Navigating and Manipulating Childbirth Services in Afar, Ethiopia: A Qualitative Study of Cultural Safety in the Birthing Room

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Citation

Hagaman, Ashley; Gonzalez Rodriguez, Humberto; Egger, Emilie; Bitewulign, Befikadu; Case, Haley; Alemayehu, Abiyou Kiflie; Rhodes, Elizabeth C.; Estifanos, Abiy Seifu; Singh, Kavita; & Woldesenbet Keraga, Dorka, et al. (2023). Navigating and Manipulating Childbirth Services in Afar, Ethiopia: A Qualitative Study of Cultural Safety in the Birthing Room. Social Science & Medicine, 331, 116073. PMCID: PMC10410251

Abstract

Access to maternal health services has increased in Ethiopia during the past decades. However, increasing the demand for government birthing facility use remains challenging. In Ethiopia's Afar Region, these challenges are amplified given the poorly developed infrastructure, pastoral nature of communities, distinct cultural traditions, and the more nascent health system. This paper features semi-structured interviews with 22 women who were purposively sampled to explore their experiences giving birth in government health facilities in Afar. We used thematic analysis informed by a cultural safety framework to interpret findings. Our findings highlight how women understand, wield, and relinquish power and agency in the delivery room in government health facilities in Afar, Ethiopia. We found that Afari women are treated as 'others', that they manipulate their care as they negotiate 'cultural safety' in the health system, and that they use trust as a pathway towards more cultural safety. As the cultural safety framework calls for recognizing and navigating the diverse and fluid power dynamics of healthcare settings, the onus of negotiating power dynamics cannot be placed on Afari women, who are already multiply marginalized due to their ethnicity and gender. Health systems must adopt cultural safety in order to ensure health quality. Providers, particularly in regions with rich cultural diversity, must be trained in the cultural safety framework in order to be aware of and challenge the multidimensional power dynamics present in health encounters.

URL

http://dx.doi.org/10.1016/j.socscimed.2023.116073

Reference Type

Journal Article

Year Published

2023

Journal Title

Social Science & Medicine

Author(s)

Hagaman, Ashley
Gonzalez Rodriguez, Humberto
Egger, Emilie
Bitewulign, Befikadu
Case, Haley
Alemayehu, Abiyou Kiflie
Rhodes, Elizabeth C.
Estifanos, Abiy Seifu
Singh, Kavita
Woldesenbet Keraga, Dorka
Zahid, Mahrukh
Magge, Hema
Barrington, Clare

Article Type

Regular

PMCID

PMC10410251

Continent/Country

Ethiopia

Sex/Gender

Women

ORCiD

Hagaman - 0000-0002-8016-1036
Barrington - 0000-0001-7802-4051
Singh, K - 0000-0001-8670-2262