Understanding Afghan healthcare providers: a qualitative study of the culture of care in a Kabul maternity hospital

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Excellent PhD study by Rachel Arnold, comprising a qualitative study of maternity care in one of the main Kabul hospitals. The study reported that kindness and care was the exception and that for many women the birthing process was dehumanised. Suboptimal care put the lives of women and babies at risk and was, in part, the result of conflicting priorities. The underlying motivation of staff appeared to be their own personal survival in a hostile, punitive work environment and the socio-economic survival of their families. The hospital culture closely mirrored the culture and core values of Afghan society. In setting priorities for women's health post-2015 Millennium Development Goals, understanding the context-specific pressures on staff is key to more effective programme interventions and sustainability. A major recommendation of the study was the need to address the hospital culture that dehumanised not only women in childbirth but also the staff who worked there. A humanising childbirth approach was one suggestion, its strength being that it would not introduce another power dynamic but rather promote the dignity and value of all. The primary responsibility for standards of care in Kabul maternity hospitals lies with the Ministry of Public Health and senior hospital management

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