“He lets me go although he does not go with me.”:Rwandan women’s perceptions of men’s roles in maternal health

Background:Increasing men’s involvement in their pregnant partners’wellness has been reported as one of the ways to improve access to and utilization of maternal health services,including birth preparedness and complication readiness.Men can play meaningful roles in the support systems that pregnant women need to achieve better maternal health outcomes.In Rwanda,the roles that men take vary,resulting in diverse expectations and responsibilities to support the health of women during this critical time.In this study,we aimed to examine the views,perspectives,and experiences of women on men’s involvement in maternal health and how this impacts access and utilization of maternal health services.Methods:We conducted 21 interviews with pregnant and recently-pregnant women to gain an understanding of their views on men’s involvement in facilitating their partners’health during pregnancy.Interviews were conducted across five Rwandan districts in both rural and urban settings of the country.Data analysis was guided by a thematic analysis approach.This started with independent transcript review by the investigators,after which a meeting was held to discuss emergent themes and to identify potential codes.A coding scheme was created and transcripts were coded in NVIVO™software according to conceptual and practical topics that formed an understanding of men’s involvement in maternal care.Results:Three key themes emerged during the analytic process that categorize the specific roles that men play in maternal health:1)facilitating access to maternal health services,which involves assisting women with getting and or attending appointments jointly with men;2)supporting women’s decisions,wherein men can support the decisions women make with regard to their maternal healthcare in a number of ways;and 3)evaluating information,including gathering information from multiple sources,especially from community health workers,to assistwomen with making informed decisions.Conclusion:Rwandan men take on three types of roles in supporting women’s maternal health,and their responsibilities are experienced differently by women.Interventions involving men are encouraged to increase their understanding of the implications of their involvement in maternal health without compromising women’s autonomy in decision-making and to promote positive maternal health outcomes.

What does the development of medical tourism in Barbados hold for health equity?an exploratory qualitative case study

Background:Although the global growth of privatized health care services in the form of medical tourism appears to generate economic benefits,there is debate about medical tourism’s impacts on health equity in countries that receive medical tourists.Studies of the processes of economic globalization in relation to social determinants of health suggest that medical tourism’s impacts on health equity can be both direct and indirect.Barbados,a small Caribbean nation which has universal public health care,private sector health care and a strong tourism industry,is interested in developing an enhanced medical tourism sector.In order to appreciate Barbadians’understanding of how a medical tourism industry might impact health equity.Methods:We conducted 50 individual and small-group interviews in Barbados with stakeholders including government officials,business and health professionals.The interviews were coded and analyzed deductively using the schedule’s questions,and inductively for novel findings,and discussed by the authors.Results:The findings suggest that in spite of Barbados’universal health care and strong population health indicators,there is expressed concern for medical tourism’s impact on health equity.Informants pointed to the direct ways in which the domestic population might access more health care through medical tourism and how privately-provided medical tourism in Barbados could provide health benefits indirectly to the Barbadian populations.At the same time,they cautioned that these benefits may not materialize.For example,the transfer of public resources-health workers,money,infrastructure and equipment-to the private sector to support medical tourism with little to no return to government revenues could result in health inequity through reductions in access to and availability of health care for residents.Conclusions:In clarifying the direct and indirect pathways by which medical tourism can impact health equity,these findings have implications for health system stakeholders and decision-makers in Barbados and other countries attempting both to build a medical tourism industry and to protect health equity.