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Health Policy and Planning Advance Access originally published online on September 23, 2005
Health Policy and Planning 2005 20(6):385-393; doi:10.1093/heapol/czi046
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© The Author 2005. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved.

Original article

Dilemmas and paradoxes in providing and changing antenatal care: a study of nurses and midwives in rural Zimbabwe

T Mathole1, G Lindmark1 and BM Ahlberg1,2

1 Department of Women's and Children's Health, Section for International Maternal and Child Health, Uppsala University, Sweden and 2 Skaraborg Institute for Research and Development, Skövde, Sweden

Correspondence: Thuba Mathole, Uppsala University, Department of Women and Children's Health, Section for International Maternal and Child Health (IMCH), University Hospital, Entrance 11, SE-751 85 Uppsala, Sweden. Tel: +46 18 611 5872. E-mail: tmathole{at}hotmail.com

This paper describes the experiences of caregivers in a rural district in Zimbabwe, in caring for pregnant women within a context of changing antenatal care routines. Data were generated using individual interviews with 18 nurses and midwives.

The caregivers experienced their working situation as stressful and frustrating due to high staff turnover, inconsistent policies, parallel programmes and limited resources, including time. They also faced difficulties when implementing some of the proposed changes. Furthermore, the caregivers had to deal with the pressure and resistance from the pregnant women, whose reasoning and rationale for using care appeared different from those of the health professionals.

In light of the above, we stress the necessity for reflecting on and including the experiences and perspectives of caregivers and the users of care, as well as their contexts and realities, when implementing change.

Key Words: antenatal care, midwifery, evidence-based care, maternal health, Zimbabwe


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