GLOBALIZATION RELOADED: AN UNCTAD PERSPECTIVE

This paper rejects the characterization of globalization as an autonomous and irresistible process driven by the impersonal forces of the market and technical progress. Whether domestic or global, market forces are shaped and controlled by policy choices and the institutional frameworks in which they are made. In the absence of adequate institutional frameworks and productive capacities, rapid liberalization is as likely to lead to stagnation and unemployment as to growth and rising incomes per head. We show that the major economic forces presumed to be crucial for spreading the benefits of globalization have been less global than often presented, have proved to be much weaker than widely predicted and carry potentially damaging effects as well as benefits. Accordingly, and without denying that by the late 1970s many developing countries needed to find new ways of inserting themselves into the international economy, we argue that the new policy orientation of macroeconomic stringency, downsizing the public sector and the rapid opening of developing country markets to foreign trade and capital after the debt crisis, has failed to produce an economic environment that supports faster economic growth and strengthens productivity performance. In suggesting the outlines of a more strategic approach to economic development the emphasis is on the need for domestic investment to be mobilized as the basis for industrialization and for a gradual approach to integration with the global economy.

Midwives’ perspectives on (dis)respectful intrapartum care during facility-based delivery in sub-Saharan Africa: a qualitative systematic review and meta-synthesis

Background In the past decade, the negative impact of disrespectful maternity care on women’s utilisation and experiences of facility-based delivery has been well documented. Less is known about midwives’ perspectives on these labour ward dynamics. Yet efforts to provide care that satisfies women’s psycho-socio-cultural needs rest on midwives’ capacity and willingness to provide it. We performed a systematic review of the emerging literature documenting midwives’ perspectives to explore the broader drivers of (dis)respectful care during facility-based delivery in the sub-Saharan African context. Methods Seven databases (CINAHL, PsychINFO, PsychArticles, Embase, Global Health, Maternity and Infant Care and PubMed) were systematically searched from 1990 to May 2018. Primary qualitative studies with a substantial focus on the interpersonal aspects of care were eligible if they captured midwives’ voices and perspectives. Study quality was independently assessed by two reviewers and PRISMA guidelines were followed. The results and findings from each study were synthesised using an existing conceptual framework of the drivers of disrespectful care. Results Eleven papers from six countries were included and six main themes were identified. ‘Power and control’ and ‘Maintaining midwives’ status’ reflected midwives’ focus on the micro-level interactions of the mother-midwife dyad. Meso-level drivers of disrespectful care were: the constraints of the ‘Work environment and resources’; concerns about ‘Midwives’ position in the health systems hierarchy’; and the impact of ‘Midwives’ conceptualisations of respectful maternity care’. An emerging theme outlined the ‘Impact on midwives’ of (dis)respectful care. Conclusion We used a theoretically informed conceptual framework to move beyond the micro-level and interrogate the social, cultural and historical factors that underpin (dis)respectful care. Controlling women was a key theme, echoing women’s experiences, but midwives paid less attention to the social inequalities that distress women. The synthesis highlighted midwives’ low status in the health system hierarchy, while organisational cultures of blame and a lack of consideration for them as professionals effectively constitute disrespect and abuse of these health workers. Broader, interdisciplinary perspectives on the wider drivers of midwives’ disrespectful attitudes and behaviours are crucial if efforts to improve the maternity care environment - for women and midwives - are to succeed

Correcting for tissue nitrogen excretion in multiple breath washout measurements.

Nitrogen excreted from body tissues impacts the calculation of multiple breath nitrogen washout (MBWN2) outcomes. The aim of this study was to determine the effect of tissue N2 on MBWN2 outcomes in both healthy subjects and patients with CF and to assess whether it is possible to correct for tissue N2. The contribution of tissue N2 to MBWN2 outcomes was estimated by comparing MBWN2-derived functional residual capacity (FRCN2) to FRC measured by body plethysmography (FRCpleth) and by comparing MBW outcome measures derived from MBWN2 and sulfur hexafluoride MBW (MBWSF6). Compared to plethysmography and MBWSF6, MBWN2 overestimated FRC and lung clearance index (LCI). Application of mathematical tissue N2 corrections reduced FRCN2 values closer to FRCpleth in health and reduced LCIN2 in both health and CF, but did not explain all of the differences observed between N2-dependent and -independent techniques. Use of earlier washout cut-offs could reduce the influence of tissue N2. Applying tissue N2 corrections to LCIN2 measurements did not significantly affect the interpretation of treatment effects reported in a previously published interventional trial. While tissue N2 excretion likely has an impact on MBWN2 outcomes, better understanding of the nature of this phenomenon is required before routine correction can be implemented into current MBWN2 protocols

