Delaying factors for maternal health service utilization in eastern Ethiopia: A qualitative exploratory study

BackgroundIn Ethiopia, maternal health service utilization is still unacceptably low. The societal and cultural factors that constrain women from attending these services have not yet been sufficiently explored. Using qualitative methods, we aimed to explore the factors that delay maternal health service utilization in eastern Ethiopia.MethodA total of 13 audio-recorded focus group discussions were conducted comprising 88 participants. We conducted separate group discussions with reproductive aged women, mothers-in-law, traditional birth attendants, husbands, and Health Extension Workers to capture their knowledge, practices, feelings, thoughts and attitudes towards maternal health service utilization. The recorded sessions were transcribed into the local language and then translated into English for analysis.ResultThe study identified a number of factors that may delay maternal health service utilization. Factors were grouped using the Three Delays model as a framework. Low level of awareness regarding need, poor involvement of husband, perceived absence of health problems, social power, community misperceptions and cultural restrictions, negative attitudes towards male midwives, acceptance of traditional birth attendants and poor social networking were Delay One factors. Lack of physical accessibility and high transportation costs were categorised as Delay Two factors for skilled birth care attendance. Perceived or experienced poor quality of care were categorised as Delay Three factors for both skilled birth and postnatal care utilization.ConclusionDespite the ongoing government measures to improve maternal health service utilization in Ethiopia, numerous factors continue to contribute to delays in service use, which in turn contribute to high maternal mortality.     

Educational assortative mating and time use in the home

This study examines the association between individuals' educational assortative mating and time spent on child care and housework. Focus is put on hypogamous couples, or couples in which wives have more education than their husbands. Relative resources and gender revolution frameworks are considered as contexts to explain why hypogamous couples may share their time differently than other couples. A series of ordinary least squares regressions with population and sampling weights are employed using American Time Use Survey data from 2003 to 2018. Three, separate analyses using relative education, gender, and all educational pairings as the independent variables of interest are presented with child care and housework as the dependent variables. The current findings show that men in hypogamous marriages perform about 10 min more of child care per day on average than their peers in hypergamous and homogamous marriages, and that this comes primarily from basic care activities. This accounts for approximately 43% of the difference between men and women in the average amount of time spent on child care. No clear pattern of significance is apparent comparing individuals’ time spent on housework by relative education, suggesting that housework and child care have evolved differently in the context of gendered domestic responsibilities. Men in hypogamous marriages are more egalitarian in their sharing of child care. However, this is only true for couples in which men have at least a high school diploma and women are highly educated.     

Loss and grief: The experience of transition to residential aged care

There is growing recognition of the experience of non-death-related loss and grief. One unexplored area of non-death-related loss and grief is associated with older people’s transition from home to residential aged care (RAC). This paper reports findings from a qualitative study that explored the experiences of people living in RAC, carer-relatives of people living in RAC and RAC staff. Using theories of loss and grief, the paper identifies features of the transition to RAC that are associated with unresolved loss and maladaptation to changed circumstances, and the types of support that would mitigate these. Using a series of focus groups with both residents and carer-relatives, as well as staff, the study found that residents and their families need more support to negotiate the multiple, often necessarily hasty decisions and bureaucratic requirements associated with transitioning to RAC, while simultaneously experiencing loss and grief. The types of support that families would welcome from service providers include facilitating shared decision making, valuing family and community carer expertise and providing practical information and assistance to fulfil administrative obligations.     

Supplemental home care and topping‐up: A shift from service universalism towards a new and privatised public service model?

How does a public service model based on service universalism react to the introduction of market principles of topping up? In a recent so‐called Free Municipality Scheme (an experimental scheme that allowed for greater operational autonomy locally in an effort to reduce state bureaucracy), a number of Danish municipalities were for the first time ever allowed to compete with for‐profit providers of home care in selling supplemental home care services paid entirely by the user. The take‐home message from this experience is that the introduction of supplemental home care entails challenges and eventually wider implications for the public service model, on an economic, organisational and cultural level. Supplemental services represent a new and potentially powerful combination of market and state logics that eventually redirects away from the universalist welfare state and towards a new and increasingly privatised public service model – a model where the service level is determined by the user's capacity to purchase and pay for services. The introduction of such services therefore implies a change of the potential of the Nordic welfare state to ensure equal access regardless of class and income.     

