A meta-ethnographic study of health care staff perceptions of the WHO/UNICEF Baby Friendly Health Initiative

Background Implementation of the Baby Friendly Health Initiative (BFHI) is associated with increases in breastfeeding initiation and duration of exclusive breastfeeding and ‘any’ breastfeeding. However, implementation of the BFHI is challenging. Aim To identify and synthesise health care staff perceptions of the WHO/UNICEF BFHI and identify facilitators and barriers for implementation. Method Seven qualitative studies, published between 2003 and 2013 were analysed using meta-ethnographic synthesis. Findings Three overarching themes were identified. First the BFHI was viewed variously as a ‘desirable innovation or an unfriendly imposition’. Participants were passionate about supporting breastfeeding and improving consistency in the information provided. This view was juxtaposed against the belief that BFHI represents an imposition on women's choices, and is a costly exercise for little gain in breastfeeding rates. The second theme highlighted cultural and organisational constraints and obstacles to BFHI implementation including resource issues, entrenched staff practices and staff rationalisation of non-compliance. Theme three captured a level of optimism and enthusiasm amongst participants who could identify a dedicated and credible leader to lead the BFHI change process. Collaborative engagement with all key stakeholders was crucial. Conclusions Health care staff hold variant beliefs and attitudes towards BFHI, which can help or hinder the implementation process. The introduction of the BFHI at a local level requires detailed planning, extensive collaboration, and an enthusiastic and committed leader to drive the change process. This synthesis has highlighted the importance of thinking more creatively about the translation of this global policy into effective change at the local level

Creating online communities to build positive relationships and increase engagement in not-for-profit organisations

The introduction of social media and social networking sites (SNSs) such as Facebook, has created public relations opportunities for not-for-profit (NFP) organisations that are substantially different from those available via traditional websites. Of the many types of social media that exist, Facebook is the most valued platform by businesses, which is no surprise as Facebook has the largest user rate and a diverse range of users globally, making it a perfect platform through which organisations can target their stakeholders. Drawing on a recent case study of the use of closed Facebook groups by the Australian Breastfeeding Association (ABA), this paper demonstrates how SNSs such as Facebook can be used by NFP organisations to create online communities that provide support for their stakeholders while building positive relationships that work towards achieving the elusive two-way symmetrical model of communication

Birthing outside the system : the motivation behind the choice to freebirth or have a homebirth with risk factors in Australia

Background: Childbirth in Australia occurs predominantly in a biomedical context, with 97% of births occurring in hospital. A small percentage of women choose to birth outside the system – that is, to have a midwife attended homebirth with risk factors, or a freebirth, where the birth at home is intentionally unattended by any health professional. Method: This study used a Grounded Theory methodology. Data from 13 women choosing homebirth and 15 choosing freebirth were collected between 2010 and 2014 and analysed over this time. Results: The core category was ‘wanting the best and safest,’ which describes what motivated the women to birth outside the system. The basic social process, which explains the journey women took as they pursued the best and safest, was ‘finding a better way’. Women who gave birth outside the system in Australia had the countercultural belief that their knowledge about what was best and safest had greater authority than the socially accepted experts in maternity care. The women did not believe the rhetoric about the safety of hospitals and considered a biomedical approach towards birth to be the riskier birth option compared to giving birth outside the system. Previous birth experiences taught the women that hospital care was emotionally unsafe and that there was a possibility of further trauma if they returned to hospital. Giving birth outside the system presented the women with what they believed to be the opportunity to experience the best and safest circumstances for themselves and their babies. Conclusion: Shortfalls in the Australian maternity care system is the major contributing factor to women’s choice to give birth outside the system. Systematic improvements should prioritise humanising maternity care and the expansion of birth options which prioritise midwifery-led care for women of all risk

Sistem Hirarki Kelembagaan Badan Pengelola Zakat di Indonesia (Tinjauan terhadap Pelaksanaan Undang-undang No. 23 Tahun 2011)

