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Article ; Online: A critical interpretive synthesis of power and mistreatment of women in maternity care.

Schaaf, Marta / Jaffe, Maayan / Tunçalp, Özge / Freedman, Lynn

PLOS global public health

2023 Volume 3, Issue 1, Page(s) e0000616

Abstract: Labouring women may be subjected to physical and verbal abuse that reflects dynamics of power, described as Mistreatment of Women (MoW). This Critical Interpretive Synthesis on power and MoW consolidates current research and advances theory and practice ... ...

Abstract	Labouring women may be subjected to physical and verbal abuse that reflects dynamics of power, described as Mistreatment of Women (MoW). This Critical Interpretive Synthesis on power and MoW consolidates current research and advances theory and practice through inter-disciplinary literature exploration. The review was undertaken in 3 phases. Phase 1 consisted of topic scoping; phase 2 entailed exploration of key power-related drivers emerging from the topic scoping; and phase 3 entailed data synthesis and analysis, with a particular focus on interventions. We identified 63 papers for inclusion in Phase 1. These papers utilized a variety of methods and approaches and represented a wide range of geographic regions. The power-related drivers of mistreatment in these articles span multiple levels of the social ecological model, including intrapersonal (e.g. lack of knowledge about one's rights), interpersonal (e.g. patient-provider hierarchy), community (e.g. widespread discrimination against indigenous women), organizational (e.g. pressure to achieve performance goals), and law/policy (e.g. lack of accountability for rights violations). Most papers addressed more than one level of the social-ecological model, though a significant minority were focused just on interpersonal factors. During Phase 1, we identified priority themes relating to under-explored power-related drivers of MoW for exploration in Phase 2, including lack of conscientization and normalization of MoW; perceptions of fitness for motherhood; geopolitical and ethnopolitical projects related to fertility; and pressure to achieve quantifiable performance goals. We ultimately included 104 papers in Phase 2. The wide-ranging findings from Phase 3 (synthesis and analysis) coalesce in several key meta-themes, each with their own evidence-base for action. Consistent with the notion that research on power can point us to "drivers of the drivers," the paper includes some intervention-relevant insights for further exploration, including as relating to broader social norms, health systems design, and the utility of multi-level strategies.
Language	English
Publishing date	2023-01-30
Publishing country	United States
Document type	Journal Article ; Review
ISSN	2767-3375
ISSN (online)	2767-3375
DOI	10.1371/journal.pgph.0000616
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Necessary but not sufficient: a scoping review of legal accountability for sexual and reproductive health in low-income and middle-income countries.

Schaaf, Marta / Khosla, Rajat

BMJ global health

2021 Volume 6, Issue 7

Abstract: Background: This paper is a scoping review of the impact of legal accountability efforts for sexual and reproductive health and rights (SRHR), exploring the links between legal accountability strategies and changes in the desired SRHR outcomes.: ... ...

Abstract	Background: This paper is a scoping review of the impact of legal accountability efforts for sexual and reproductive health and rights (SRHR), exploring the links between legal accountability strategies and changes in the desired SRHR outcomes. Methods: We defined legal accountability as use of the judicial system following state failure to respect, protect or fulfil SRHR as enshrined in national law, as well as individuals' or the state's use of criminal law mechanisms to prevent unwanted behaviour and to provide remedy. We undertook a keyword search in PubMed, Scopus and LexisNexis and then consulted a group of experts to provide guidance regarding further peer-reviewed and grey literature, yielding a total of 191 articles. Results: The majority of the empirical, peer-reviewed articles identified were regarding abortion law and abortion care availability, followed by violence against women. Most of these articles explore the gaps between law and practice. We identified seven key factors that shape the efficacy of legal accountability efforts, including the ways a law or court decision is formulated, access to courts, the (dis)advantages of criminal law in the given context, cultural norms, politics, state capacity and resources and the potential for further litigation. Many articles explained that use of the judiciary may be necessary to effect change and that the act of claiming rights can empower, but that legal avenues for change can be imperfect tools for justice. Conclusions: Legal accountability can be effective as part of a broader, long-term strategy, with due attention to context.
MeSH term(s)	Developing Countries ; Female ; Humans ; Politics ; Poverty ; Pregnancy ; Reproductive Health ; Social Responsibility
Language	English
Publishing date	2021-07-28
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ISSN	2059-7908
ISSN	2059-7908
DOI	10.1136/bmjgh-2021-006033
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: A critical interpretive synthesis of power and mistreatment of women in maternity care.

