Principles and processes behind promoting awareness of rights for quality maternal care services: a synthesis of stakeholder experiences and implementation factors

BACKGROUND: Promoting awareness of rights is a value-based process that entails a different way of thinking and acting, which is at times misunderstood or deemed as aspirational. METHODS: Guided by the SURE framework, we undertook a secondary analysis of 26 documents identified by an earlier systematic review on promoting awareness of rights to increase use of maternity care services. We thematically analysed stakeholder experiences and implementation factors across the diverse initiatives to derive common elements to guide future efforts. RESULTS: Interventions that promote awareness of rights for maternal health varied in nature, methodological orientation, depth and quality. Materials included booklets, posters, pamphlets/ briefs and service standards/charters. Target populations included women, family members, communities, community structures, community-based and non governmental organizations, health providers and administrators, as well as elected representatives. While one initiative only focused on raising awareness, most were embedded within larger efforts to improve the accountability and responsiveness of service delivery through community monitoring and advocacy, with a few aiming to change policies and contest elections. Underlying these action oriented forms of promoting awareness of rights, was a critical consciousness and attitudinal change gained through iterative capacity-building for all stakeholders; materials and processes that supported group discussion and interaction; the formation or strengthening of community groups; situational analysis to ensure adaptation to local context; facilitation to ensure common ground and language across stakeholders; and strategic networking and alliance building across health system levels. While many positive experiences are discussed, few challenges or barriers to implementation are documented. The limited documentation and poor quality of information found indicate that while various examples of promoting awareness of rights for maternal health exists, research partnerships to systematically evaluate their processes, learning and effects are lacking. CONCLUSION: Rather than being aspirational, several examples of promoting awareness of women’s rights for quality maternity care services exist. More than mainly disseminate information, they aim to change stakeholder mindsets and relationships across health system levels. Due to their transformatory intent they require sustained investment, with strategic planning, concrete operationalization and political adeptness to manage dynamic stakeholder expectations and reactions overtime. More investment is also required in research partnerships that support such initiatives and better elucidate their context specific variations.ScopusIS

THE HEALTH IMPACT OF LABOR RIGHTS VIOLATIONS AGAINST MIGRANT WORKERS IN SELANGOR STATE, MALAYSIA

The overarching goal of this dissertation is to provide a more nuanced understanding of migrant workers’ experiences of occupational injury and illness, their health care needs and the types of support they require to exercise their right to health care under national and international laws. It focuses specifically on migrants (> 18 years of age) from Malaysia’s top source countries (Bangladesh, Indonesia, the Philippines and Nepal) employed in the construction, domestic work, manufacturing, and service work sectors. Research Aims 1 and 2 (Qualitative) utilize data from In-Depth Interviews (n=58) and Focus Group Discussions (n=56). Research Aim 3 (Quantitative) uses data on labor rights violations experienced by more than 1,900 migrant workers assisted by a local non-governmental organization, Tenaganita, between 2009 and 2014. Broadly, the results reveal a complex relationship between occupational injury and illness and systematic violations of the right to a healthy and safety work environment, which extend well beyond the absence of injuries in the workplace. In addition to illustrating the hazardous and exploitative working conditions of migrant workers in Malaysia, this thesis also provides evidence of the Malaysian Government’s failure to uphold its international human rights obligations under multiple international human rights treaties and International Labour Organization Conventions. Without adequate mechanisms in place for monitoring and enforcement of existing labor laws, migrant workers face multiple barriers to redress for violations of their right to “work, to free choice of employment, to just and favorable conditions of work” (UN General Assembly, 1948). As a result, these rights only remain on paper for more than two million migrant workers in Malaysia and beyond

Global Trafficking Prevalence Data Advances the Fight against Trafficking in Persons

We defend the proposition that global trafficking prevalence data—when gathered using validated methods and presented with sufficient detail on study design and data analysis—can advance the fight against trafficking in persons. Space does not allow us to engage in a full review and critique of existing data and methodologies, but we subscribe to the view that the field in general suffers from ‘“epidemiological anaemia”—lack of primary data collection based on sound sampling procedures’. We would add another condition: demographic disorder—unsystematic use and interpretation of population data. Until that situation improves, and it can best do so through systematic application of qualitative and quantitative ‘microlevel research’, we recommend that existing global prevalence data be presented with clearer caveats and used with due caution

Do Interventions that Promote Awareness of Rights Increase Use of Maternity Care Services? A Systematic Review

<div><p>Twenty years after the rights of women to go through pregnancy and childbirth safely were recognized by governments, we assessed the effects of interventions that promote awareness of these rights to increase use of maternity care services. Using inclusion and exclusion criteria defined in a peer-reviewed protocol, we searched published and grey literature from one database of studies on maternal health, two search engines, an internet search and contact with experts. From the 707 unique documents found, 219 made reference to rights, with 22 detailing interventions promoting awareness of rights for maternal and newborn health. Only four of these evaluated effects on health outcomes. While all four interventions promoted awareness of rights, they did so in different ways. Interventions included highly-scripted dissemination meetings with educational materials and other visual aids, participatory approaches that combined raising awareness of rights with improving accountability of services, and broader multi-stakeholder efforts to improve maternal health. Study quality ranged from weak to strong. Measured health outcomes included increased antenatal care and facility birth. Improvements in human rights outcomes such as availability, acceptability, accessibility, quality of care, as well as the capacity of rights holders and duty bearers were also reported to varying extents. Very little information on costs and almost no information on harms or risks were described. Despite searching multiple sources of information, while some studies did report on activities to raise awareness of rights, few detailed how they did so and very few measured effects on health outcomes. Promoting awareness of rights is one element of increasing demand for and use of quality maternity care services for women during pregnancy, birth and after birth. To date efforts have not been well documented in the literature and the program theories, processes and costs, let alone health effects have not been well evaluated.</p></div

Internet "Gateway Sites" and Linked URLs.

<p>Internet "Gateway Sites" and Linked URLs.</p

Rights-based approaches to health.

<p>Rights-based approaches to health.</p

Studies that promote awareness of rights and document effects on maternal health care-seeking.

<p>Studies that promote awareness of rights and document effects on maternal health care-seeking.</p

Flow chart outlining study selection results.

<p>Flow chart outlining study selection results.</p

Concepts and terms for PubMed search: January 1, 2010—May 31, 2014.

<p>Concepts and terms for PubMed search: January 1, 2010—May 31, 2014.</p