Use of biomedical obstetric care in south-central Tanzania: production and effects of embodied inequality Public Deposited

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  • March 22, 2019
  • Spangler, Sydney A.
    • Affiliation: Gillings School of Global Public Health, Department of Maternal and Child Health
  • In order to reduce high levels of maternal mortality and morbidity in resource-poor countries, institutions working for maternal health have committed to making biomedical obstetric care more available to all women during childbirth. However, implementation of this strategy does not appear to be reaching women at the lower end of the socioeconomic spectrum, while those at the upper end are getting more and higher-quality services. At present, there is insufficient knowledge on how states and processes of inequality influence demand for, decisions about, and behavior towards and away from obstetric care. We are also lacking information on the quality and delivery of this care in specific contexts, including how well established schemes for assessing obstetric services apply to the care actually being performed. The purpose of this dissertation, therefore, is to better understand use of obstetric care in a rural Tanzanian setting where this care is being supplied, including identification of what existing services consist of and the manner in which they are delivered. Most especially, this research explains how and why social and material positioning among women affect choices and actions in relation to biomedical obstetric care. To approach this work comprehensively, an interdisciplinary approach was taken that draws on theoretical perspectives from social epidemiology, medical anthropology, and development studies. Methods employed include descriptive statistics, participant observation, logistic regression analysis, and ethnographic interviews. Taken together, the study findings indicate that a great deal of complexity exists in how obstetric services are performed, who uses them, and for what reasons. It is not simply a matter of what women want but also what they can reasonably access - women seek and receive the particular care available to them according to their relative positioning in society. In order to effectively make biomedical obstetric care available to all women at childbirth, we need to improve assessment schemes so that they allow for more realistic interpretation and thus more appropriate interventions. We also need to prioritize research, policy, and programs that explicitly aim to improve accessibility of obstetric services for women who are socially and materially disadvantaged.
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  • In Copyright
  • Bennett, Trude
  • Holland, Dorothy
  • Open access

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