Navigating and manipulating childbirth services in Afar, Ethiopia: A qualitative study of cultural safety in the birthing room

• Published in: Social science & medicine (1982) Vol. 331; p. 116073
• Main Authors: 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
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.08.2023; Pergamon
• Subjects: Childbirth; Cultural safety; Delivery, Obstetric; Ethiopia; Female; Health Services Accessibility; Healthcare quality; Humans; Maternal health; Maternal Health Services; Parturition; Pregnancy; Qualitative; Qualitative Research; Ethiopia; Cultural safety; Qualitative; Maternal health; Healthcare quality; Childbirth; Ethiopia
• ISSN: 0277-9536; 1873-5347
• DOI: 10.1016/j.socscimed.2023.116073

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. •Cultural safety is a powerful framework to interpret and contextualize minority women's experiences in birth.•Afari women are treated as ‘others’ in their health system.•Afari women manipulate their care to enhance their own safety during childbirth.•Health systems, and their providers, must adopt cultural safety to ensure health quality.