Marta Schaaf / Maayan Jaffe / Özge Tunçalp / Lynn Freedman

PLOS Global Public Health, Vol 3, Iss 1, p e

2023 Volume 0000616

Abstract	Labouring women may be subjected to physical and verbal abuse that reflects dynamics of power, described as Mistreatment of Women (MoW). This Critical Interpretive Synthesis on power and MoW consolidates current research and advances theory and practice through inter-disciplinary literature exploration. The review was undertaken in 3 phases. Phase 1 consisted of topic scoping; phase 2 entailed exploration of key power-related drivers emerging from the topic scoping; and phase 3 entailed data synthesis and analysis, with a particular focus on interventions. We identified 63 papers for inclusion in Phase 1. These papers utilized a variety of methods and approaches and represented a wide range of geographic regions. The power-related drivers of mistreatment in these articles span multiple levels of the social ecological model, including intrapersonal (e.g. lack of knowledge about one's rights), interpersonal (e.g. patient-provider hierarchy), community (e.g. widespread discrimination against indigenous women), organizational (e.g. pressure to achieve performance goals), and law/policy (e.g. lack of accountability for rights violations). Most papers addressed more than one level of the social-ecological model, though a significant minority were focused just on interpersonal factors. During Phase 1, we identified priority themes relating to under-explored power-related drivers of MoW for exploration in Phase 2, including lack of conscientization and normalization of MoW; perceptions of fitness for motherhood; geopolitical and ethnopolitical projects related to fertility; and pressure to achieve quantifiable performance goals. We ultimately included 104 papers in Phase 2. The wide-ranging findings from Phase 3 (synthesis and analysis) coalesce in several key meta-themes, each with their own evidence-base for action. Consistent with the notion that research on power can point us to "drivers of the drivers," the paper includes some intervention-relevant insights for further exploration, including as relating to broader ...
Keywords	Public aspects of medicine ; RA1-1270
Subject code	360
Language	English
Publishing date	2023-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: The use of legal empowerment to improve access to quality health services: a scoping review.

Joshi, Anuradha / Schaaf, Marta / Zayed, Dina

International journal for equity in health

2022 Volume 21, Issue 1, Page(s) 136

Abstract: This paper presents the results of a scoping review that examines the extent to which legal empowerment has been used as a strategy in efforts to improve access to quality health services in low- and middle-income countries. The review identifies lessons ...

Abstract	This paper presents the results of a scoping review that examines the extent to which legal empowerment has been used as a strategy in efforts to improve access to quality health services in low- and middle-income countries. The review identifies lessons learned regarding legal empowerment program strategy, as well as impact on health empowerment and health outcomes, research gaps, areas of consensus and tension in the field.The review included three main sources of data: 1) peer-reviewed literature, 2) grey literature, and 3) interviews with key legal empowerment stakeholders. Peer-reviewed and grey literature were identified via keyword searches, and interviewees were identified by searching an organizational database and snowball sampling.The key findings were: first, there is very limited documentation on the use of legal empowerment strategies for improving health services. Second, the legal empowerment approach tends to be focussed on issues that communities themselves prioritize, often narrowly defined local challenges. However, legal empowerment as a strategy that pursues collective and individual remedies has the potential to contribute to structural change. Third, for this potential to be realised, legal empowerment entails building capacity of service providers and other duty bearers on health and related rights. Finally, the review also highlights the importance of trust-trust in state institutions, trust in the paralegals who support the process and trust in the channels of engagement with public authorities for grievance redress.Several gaps also became evident through the review, including lack of work on private health providers, lack of discussion of the 'empowerment' effects of legal empowerment programs, and limited exploration of risk and sustainability. The paper concludes with a caution that practitioners need to start with the health challenges they are trying to address, and then assess whether legal empowerment is an appropriate approach, rather than seeing it as a silver bullet.
MeSH term(s)	Health Services ; Health Services Accessibility ; Humans
Language	English
Publishing date	2022-09-16
Publishing country	England
Document type	Journal Article ; Review ; Research Support, Non-U.S. Gov't
ZDB-ID	2092056-8
ISSN	1475-9276 ; 1475-9276
ISSN (online)	1475-9276
ISSN	1475-9276
DOI	10.1186/s12939-022-01731-3
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: A narrative review of challenges related to healthcare worker rights, roles and responsibilities in the provision of sexual and reproductive services in health facilities.