Issue Information

In 2017, the number of applications for care orders in England and Wales was the highest ever recorded at 14,207. This is a significant factor, contributing to the rise in the number of children who are looked after, which is at the highest level since 1985. The authors reflect on the recently published Care Crisis Review 2018, a sector‐led review, which examines the reasons for the rise in care proceedings and the number of children in care. The review sought to identify changes to policy and practice within local authorities and the family justice system, in an attempt to divert cases away from the family courts and to reduce the number of children in care, where it is safe to do so. Whilst the legislative framework is largely effective and the system generally works well, there is insufficient funding and resources to meet the needs of children and their families when they seek help, regardless of whether this is at an early stage or when they are in crisis and most in need of care and protection.     

The functional patterns of adolescent mothers leaving foster care: Results from a cluster analysis

Few studies have explored the outcomes of adolescent mothers leaving foster care, especially using person‐oriented methods. The current study employed a cluster analysis to identify unique patterns of functioning among adolescent mothers aged 19 (n = 777). Data from the National Youth in Transition Database and the Adoption and Foster Care Analysis and Reporting System were utilized. Findings revealed five subpopulations characterized by distinct constellations of outcomes at age 19. The largest group (43%) exhibited competent functioning across all the domains studied—its members were connected to school and/or employment and did not experience homelessness, substance abuse referrals, or incarceration during the past 2 years (i.e., “resilient”). A relatively small group (12%) exhibited challenges across all the above‐referenced domains, whereas the remaining groups presented challenges in some domains, but not in others. Follow‐up analyses revealed that adolescent mothers classified as resilient at age 19 had the lowest rates of congregate care placements and the highest rates of nonrelative foster care placements at age 17. Moreover, they had lower placement instability and higher rates of extended foster care as compared with members of the other clusters. Implications for practice, policy, and research are discussed.     

‘Actually There is a Brain in There’: Uncovering Complexity in Pathways Through Education for Young Adults Who Have Been in Care

Internationally, research has highlighted disruption to the educational trajectories of young people in care, documenting concern about upheaval and poor educational outcomes. We present findings from English data arising from qualitative longitudinal research with care experienced people (16–32 years) who were also in education, employment or training. The analysis extends understanding of the experiences of those who achieve educational ‘success’, including those who followed non‐linear trajectories. The need for a flexible education system, and leaving care entitlements, which take into account the disruption experienced by young people in care and the consequent possibility of delayed educational pathways, is discussed.     

Reconciling care and justice in contesting social harm through performance and arts practice with looked after children and care leavers

The proportion of young people taken into the care of the state has increased recently and there is evidence that this social group suffer negative long‐term outcomes that might be conceptualised by the emergent criminological category of ‘social harm’. Debates in social work around an ethics of care and justice offer different ways of thinking about responding to social harm. This paper reports findings from an innovative arts‐based intervention with Looked After Children and young people and concludes that holding these competing value sets in creative tension is central to the success of the programme in helping young people to cope with and contest social harm.     

Who cares? A lack of self‐care for women in the non‐profit/non‐governmental sector

In this article I examine the lack of self‐care regimes for women working in the non‐profit/non‐governmental sector. While I draw on ethnographic research conducted in the Malaysian context of women's organizations, the issue of self‐care for activists and feminist activists is a global one that crosses borders and boundaries. I explore the gendered nature of care and care professions to demonstrate how women are predominantly affected in these working environments. To date, there has been little scholarship on self‐care and care in non‐profit/non‐governmental working environments. Using interviews with women working in the sector, I argue that women's emotional, mental and physical health comes at a cost in these hectic workplaces. This article contributes to the literature on gender, work and care in women's organizations by taking seriously women's concerns working in these spaces, where they experience self‐neglect and institutional barriers in care regimes.