Experiences of pregnancy in adolescence of internally displaced women in Bogotá : an ethnographic approach

Antecedentes: El embarazo en la adolescencia es mayor en mujeres en condición de desplazamiento interno en Colombia, con respecto a las no desplazadas. Dicha condición es definida como un problema con consecuencias significativas desde el punto de vista biomédico y epidemiológico. Sin embargo, es necesario indagar estas experiencias desde las perspectivas de las mujeres que lo han experimentado, específicamente en el contexto del conflicto armado y del desplazamiento. Objetivo: Este artículo tiene por objeto comprender cómo interpretan las mujeres en condición de desplazamiento interno sus propias experiencias de embarazo en la adolescencia en el contexto del conflicto armado Colombiano a través de una aproximación etnográfica en una comunidad receptora en Bogotá. Métodos: Con base en 10 años de experiencia trabajando en la comunidad, realizamos un año de trabajo de campo a través de observación participante, 20 entrevistas a profundidad para reconstruir sus historias de vida y 8 talleres con las mujeres en condición de desplazamiento en un barrio en Ciudad Bolívar, en Bogotá. Realizamos análisis temático de la información para analizar los datos de las mujeres desplazadas y explorar como ellas entendieron sus experiencias de embarazo en la adolescencia tras el contexto del desplazamiento. Resultados: Los principales temas que emergieron de las experiencias de las participantes incluyeron la violencia en áreas rurales, su niñez (incluso los significados de embarazo a temprana edad y el enamoramiento), y las diferentes reacciones frente al embarazo (como la estigmatización) por parte de sus familias y sus parejas. Conclusión: El embarazo en la adolescencia en mujeres en condición de desplazamiento interno tiene dinámicas complejas e incluye el contexto violento que viven en las áreas rurales de donde son originarias, pero principalmente la violencia que vivieron durante su niñez. La experiencia de embarazo durante la adolescencia les genera sentimientos de pertenencia y las anima a sobrellevar las condiciones del desplazamiento. Estos hallazgos pueden ayudar en la construcción de políticas públicas y al personal de salud para trabajar con esta población.Q2Q1Paciente femeninoBackground: Pregnancy in adolescence is higher among internally displaced women in Colombia than nondisplaced women. It is defined as a problem with significant negative outcomes by both biomedical and epidemiological approaches. However, little is known about pregnancy during adolescence from the perspective of women who experienced this in the specific context of armed conflict and displacement. Aim: This article focuses on how internally displaced women understand their experiences of pregnancy in adolescence in the context of armed conflict through an ethnographic approach in a receptor community of internally displaced women in Bogotá, Colombia. Methods: Based on 10 years of experience in the community, we conducted 1 year of fieldwork, using an ethnographic approach. We collected life stories of 20 internally displaced women through in-depth interviews and ran 8 workshops with them and other women from the community. We used thematic analysis to analyse the responses of internally-displaced women and understand how they made meaning around their experiences of adolescent pregnancy in the context of displacement. Results: The main themes that emerged from participants’ experiences include rural violence, early family life (characterized by violence and mistreatment at home), meanings of pregnancy at an early age (including being challenged and feelings of love), and reactions to their pregnancies during adolescence (such as stigmatization) from their families and partners. Conclusion: Our analysis of the in-depth interviews and the workshops suggests that adolescent pregnancy among women who are internally displaced has complex dynamics, characterized by the violent context of the rural areas, but primarily by the violence experienced during their childhood. The experience of pregnancy during adolescence brings feelings of ownership and also challenges, together with the forced displacement. This understanding will provide insights for policy makers and healthcare providers on how to work with this specific population who have experienced pregnancy in adolescence.https://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0001363227https://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0000186929Revista Nacional - Indexad

Making a difference: The construction of ethnicity in HIV and STI epidemiological research by the Dutch National Institute for Public Health and the Environment (RIVM)

http://dx.doi.org/10.1016/j.socscimed.2011.03.04

Authorship position as a proxy for contextual knowledge

Current health sciences literature is predominantly disseminated by, through and for Western scholars, resulting in underrepresentation of contextual knowledge in health policies worldwide. Commonly, this literature is evidence-based, build on principles of universality, neglecting and disregarding the importance of contextual and local expertise. Using a global health research question applied to three countries, Maastricht University Library’s collection was evaluated to explore the extent of contextual knowledge by authorship positions. Preliminary results showed that while Dutch articles had more local authors on first and/or last authorship positions compared to Bangladesh and Tanzania, they had no Dutch authors in middle positions, as opposed to Bangladesh and Tanzania (23% and 16%).  This indicates a need for further understanding of geographic authorship position customs. Key words: Global health; Information dissemination; Information sources; Health information exchange; Diversity, Equity, Inclusio

‘We just been forced to do it’ : exploring victimization and agency among internally displaced young mothers in Bogotá

