Navigating with logics: Care for women with hypertensive disorders of pregnancy in a tertiary hospital in Ghana
Date
2021
Journal Title
Journal ISSN
Volume Title
Publisher
Social Science & Medicine
Abstract
This paper explores how care for women with hypertensive disorders of pregnancy (HDP) is practiced in a
tertiary hospital in Ghana. Partly in response to the persistently high maternal and neonatal mortality rates in
Low- and Middle-income countries, efforts to improve quality of maternity care have increased. Quality
improvement initiatives are shaped by the underlying conceptualisation of quality of care, often driven by global
(WHO) standards and protocols. However, there are tensions between global standards of care and local clients’
and providers’ understandings of care practices and quality of care. Implementation of standards is further
complicated by structural and organisational restrictions that influence providers’ possibilities and priorities.
Based on ethnographic fieldwork, we explore how clinical guidelines and professionals’ and patients’ perspectives
converge and, more importantly, diverge. We illuminate local, situated care practices and show how
professionals creatively deal with tensions that arise on the ground. In this middle-income setting, caring for
women with HDP involves tinkering and navigating in contexts of uncertainty, scarcity, varying responsibilities
and conflicting interests. We unravelled a complex web of, at times, contradictory logics, from which various
forms of care arise and in which different notions of good care co-exist. While practitioners navigated through
and with these varying logics of care, the logic of survival permeated all practices. This study provides important
initial insights into how professionals might implement and innovatively adapt the latest quality of maternity
care guidelines which seek to marry clinical standards and patients’ needs, preferences and experiences.
Description
Research Article
Keywords
Quality of care, Maternity care, Hypertensive disorders of pregnancy, Logics in care, Patient-centred care, Ethnography