Disrespectful intrapartum care during facility-based delivery in sub-Saharan Africa: A qualitative systematic review and thematic synthesis of women's perceptions and experiences

The psycho-social elements of labour and delivery are central to any woman's birth experience, but international efforts to reduce maternal mortality in low-income contexts have neglected these aspects and focused on technological birth. In many contexts, maternity care is seen as dehumanised and disrespectful, which can have a negative impact on utilisation of services. We undertook a systematic review and meta-synthesis of the growing literature on women's experiences of facility-based delivery in sub-Saharan Africa to examine the drivers of disrespectful intrapartum care. Using PRISMA guidelines, databases were searched from 1990 to 06 May 2015, and 25 original studies were included for thematic synthesis. Analytical themes, that were theoretically informed and cognisant of the cultural and social context in which the dynamics of disrespectful care occur, enabled a fresh interpretation of the factors driving midwives' behaviour. A conceptual framework was developed to show how macro-, meso- and micro-level drivers of disrespectful care interact. The synthesis revealed a prevailing model of maternity care that is institution-centred, rather than woman-centred. Women's experiences illuminate midwives' efforts to maintain power and control by situating birth as a medical event and to secure status by focusing on the technical elements of care, including controlling bodies and knowledge. Midwives and women are caught between medical and social models of birth. Global policies encouraging facility-based delivery are forcing women to swap the psycho-emotional care they would receive from traditional midwives for the technical care that professional midwives are currently offering. Any action to change the current performance and dynamic of birth relies on the participation of midwives, but their voices are largely missing from the discourse. Future research should explore their perceptions of the value and practice of interpersonal aspects of maternity care and the impact of disrespectful care on their sense of professionalism and personal ethics

What makes alongside midwifery-led units work? Lessons from a national research project

The findings of the Birthplace in England Research Programme showed that midwife-led units are providing the safest and most cost-effective care for low risk women in England. Since the publication of the updated National Institute for Health and Care Excellence (NICE) intrapartum guidelines, there is likely to be even more interest in the development of midwife-led units to promote birth outside obstetric units (OUs) for low-risk women. Professional bodies, policy makers and trusts have focused their energies on alongside midwife-led units (AMUs), which are seen to provide the 'best of both worlds' between home and an OU. Between 2012 and 2013, we carried out a study of the organisation of four AMUs in England and the experiences of midwives and women who worked and birthed there. Learning from their experiences, this article presents five key factors which help make AMUs work

Pyrogenic organic matter production from wildfires: a missing sink in the global carbon cycle

Wildfires release substantial quantities of carbon (C) into the atmosphere but they also convert part of the burnt biomass into pyrogenic organic matter (PyOM). This is richer in C and, overall, more resistant to environmental degradation than the original biomass, and, therefore, PyOM production is an efficient mechanism for C sequestration. The magnitude of this C sink, however, remains poorly quantified, and current production estimates, which suggest that ∽1-5% of the C affected by fire is converted to PyOM, are based on incomplete inventories. Here, we quantify, for the first time, the complete range of PyOM components found in-situ immediately after a typical boreal forest fire. We utilized an experimental high-intensity crown fire in a jack pine forest (Pinus banksiana) and carried out a detailed pre- and postfire inventory and quantification of all fuel components, and the PyOM (i.e., all visually charred, blackened materials) produced in each of them. Our results show that, overall, 27.6% of the C affected by fire was retained in PyOM (4.8 ± 0.8 t C ha(−1)), rather than emitted to the atmosphere (12.6 ± 4.5 t C ha(−1)). The conversion rates varied substantially between fuel components. For down wood and bark, over half of the C affected was converted to PyOM, whereas for forest floor it was only one quarter, and less than a tenth for needles. If the overall conversion rate found here were applicable to boreal wildfire in general, it would translate into a PyOM production of ∽100 Tg C yr(−1) by wildfire in the global boreal regions, more than five times the amount estimated previously. Our findings suggest that PyOM production from boreal wildfires, and potentially also from other fire-prone ecosystems, may have been underestimated and that its quantitative importance as a C sink warrants its inclusion in the global C budget estimates