Q2Q1Background: Armed conflict in Colombia has a history of 50 years that continues to this day. According to the Victims Record of Colombia, from 1985 to 2013 2.683.335 women have been victims of the armed conflict. Women have been described as the main victims of the armed conflict, especially in the Colombian cultural context that in some regions is still considered to be a ‘machista’ and patriarchal one. In contrast, some authors have explicitly stressed Colombian women’s agency instead of positioning them only as victims. Some of them are described as ‘survivors’ of the war, emphasizing their impressive resistance to the outcomes of war and forced displacement. In contrast to the background of these scholarly discussions, our study focused on how displaced women living in Bogotá themselves articulate their experiences of agency and victimization. This paper will therefore explore how women, in reconstructing their life stories, expressed the tussles between victimization and agency. Methods: We used qualitative methods conducted within an ethnographic approach. Based on ten years of experience in the neighborhood and one year of fieldwork, we collected the life stories of twenty internally displaced mothers, and ran eight workshops with them. We analyzed the narratives with a specific focus on how women expressed victimization and agency in four important periods in their life that related to the process of displacement: when they left home, when they became pregnant, when they were forced to leave their towns, and when they arrived in Bogotá. Results: Participants’ life stories showed how they struggled with agency during their lives. They were victims of abuse and violence during childhood and finally decided to leave their homes. They decided to have their babies despite the fact that they were abandoned by their partners and families, and after doubts about and attempts to have an abortion. Throughout the process of displacement the participants had been engaged in ambiguous relationships with armed groups. Finally they arrived in Bogotá and faced adverse circumstances but were looking for better opportunities for them and their children. Conclusion: The analysis of how internally displaced women narrated their life stories showed us that the concepts that dominate scholarly debates about agency, victimization and survivorship do not do justice to the life stories of the participants in our study. These stories show that changes with a major impact were loaded with ambiguity and were characterized by helplessness, lack of control and agency simultaneously. The reconstruction of these life stories goes beyond the stereotype of displaced women as only ‘victims’, but points also to their agency and courageous decisions they made in contexts that were not controlled by them and where support was often lacking. Instead of label them, it is important to understand the complexity of the life experiences of IDW, in order to build policies that offer them aids as victims, but also build policies and intervention programs that empower them as agents in order to support them during resettlement.https://orcid.org/0000-0002-5016-6119Revista Internacional - Indexad

Identity struggles during resettlement : an ethnographic approach of internally displaced adolescent mothers in Bogotá

Q1Q1Madres adolescdentes en BogotáMany internally displaced persons (IDPs) in Colombia are teenage mothers, who experience unique gendered identity struggles in the rural areas where they were born and during processes of displacement and resettlement. We chose an ethnographic approach both to collect the life stories of 20 displaced adolescent mothers who had resettled in Bogotá and to conduct eight workshops. The analysis shows that the participants struggled with their identities as ‘women’ in the rural areas in the context of violence and armed conflict when they faced motherhood while still being adolescent and becoming displaced and when they embraced the formal ‘displaced person’ identity while enduring difficulties with the receptor communities during resettlement. The new identity status as ‘displaced’ that they wished for as a basis for benefits does not imply that the identity struggles are over. Our analysis shows that the gendered struggles of adolescent IDP mothers with multiple identities that are not easily aligned are accumulating, resulting in a complex challenge during resettling.https://orcid.org/0000-0002-5016-6119Revista Internacional - Indexad

‘We are the advocates for the babies’ - understanding interactions between patients and health care providers during the prevention of mother-to-child transmission of HIV in South Africa : a qualitative study

BACKGROUND : HIV/AIDS has had a significant impact on maternal and child health in South Africa. It is thus of vital importance to implement interventions to prevent mother-to-child transmission of HIV (PMTCT) as early as possible during pregnancy. Negative interactions between patients and health care providers (HCPs) can be an important barrier to antenatal care, PMTCT use and PMTCT adherence. Research about respectful maternity care has focused more on the patient perspective. We therefore compared the patient and HCP perspectives and reflected on how interactions between HCPs and patients can be improved. OBJECTIVE : To obtain insights into the attitudes of HCPs in the context of HIV and PMTCTrelated care, by studying patient and HCP perceptions of their interactions, in a peri-urban hospital setting in Gauteng province, South Africa. METHODS : A qualitative study was conducted in a public tertiary-level hospital. Fourteen semistructured in-depth interviews were conducted with nurses and doctors in the antenatal clinic and postnatal ward. Thirty-one semi-structured in-depth interviews and two focus group discussions were conducted with HIV positive and negative women on the postnatal ward. RESULTS : HCPs experienced a difficult work environment due to a high workload. This was combined with frustrations when they felt that patients did not take responsibility for their own or their child’s health. They were motivated by the need to help the child. Patients experienced judging comments by HCPs especially towards younger, older and foreign women. They expressed fear to ask questions and self-blame, which in some cases delayed health care seeking. No discrimination or isolation of HIV infected patients was reported by patients and HCPs. CONCLUSION : We hypothesize that more humane working conditions for obstetric HCPs and a caring, personalised approach to patient management can improve patient-provider interactions and access to respectful care. These are critical to preventing mother-to-child transmission of HIV.The South African Medical Research Councilhttp://www.tandfonline.com/loi/zgha20am2020Paediatrics and Child Healt

