Contents
List of Acronyms and Abbreviations
Glossary of Acholi (Luo) Words
Acknowledgements
Chapter One: Introduction to A Crisis in Maternal Health
Introduction
Contexts of Care
Background on the Millennium Development Goals (MDGs)
Skilled birth attendants (SBAs) and traditional birth attendants (TBAs)
Policy and social contexts for maternity care and childbirth
The post-conflict setting
Methodology and Methods
Key Institutional Ethnography definitions: Institutions, participants, and work
Data collection
Positioning myself as researcher
Theorizing methods
Outline
Chapter Two: Ongoing Social Distress: Care-seeking in a Remote Post-Conflict Context
Introduction
Overview of the Conflict in Northern Uganda
Ongoing Social and Economic Impacts of the War
Abduction, health and community membership
The internally displaced persons (IDP) camps
Ongoing Social Distress: Land Conflicts and Disease Epidemics
The outbreak of disease
Agriculture
Land disputes
Poverty and lack of infrastructure
Impacts on study participants
Conclusion
Map of Uganda
Chapter Three: Pregnancy and Daily Life: Health System and Home Factors Shaping Care
Introduction
Focused (Goal-Oriented) Antenatal Care (ANC)
The Message to Attend ANC
The Provision of Mama Kits
Formal Health Care Providers
The setting for formal health care provision
Clinical officers
Midwives
Enrolled comprehensive nurses, registered nurses, nursing assistants, and nurse aides
Informal Health Care Providers
Traditional birth attendants (TBAs)
The village health team (VHT)
Transportation, Nutrition, and Work
Transportation
Lack of capacity to provide care at sub-county health centres
Nutrition and work
Chapter Four: Charity and Control: When Help Requires Compliance
Introduction
A Reward for Care or a Gift to the Vulnerable? Divergent Ideas the Mama Kit’s Role
The mama kit as creating and rewarding compliance with ANC
The mama kits as an incentive or reward for health centre delivery
The mama kits as supporting and signaling ‘vulnerable’ women
The mama kits as a gift or charity
Registration and Distribution of Mama Kits
Health Centre Staff and Administrators on the Mama Kits’ Role: Helping the Vulnerable, or Motivating Care-seeking?
“In our setting, who is the most poor?” Perceptions of vulnerability as a distribution criteria
Health centre staff on the mama kit: ‘Motivating’ women to deliver at a health facility
The Goals of the Uganda Red Cross
NGO - Health Centre Partnerships: Problems with Withdrawal and Shortages
Unpredictable Distribution Affects how Women Perceive Formal Care and Health Workers
Conclusion
Chapter Five: Vertical Health: Failures of Compulsory Couples HIV Testing
Introduction
Background: Prevalence, Policies, and Practice
Women’s experiences of male reluctance
Health Worker Perspectives on Couples HIV Testing During ANC
Health Worker Strategies for Couples Testing in the Face of Male Reluctance
“Without a Man We are Not Going to Give you a Card”: Male Refusal as a Barrier to Women’s Care
Gender, Couples Testing, and Vertical Health
Gender and Intersectional Power Relationships
Conclusion
Chapter Six: Conclusions: Reconceiving the Maternal Health Crisis
Introduction
Global goals, Local lives
Discourses governing care: Choice, tradition and culture
Limitations
Conclusion
References