: Government support for the existence and role of zakat management organization indicated by the issuance of legislation on the management of zakat that Act No. 38 of 1999 and the decision of the Minister of Religion No. 581 of 1999 on the implementation of Act No. 38 of 1999 which was amended by Act No. 23 of 2011 concerning the management of zakat. Many factors of causing non-optimal zakat as legislation, mostly related to the system and institutional factors. In this case, should the government as well as amil zakat organization has a strategic role to establish an institutional system of zakat and charity empowerment and support the establishment of the implementation of the charity as a binding regulation. This can occur if the control system of zakat management organization operating effectively, as well as the existence of legislation on the management of zakat either No. 38 of 1999 and No. 23 of 2011. In other words, the optimization of the implementation of zakat is affected by the system and the effective management of zakat management in addition to firmness of government in enforcing the implementation of zakat either written in the legislation and are implementable in order to achieve good governance zakat (alms good governance)

The role and nature of universal health services for pregnant women, children and families in Australia

INTRODUCTION Recent reports indicate that social policy in developed countries has seen positive results in well - child health and safety, child material security, education and socialisation (UNICEF, 2007) . In countries where child health is supported by policy, children have relatively high levels of well - being as measured by material well - being, health and safety, educational well - being, family and peer relationships, behaviours, risks and subjective well - being (UNICEF, 2007) . In Australia, the overall health, development and well - being of children is high on many indicators. Childhood mortality rates have halved over the last two decades, the incidence of vaccin e - preventable diseases has been reduced since the introduction of immunisation (92% of two - year - olds being fully vaccinated in 2004) and the proportion of households with young children in which a household member smoked inside the house has decreased over the past decade (Australian Institute of Health and Welfare, 2005) . However, concerns are emerging related to rapid social change and the associated new morbidities such as increasing levels of behaviou ral, developmental, mental health and social problems. This has resulted in early childhood becoming a priority for Australian government and non - government organizations (Australian Institute of Health a nd Welfare, 2005) . Health indicators also continue to show significant disparities between Indigenous and non - Indigenous children. The Aboriginal and Torres Strait Islander Infant mortality is three times the rate of non - Indigenous Australians and more th an 50 per cent higher than Indigenous children in the USA and New Zealand (National Aboriginal Community Controlled Health Organisation & Oxfam Australia, 2007) , and Indigenous babies are more than twice as likely to be born with low birth weight or premature, wi th a negative impact on their growth and development (Australian medical Association report care series, 2005

Holding momentum : a grounded theory study of strategies for sustaining living at home in older persons

Purpose: Government strategies are putting increasing emphasis on sustaining the capacity of older persons to continue living independently in their own homes to ease strain on aged care services. The aim of this study was to understand the experiences and strategies that older people utilize to remain living at home from their own perspective. Methods: A grounded theory methodology was used to explore the actions and strategies used by persons over the age of 65 to enable them to remain living in their own homes. Data were collected from 21 women and men in three focus group discussions and 10 in-depth semi-structured interviews. Results: The data revealed that the central process participants used to hold momentum and sustain living at home involves a circular process in which older people acknowledge change and make ongoing evaluations and decisions about ageing at home. Conclusion: These findings have implications for informing policy and service provision by identifying appropriate resources and services to promote successful ageing at home

Why do some pregnant women not fully disclose at comprehensive psychosocial assessment with their midwife?

Problem: While comprehensive psychosocial assessment is recommended as part of routine maternity care, unless women engage and disclose, psychosocial risk will not be identified or referred in a timely manner. We need to better understand and where possible overcome the barriers to disclosure if we are to reduce mental health morbidity and complex psychosocial adversity. Aims: To assess pregnant women's attitude to, and reasons for non-disclosure at, comprehensive psychosocial assessment with their midwife. Methods: Data from 1796 pregnant women were analysed using a mixed method approach. After ascertaining women's comfort with, attitude to, and non-disclosure at psychosocial screening, thematic analysis was used to understand the reasons underpinning non-disclosure. Findings: 99% of participants were comfortable with the assessment, however 11.1% (N = 193) reported some level of nondisclosure. Key themes for non-disclosure included (1) Normalising and negative self-perception, (2) Fear of negative perceptions from others, (3) Lack of trust of midwife, (4) Differing expectation of appointment and (5) Mode of assessment and time issues. Discussion: Factors associated with high comfort and disclosure levels in this sample include an experienced and skilled midwifery workforce at the study site and a relatively advantaged and mental health literate sample. Proper implementation of psychosocial assessment policy; setting clear expectations for women and, for more vulnerable women, extending assessment time, modifying mode of assessment, and offering continuity of midwifery care will help build rapport, improve disclosure, and increase the chance of early identification and intervention. Conclusions: This study informs approaches to improving comprehensive psychosocial assessment in the maternity setting