Framing the Health Workforce Agenda Beyond Economic Growth

The fourth Global Forum on Human Resources (HRH) for Health was held in Ireland November 2017. Its Dublin declaration mentions that strategic investments in the health workforce could contribute to sustainable and inclusive growth and are an imperative to shared prosperity. What is remarkable about the investment frame for health workforce development is that there is little debate about the type of economic development to be pursued. This article provides three cautionary considerations and argues that, in the longer term, a perspective beyond the dominant economic frame is required to further equitable development of the global health workforce. The first argument includes the notion that the growth that is triggered may not be as inclusive as proponents say it is. Secondly, there are considerable questions on the possibility of expanding fiscal space in low-income countries for public goods such as health services and the sustainability of the resulting economic growth. Thirdly, there is a growing consideration that economic growth solely expressed as increasing gross domestic product (GDP) might have intrinsic problems in advancing sustainable development outcomes. Economic development goals are a useful approach to guiding health workforce policies and health employment but this depends very much on the context. Alternative development models and policy options, such as a Job Guarantee scheme, need to be assessed, deliberated and tested. This would meet considerable political challenges but a narrow single story and frame of economic development is to be rejected

Framing the Health Workforce Agenda Beyond Economic Growth

Abstract The fourth Global Forum on Human Resources (HRH) for Health was held in Ireland November 2017. Its Dublin declaration mentions that strategic investments in the health workforce could contribute to sustainable and inclusive growth and are an imperative to shared prosperity. What is remarkable about the investment frame for health workforce development is that there is little debate about the type of economic development to be pursued. This article provides three cautionary considerations and argues that, in the longer term, a perspective beyond the dominant economic frame is required to further equitable development of the global health workforce. The first argument includes the notion that the growth that is triggered may not be as inclusive as proponents say it is. Secondly, there are considerable questions on the possibility of expanding fiscal space in low-income countries for public goods such as health services and the sustainability of the resulting economic growth. Thirdly, there is a growing consideration that economic growth solely expressed as increasing gross domestic product (GDP) might have intrinsic problems in advancing sustainable development outcomes. Economic development goals are a useful approach to guiding health workforce policies and health employment but this depends very much on the context. Alternative development models and policy options, such as a Job Guarantee scheme, need to be assessed, deliberated and tested. This would meet considerable political challenges but a narrow single story and frame of economic development is to be rejected

A qualitative study on patients' selection in the scarcity of resources in the COVID-19 pandemic in a communal culture

The scarcity of resources during the COVID‐19 pandemic caused ethical dilemmas in prioritizing patients for treatment. Medical and ethical guidance only emphasizes clinical procedures but does not consider the sociocultural aspect. This study explored the perception of former COVID‐19 patients and their families on the decision‐making process of the patient's selection at a time of scarcity of resources. The result will inform the development of an ethical guide for allocating scarce resources that aligns with Indonesian culture. We conducted qualitative research with in‐depth interviews between May ‐ December 2022 involving sixteen participants from various cities in Indonesia. We transcribed the interviews and analyzed the results using thematic analysis. This study found that doctor's decisions often differed from patient's expecta- tions in allocating scarce resources, and therefore, it should be communicated appropriately. Medical decisions were not sufficiently made ethically, but must also be made communicatively. In Indonesia's strong communal culture, community involvement was essential to distributing limited resources. A better approach to ethical education, including adequate communication skills, is necessary to prepare health professionals for facing unpredictable future pandemics

Burnout And Welfare In Health Care Workers During Covid-19 In Indonesia

Pandemi Covid-19 menimbulkan berbagai dampak terhadap kesehatan di seluruh dunia, termasuk Indonesia. Salah satunya adalah keterbatasan sumber daya yang menuntut kemampuan tenaga kesehatan untuk bisa mengalokasikan sumber daya yang terbatas tersebut sesuai keilmuan medis dan kaidah etika. Tetapi ternyata seringkali terjadi dilema yang berakibat menimbulkan burnout saat tenaga kesehatan mengalokasikan sumber daya yang terbatas tersebut. Hal ini karena adanya tuntutan dari masyarakat, tuntutan dari pemerintah atau instansi kesehatan, tuntutan hati nurani yang ingin menyelamatkan sebanyak mungkin pasien, dll. Oleh karena itu diperlukan kesadaran bahwa ada perbedaan persepsi antara tenaga kesehatan dan pasien tentang kriteria pemilihan pasien yang mendapatkan sumber daya, dan pemahaman bahwa yang dilakukan tenaga kesehatan sudah sesuai dengan kaidah etik atau belum. Selain itu diperlukan manajemen atau mitigasi untuk menghadapi burnout tersebut