Schaaf, Marta / Lavelanet, Antonella / Codjia, Laurence / Nihlén, Åsa / Rehnstrom Loi, Ulrika

BMJ global health

2023 Volume 8, Issue Suppl 4

Abstract: Introduction: This paper identifies and summarises tensions and challenges related to healthcare worker rights and responsibilities and describes how they affect healthcare worker roles in the provision of sexual and reproductive health (SRH) care in ... ...

Abstract	Introduction: This paper identifies and summarises tensions and challenges related to healthcare worker rights and responsibilities and describes how they affect healthcare worker roles in the provision of sexual and reproductive health (SRH) care in health facilities. Method: The review was undertaken in a two-phase process, namely: (1) development of a list of core constructs and concepts relating to healthcare worker rights, roles and responsibilities to guide the review and (2) literature review. Result: A total of 110 papers addressing a variety of SRH areas and geographical locations met our inclusion criteria. These papers addressed challenges to healthcare worker rights, roles and responsibilities, including conflicting laws, policies and guidelines; pressure to achieve coverage and quality; violations of the rights and professionalism of healthcare workers, undercutting their ability and motivation to fulfil their responsibilities; inadequate stewardship of the private sector; competing paradigms for decision-making-such as religious beliefs-that are inconsistent with professional responsibilities; donor conditionalities and fragmentation; and, the persistence of embedded practical norms that are at odds with healthcare worker rights and responsibilities. The tensions lead to a host of undesirable outcomes, ranging from professional frustration to the provision of a narrower range of services or of poor-quality services. Conclusion: Social mores relating to gender and sexuality and other contested domains that relate to social norms, provider religious identity and other deeply held beliefs complicate the terrain for SRH in particular. Despite the particularities of SRH, a whole of systems response may be best suited to address embedded challenges.
MeSH term(s)	Humans ; Reproductive Health Services ; Sexual Behavior ; Reproductive Health ; Health Facilities ; Health Personnel
Language	English
Publishing date	2023-11-02
Publishing country	England
Document type	Review ; Journal Article ; Research Support, Non-U.S. Gov't
ISSN	2059-7908
ISSN	2059-7908
DOI	10.1136/bmjgh-2023-012421
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: A narrative review of challenges related to healthcare worker rights, roles and responsibilities in the provision of sexual and reproductive services in health facilities

Marta Schaaf / Antonella Lavelanet / Åsa Nihlén / Ulrika Rehnstrom Loi / Laurence Codjia

BMJ Global Health, Vol 8, Iss Suppl

2023 Volume 4

Keywords	Medicine (General) ; R5-920 ; Infectious and parasitic diseases ; RC109-216
Language	English
Publishing date	2023-11-01T00:00:00Z
Publisher	BMJ Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: A critical interpretive synthesis of informal payments in maternal health care.

Schaaf, Marta / Topp, Stephanie M

Health policy and planning

2019 Volume 34, Issue 3, Page(s) 216–229

Abstract: Informal payments for healthcare are widely acknowledged as undercutting health care access, but empirical research is somewhat limited. This article is a critical interpretive synthesis that summarizes the evidence base on the drivers and impact of ... ...

