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Successful Community Midwives in Pakistan: An Asset-Based Approach

In response to the low levels of skilled birth attendance in rural Pakistan, the government introduced a new cadre of community midwives (CMWs) in 2006. Assessments to-date have found that these CMWs have yet to emerge as significant providers for a number of sociocultural, geographic and financial...

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Detalles Bibliográficos
Autores principales: Mumtaz, Zubia, Levay, Adrienne V., Bhatti, Afshan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4557986/
https://www.ncbi.nlm.nih.gov/pubmed/26333067
http://dx.doi.org/10.1371/journal.pone.0135302
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author Mumtaz, Zubia
Levay, Adrienne V.
Bhatti, Afshan
author_facet Mumtaz, Zubia
Levay, Adrienne V.
Bhatti, Afshan
author_sort Mumtaz, Zubia
collection PubMed
description In response to the low levels of skilled birth attendance in rural Pakistan, the government introduced a new cadre of community midwives (CMWs) in 2006. Assessments to-date have found that these CMWs have yet to emerge as significant providers for a number of sociocultural, geographic and financial reasons. However, a small number of CMWs have managed to establish functional practices in the private sector in conservative, infrastructure-challenged rural contexts. With an objective to highlight “what are the successful CMWs doing right given their context?” this paper adopts an asset-based approach to explore the experiences of the Pakistani CMWs who have managed to overcome the barriers and practice. We drew upon ethnographic data that was collected as part of a larger mixed methods study conducted in 2011–2012 in districts Jhelum and Layyah, Pakistan. Thirty eight CMWs, 45 other health care providers, 20 policymakers, 78 women, 35 husbands and 23 older women were interviewed. CMW clinics and practices were observed. Our data showed that only eight 8 out of 38 CMWs sampled were active providers. Poverty as a push factor to work and intrinsic individual-level characteristics that enabled the CMWs to respond successfully to the demands of the midwifery profession in the private sector emerged as the two key themes. Household poverty pushed the CMWs to work in this perceived low-status occupation. Their families supported them since they became the breadwinners. The successful CMWs also had an intrinsic sense of what was required to establish a private practice; they exhibited professionalism, had strong business sense and provided respectful maternity care. The study provides insight into how the program might improve its functioning by adapting its recruitment criteria to ensure selection of right candidates.
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spelling pubmed-45579862015-09-10 Successful Community Midwives in Pakistan: An Asset-Based Approach Mumtaz, Zubia Levay, Adrienne V. Bhatti, Afshan PLoS One Research Article In response to the low levels of skilled birth attendance in rural Pakistan, the government introduced a new cadre of community midwives (CMWs) in 2006. Assessments to-date have found that these CMWs have yet to emerge as significant providers for a number of sociocultural, geographic and financial reasons. However, a small number of CMWs have managed to establish functional practices in the private sector in conservative, infrastructure-challenged rural contexts. With an objective to highlight “what are the successful CMWs doing right given their context?” this paper adopts an asset-based approach to explore the experiences of the Pakistani CMWs who have managed to overcome the barriers and practice. We drew upon ethnographic data that was collected as part of a larger mixed methods study conducted in 2011–2012 in districts Jhelum and Layyah, Pakistan. Thirty eight CMWs, 45 other health care providers, 20 policymakers, 78 women, 35 husbands and 23 older women were interviewed. CMW clinics and practices were observed. Our data showed that only eight 8 out of 38 CMWs sampled were active providers. Poverty as a push factor to work and intrinsic individual-level characteristics that enabled the CMWs to respond successfully to the demands of the midwifery profession in the private sector emerged as the two key themes. Household poverty pushed the CMWs to work in this perceived low-status occupation. Their families supported them since they became the breadwinners. The successful CMWs also had an intrinsic sense of what was required to establish a private practice; they exhibited professionalism, had strong business sense and provided respectful maternity care. The study provides insight into how the program might improve its functioning by adapting its recruitment criteria to ensure selection of right candidates. Public Library of Science 2015-09-02 /pmc/articles/PMC4557986/ /pubmed/26333067 http://dx.doi.org/10.1371/journal.pone.0135302 Text en © 2015 Mumtaz et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Mumtaz, Zubia
Levay, Adrienne V.
Bhatti, Afshan
Successful Community Midwives in Pakistan: An Asset-Based Approach
title Successful Community Midwives in Pakistan: An Asset-Based Approach
title_full Successful Community Midwives in Pakistan: An Asset-Based Approach
title_fullStr Successful Community Midwives in Pakistan: An Asset-Based Approach
title_full_unstemmed Successful Community Midwives in Pakistan: An Asset-Based Approach
title_short Successful Community Midwives in Pakistan: An Asset-Based Approach
title_sort successful community midwives in pakistan: an asset-based approach
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4557986/
https://www.ncbi.nlm.nih.gov/pubmed/26333067
http://dx.doi.org/10.1371/journal.pone.0135302
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