En Route to Midwifery Professionalisation: Contextualising Midwifery Care in the Indian Public Health System.

Sanjana Santosh
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Abstract

BackgroundThe 'Guidelines on Midwifery Services Initiative, 2018' introduces the Nurse Practitioner in Midwifery (NPM) cadre to improve maternal mortality rates, quality of care, and reduce overmedicalisation in the Indian public health system. The paper examines how the NPM cadre is envisioned in the guidelines, positioned within the medical hierarchy, and aligned within the existing maternal health context. It also looks at how existing midwives and midwifery advocates perceive the changes introduced and the accompanying professionalisation process.MethodologyThe study employed two methods: (a) qualitative document analysis (QDA) of the midwifery guidelines and (b) semi-structured in-depth interviews with 14 nurse-midwifery leaders and advocates.FindingsThe QDA uncovers the underlying themes of task shifting and institutional deliveries as dominant, discussions on professional autonomy and primary health care receiving less importance and even less reflection on the history of midwifery in India. The interview findings highlight (a) tensions around carving out a separate profession, (b) the implications of midwifery at the primary healthcare level and (c) the need for an enabling environment for midwives. This paper reveals how the guidelines frame midwifery as a cost-effective, specialised nursing care within the institutional delivery framework and distanced from its traditional connotations.DiscussionIt elucidates tensions around autonomous midwifery involving professional boundaries, negotiations with medical professionals, institutional perceptions, and historical stereotypes. It builds on the broader literature on 'professions' in sociology by identifying aspects of 'professional boundary work' embedded in policy documents and experiences of participants - thereby unpacking the midwifery professionalisation process in the Indian context.

在通往助产专业化的道路上:印度公共卫生系统中助产护理的情境化。
“2018年助产服务倡议指南”引入了助产护士(NPM)干部,以提高孕产妇死亡率,提高护理质量,并减少印度公共卫生系统中的过度医疗化。本文探讨了指导方针如何设想国家预防机制干部,如何在医疗等级体系中定位,并在现有的孕产妇保健背景下保持一致。它还着眼于现有助产士和助产倡导者如何看待引入的变化和随之而来的专业化进程。方法采用两种方法:(a)助产指南的定性文献分析(QDA)和(b)对14名助产护士领导和倡导者进行半结构化深度访谈。调查结果QDA揭示了任务转移和机构交付占主导地位的基本主题,关于专业自主和初级卫生保健的讨论不那么重要,甚至对印度助产史的反思也更少。访谈结果突出了(a)围绕创建一个单独职业的紧张关系,(b)初级保健一级助产的影响,以及(c)需要为助产士创造有利的环境。本文揭示了指导方针如何将助产作为一种具有成本效益的专业护理,在机构交付框架内,远离其传统内涵。它阐明了围绕自主助产的紧张关系,包括专业界限、与医疗专业人员的谈判、制度观念和历史刻板印象。它通过确定政策文件和参与者经验中嵌入的“专业边界工作”的各个方面,建立在社会学中关于“专业”的更广泛文献的基础上——从而揭示了印度背景下的助产专业化过程。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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CiteScore
2.70
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