Abstract	Informal payments for healthcare are widely acknowledged as undercutting health care access, but empirical research is somewhat limited. This article is a critical interpretive synthesis that summarizes the evidence base on the drivers and impact of informal payments in maternal health care and critically interrogates the paradigms that are used to describe informal payments. Studies and conceptual articles identified both proximate and systems drivers of informal payments. These include norms of gift giving, health workforce scarcity, inadequate health systems financing, the extent of formal user fees, structural adjustment and the marketization of health care, and patient willingness to pay for better care. Similarly, there are proximal and distal impacts, including on household finances, patient satisfaction and provider morale. Informal payments have been studied and addressed from a variety of different perspectives, including anti-corruption, ethnographic and other in-depth qualitative approaches and econometric modelling. Summarizing and discussing the advantages and disadvantages of these and other paradigms illustrates the value of an inter-disciplinary approach. The same tacit, hidden attributes that make informal payments hard to measure also make them hard to discuss and address. A multidisciplinary health systems approach that leverages and integrates positivist, interpretivist and constructivist tools of social science research can lead to better insight. With this, we can challenge 'master narratives' and meet universalistic, equity-oriented global health objectives.
MeSH term(s)	Delivery of Health Care/economics ; Female ; Financing, Personal/statistics & numerical data ; Health Expenditures/statistics & numerical data ; Health Personnel/economics ; Health Personnel/psychology ; Humans ; Maternal Health Services/economics ; Patient Satisfaction ; Pregnancy
Language	English
Publishing date	2019-03-22
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	632896-9
ISSN	1460-2237 ; 0268-1080
ISSN (online)	1460-2237
ISSN	0268-1080
DOI	10.1093/heapol/czz003
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: "Our fear is finished," but nothing changes: efforts of marginalized women to foment state accountability for maternal health care in a context of low state capacity.

Schaaf, Marta / Dasgupta, Jashodhara

BMC public health

2019 Volume 19, Issue 1, Page(s) 732

Abstract: Background: Women in India are often asked to make informal payments for maternal health care services that the government has mandated to be free. This paper is a descriptive case study of a social accountability project undertaken by SAHAYOG, a ... ...

Abstract	Background: Women in India are often asked to make informal payments for maternal health care services that the government has mandated to be free. This paper is a descriptive case study of a social accountability project undertaken by SAHAYOG, a nongovernmental organization in Uttar Pradesh, India. SAHAYOG worked with community-based organizations and a grassroots forum comprised of low caste, Muslim, and tribal women to decrease the prevalence of health provider demands that women and their families make informal payments. Methods: The study entailed document review; interviews and focus group discussions with program implementers, governmental stakeholders, and community activists; and participant observation in health facilities. Results: The study found that SAHAYOG adapted their strategy over time to engender greater empowerment and satisfaction among program participants, as well as greater impact on the health system. Participants gained knowledge resources and agency; they learned about their entitlements, had access to mechanisms for complaints, and, despite risk of retaliation, many felt capable of demanding their rights in a variety of fora. However, only program participants seemed successfully able to avoid making informal payments to the health sector; health providers still demanded that other women make payments. Several features of the micro and macro context shaped the trajectory of SAHAYOG's efforts, including deeply rooted caste dynamics, low provider commitment to ending informal payments, the embeddedness of informal payments, human resources scarcity, and the overlapping private interests of pharmaceutical companies and providers. Conclusion: Though changes were manifest in certain fora, providers have not necessarily embraced the notion of low caste, tribal, or Muslim women as citizens with entitlements, especially in the context of free government services for childbirth. Grassroots advocates, CBOs, and SAHAYOG assumed a supremely difficult task. Project strategy changes may have made the task somewhat less difficult, but given the population making the rights claims and the rights they were claiming, widespread changes in demands for informal payments may require a much larger and stronger coalition.
MeSH term(s)	Adult ; Fear ; Female ; Focus Groups ; Health Expenditures/legislation & jurisprudence ; Health Expenditures/statistics & numerical data ; Humans ; India ; Islam/psychology ; Maternal Health Services/economics ; Organizations ; Parturition/psychology ; Population Groups/psychology ; Poverty/economics ; Poverty/psychology ; Pregnancy ; Social Class ; Social Marginalization/psychology ; Social Responsibility
Language	English
Publishing date	2019-06-11
Publishing country	England
Document type	Journal Article
ISSN	1471-2458
ISSN (online)	1471-2458
DOI	10.1186/s12889-019-7028-2
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: “Our fear is finished,” but nothing changes

Marta Schaaf / Jashodhara Dasgupta

BMC Public Health, Vol 19, Iss 1, Pp 1-

efforts of marginalized women to foment state accountability for maternal health care in a context of low state capacity

2019 Volume 15

Abstract: Abstract Background Women in India are often asked to make informal payments for maternal health care services that the government has mandated to be free. This paper is a descriptive case study of a social accountability project undertaken by SAHAYOG, a ...

