delivery of care is a fundamental component of midwifery practice. However, while the content of midwifery practice is innately feminist in its emphasis on woman-centred care, it will be argued that the context of birthing in Australia is not. The resultant effect is the emergence of victim blaming in maternity care and the construction of an archetypal ‘good birthing woman’.Implications and recommendationsMoving away from the myth of the ‘good birthing woman’ and the act of victim blaming, midwifery could instead direct its focus towards challenging the rigid systems and structures within which midwives implement care. By further embracing feminist principles midwives will ensure a truly woman-centred future.     

Students as researchers: An example of high-level participation of undergraduate midwifery students as co-investigators in research

BackgroundThere is a shift in focus of the curricula of undergraduate midwifery research-education - from research content to the research process, and the student from being an observer to a participant.Aim and MethodsTo explore an example of how to involve midwifery students as co-investigators in research. This paper discusses the experiences of an educational research project that adopted the highest level of student autonomy in research, involving six Bachelor of Midwifery final-year students participating as co-investigators in qualitative research focusing on women’s lived experiences of traumatic childbirth. The experiences are supported by the parameters of research-education and learning, and are discussed in the context of the dimensions of framing undergraduate research: Motivation, Inclusivity, Content, Originality, Setting, Collaboration, Focus and AudienceDiscussionCrucial for this educational research project is the recognition of the motivation, interests, (experiential) knowledge and real-world experiences of students. It starts with listening to the questions, thoughts and ideas that students bring, recognising and respecting the content and importance of their work and what is important and meaningful to them, while facilitating a student-led learning process. Collaboration between students and students and supervisors needs to be formally facilitated and supported, as this contributes to qualitative products for curricular and extra-curricular products. An academic infrastructure is necessary to support extra-curricular activities.ConclusionTo embed research adequately and effectively in the curriculum, a pedagogical approach, institutional learning and student-centred teaching strategies and practices, including high impact practices to mainstream undergraduate research and enquiry, are crucial.     

Implementing midwifery continuity of care models in regional Australia: A constructivist grounded theory study

Problem/backgroundStrong international evidence demonstrates significantly improved outcomes for women and their babies when supported by midwifery continuity of care models. Despite this, widespread implementation has not been achieved, especially in regional settings.AimTo develop a theoretical understanding of the factors that facilitate or inhibit the implementation of midwifery continuity models within regional settings.MethodsA Constructivist Grounded Theory approach was used to collect and analyse data from 34 interviews with regional public hospital key informants.ResultsThree concepts of theory emerged: ‘engaging the gatekeepers’, ‘midwives lacking confidence’ and ‘women rallying together’. The concepts of theory and sub-categories generated a substantive theory: A partnership between midwives and women is required to build confidence and enable the promotion of current evidence; this is essential for engaging key hospital stakeholders to invest in the implementation of midwifery continuity of care models.DiscussionThe findings from this research suggest that midwives and women can significantly influence the implementation of midwifery continuity models within their local maternity services, particularly in regional settings. Midwives’ reluctance to transition is based on a lack of confidence and knowledge of what it is really like to work in midwifery continuity models. Similarly, women require education to increase awareness of continuity of care benefits, and a partnership between women and midwives can be a strong political force to overcome many of the barriers.ConclusionImplementation of midwifery continuity of care needs a coordinated ground up approach in which midwives partner with women and promote widespread dissemination of evidence for this model, directed towards consumers, midwives, and hospital management to increase awareness of the benefits.     

“一带一路”国家投资便利化水平测度与评价

系统构建投资便利化测评体系,采用《全球竞争力报告》的相关数据,运用因子分析法对2010-2015年包括“一带一路”沿线50个国家的世界140个国家和地区的投资便利化水平进行了测评比较。研究发现：“一带一路”沿线各国投资便利化水平受金融服务的影响最大,基础设施和宏观经济状况受制度环境的影响最小;“一带一路”沿线多数国家投资便利化水平较低,与发达国家差距较大;“一带一路”沿线各国之间、各地区之间的投资便利化水平差异明显,非平衡性特征突出,总体上都有较大的提升空间。未来“一带一路”沿线各国应加强政策沟通,推进基础设施互联互通,加强财政政策与货币政策协调,健全金融服务体制,营造良好的制度环境。     

The Differential Salience of Family and Community Demands and Resources for Family-to-Work Conflict and Facilitation

This paper examines the differential salience of family and community demands and resources in relation to family-to-work conflict and facilitation. The study used interviews with 1567 employed, married, parents from the 1995 National Survey of Midlife Development (MIDUS). Family demands show relatively strong positive relationships to family-to-work conflict, whereas family resources are relatively important for family-to-work facilitation. Two community demands are positively related to family-to-work conflict and one community resource is positively associated with facilitation. Community demands and resources generally do not moderate relationships between family demands and resources and family-to-work conflict and facilitation. The study suggests that processes associated with demands are relatively important for family-to-work conflict, whereas processes embedded in resources are relatively salient for family-to-work facilitation.     

中国贸易便利化的成本与收益分析

随着贸易、投资自由化的不断发展,贸易便利化被提到了WTO的议事日程之中,这对我国等发展中国家是利是弊,还要通过成本与收益分析对比才能得出结论。在此基础上文章提出在该问题中的目标及以后的努力方向。     

Canadian Gender-Based Analysis Training in South Africa

Attempts to engender post-apartheid South Africa using a Canadian model of gender-based analysis training occurred through agreements between Status of Women Canada and the Office of the Status of Women in South Africa. Using a retrospective lens, I explore how my experience of delivering and evaluating such gender-based analysis training in South Africa holds moments of hope and solidarity yet, is also restricted by issues of power, representation and agency. Throughout this lived experience, the multi-faceted issues surrounding privilege and power as they are situated within race, gender, identity, place and location are explored. I question the state practices of gender mainstreaming, and whether or not transnational feminism can challenge and create changes within such a practice. The article includes data from a gender-based analysis training session and its subsequent evaluation, along with anecdotes, suggestions and a critique. With the push by national and international machineries to mainstream gender, this article offers a timely and critical perspective on the implementation and facilitation of such practices.