Women’s experiences of transfer from primary maternity unit to tertiary hospital in New Zealand: part of the prospective cohort Evaluating Maternity Units study

BACKGROUND: There is worldwide debate regarding the appropriateness and safety of different birthplaces for well women. The Evaluating Maternity Units (EMU) study’s primary objective was to compare clinical outcomes for well women intending to give birth in either a tertiary level maternity hospital or a freestanding primary level maternity unit. Little is known about how women experience having to change their birthplace plans during the antenatal period or before admission to a primary unit, or transfer following admission. This paper describes and explores women’s experience of these changes-a secondary aim of the EMU study. METHODS: This paper utilised the six week postpartum survey data, from the 174 women from the primary unit cohort affected by birthplace plan change or transfer (response rate 73 %). Data were analysed using descriptive statistics and thematic analysis. The study was undertaken in Christchurch, New Zealand, which has an obstetric-led tertiary maternity hospital and four freestanding midwife-led primary maternity units (2010–2012). The 702 study participants were well, pregnant women booked to give birth in one of these facilities, all of whom received continuity of midwifery care, regardless of their intended or actual birthplace. RESULTS: Of the women who had to change their planned place of birth or transfer the greatest proportion of women rated themselves on a Likert scale as unbothered by the move (38.6 %); 8.8 % were ‘very unhappy’ and 7.6 % ‘very happy’ (quantitative analysis). Four themes were identified, using thematic analysis, from the open ended survey responses of those who experienced transfer: ‘not to plan’, control, communication and ‘my midwife’. An interplay between the themes created a cumulatively positive or negative effect on their experience. Women’s experience of transfer in labour was generally positive, and none expressed stress or trauma with transfer. CONCLUSIONS: The women knew of the potential for change or transfer, although it was not wanted or planned. When they maintained a sense control, experienced effective communication with caregivers, and support and information from their midwife, the transfer did not appear to be experienced negatively. The model of continuity of midwifery care in New Zealand appeared to mitigate the negative aspects of women’s experience of transfer and facilitate positive birth experiences

From coercion to respectful care : women’s interactions with health care providers when planning a VBAC

Background: In many countries caesarean section rates are increasing and this impacts on choices made around mode of birth in subsequent pregnancies. Having a vaginal birth after caesarean (VBAC) can be a safe and empowering experience for women, yet most women have repeat caesareans. High caesarean section rates increase maternal and neonatal morbidity, health costs and burden on hospitals. Women can experience varied support from health care providers when planning a VBAC. The aim of this paper is to explore the nature and impact of the interactions between women planning a VBAC and health care providers from the women’s perspective. Methods: A national Australian VBAC survey was undertaken in 2019. In total 559 women participated and provided 721 open-ended responses to six questions. Content analysis was used to categorise respondents’ answers to the open-ended questions. Results: Two main categories were found capturing the positive and negative interactions women had with health care providers. The first main category, ‘Someone in my corner’, included the sub-categories ‘belief in women birthing’, ‘supported my decisions’ and ‘respectful maternity care’. The negative main category ‘Fighting for my birthing rights’ included the sub-categories ‘the odds were against me’, ‘lack of belief in women giving birth’ and ‘coercion’. Negative interactions included the use of coercive comments such as threats and demeaning language. Positive interactions included showing support for VBAC and demonstrating respectful maternity care. Conclusions: In this study women who planned a VBAC experienced a variety of positive and negative interactions. Individualised care and continuity of care are strategies that support the provision of positive respectful maternity care