Abstract	Abstract Background Women in India are often asked to make informal payments for maternal health care services that the government has mandated to be free. This paper is a descriptive case study of a social accountability project undertaken by SAHAYOG, a nongovernmental organization in Uttar Pradesh, India. SAHAYOG worked with community-based organizations and a grassroots forum comprised of low caste, Muslim, and tribal women to decrease the prevalence of health provider demands that women and their families make informal payments. Methods The study entailed document review; interviews and focus group discussions with program implementers, governmental stakeholders, and community activists; and participant observation in health facilities. Results The study found that SAHAYOG adapted their strategy over time to engender greater empowerment and satisfaction among program participants, as well as greater impact on the health system. Participants gained knowledge resources and agency; they learned about their entitlements, had access to mechanisms for complaints, and, despite risk of retaliation, many felt capable of demanding their rights in a variety of fora. However, only program participants seemed successfully able to avoid making informal payments to the health sector; health providers still demanded that other women make payments. Several features of the micro and macro context shaped the trajectory of SAHAYOG’s efforts, including deeply rooted caste dynamics, low provider commitment to ending informal payments, the embeddedness of informal payments, human resources scarcity, and the overlapping private interests of pharmaceutical companies and providers. Conclusion Though changes were manifest in certain fora, providers have not necessarily embraced the notion of low caste, tribal, or Muslim women as citizens with entitlements, especially in the context of free government services for childbirth. Grassroots advocates, CBOs, and SAHAYOG assumed a supremely difficult task. Project strategy changes may have ...
Keywords	Social accountability ; Collective action ; Corruption ; Global health ; India ; Gender ; Public aspects of medicine ; RA1-1270
Subject code	300
Language	English
Publishing date	2019-06-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: A summative content analysis of how programmes to improve the right to sexual and reproductive health address power.

Schaaf, Marta / Boydell, Victoria / Topp, Stephanie M / Iyer, Aditi / Sen, Gita / Askew, Ian

BMJ global health

2022 Volume 7, Issue 4

Abstract: Introduction: Power shapes all aspects of global health. The concept of power is not only useful in understanding the current situation, but it is also regularly mobilised in programmatic efforts that seek to change power relations. This paper uses ... ...

Abstract	Introduction: Power shapes all aspects of global health. The concept of power is not only useful in understanding the current situation, but it is also regularly mobilised in programmatic efforts that seek to change power relations. This paper uses summative content analysis to describe how sexual and reproductive health (SRH) programmes in low-income and middle-income countries explicitly and implicitly aim to alter relations of power. Methods: Content analysis is a qualitative approach to analysing textual data; in our analysis, peer-reviewed articles that describe programmes aiming to alter power relations to improve SRH constituted the data. We searched three databases, ultimately including 108 articles. We extracted the articles into a spreadsheet that included basic details about the paper and the programme, including what level of the social ecological model programme activities addressed. Results: The programmes reviewed reflect a diversity of priorities and approaches to addressing power, though most papers were largely based in a biomedical framework. Most programmes intervened at multiple levels simultaneously; some of these were 'structural' programmes that explicitly aimed to shift power relations, others addressed multiple levels using a more typical programme theory that sought to change individual behaviours and proximate drivers. This prevailing focus on proximate behaviours is somewhat mismatched with the broader literature on the power-related drivers of SRH health inequities, which explores the role of embedded norms and structures. Conclusion: This paper adds value by summarising what the academic public health community has chosen to test and research in terms of power relations and SRH, and by raising questions about how this corresponds to the significant task of effecting change in power relations to improve the right to SRH.
MeSH term(s)	Global Health ; Humans ; Reproductive Health ; Sexual Health
Language	English
Publishing date	2022-04-20
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	2059-7908
ISSN	2059-7908
DOI	10.1136/bmjgh-2022-008438
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