Transcript Toward a Model of Health Care Empowerment

‫زیبا تقی زاده‬
‫‪ PhD‬بهداشت باروری‬
‫معاون پژوهشی دانشکده پرستاری و مامایی دانشگاه علوم‬
‫پزشکی تهران‬
‫معاون مرکز تحقیقات پرستاری و مامایی دانشگاه علوم‬
‫پزشکی تهران‬
‫‪[email protected]‬‬
‫‪2‬‬
3
History Empowerment of Women
Historically, the women’s right to vote was first
seriously proposed in the United States in 1848 .
Before the 19th century women were mostly
limited to housework and factory work. Women
were not allowed to be lawyers, doctors,
scientists … and other professions, except for
writing or teaching.
When World War II happened, men went to war
while women were called to work to replace the
men’s positions.
"Empowerment of Women" Dr. Kathleen Peoples
2013. American Center in Ho Chi Minh City (HCMC).
Empowerment of Women is a very long story that
eventually led to women becoming empowered in the
United States and that gained their right to vote.
Like other places in the world, women’s empowerment
did not happen naturally.
 To gain empowerment required a large amount of
effort, time, and change regarding socioeconomic and
political aspects in order to achieve the level of power.
The general concept of empowerment is a
multi-dimensional social process that helps people,
especially, to gain more control, participate and take
part in decision-making.
National Review on
Women's Status in the Islamic Republic of Iran
(Beijing+20)
• Preparation of the National Report on
Beijing+20 is a precious opportunity to both
illustrate the achievements in the Iranian
women's and girls' empowerment and
review the challenges.
National Review on
Women's Status in the Islamic Republic of Iran
(Beijing+20)
Education
Increase in girls' literacy rate:
• This index that was 94.27% in primary education
in 2009-2010 school year, reached 94.46% in
2011.
• This rate for the secondary school was increased
from 90.22% to 90.88%.
• Increase in girls' higher education rate: The rate
of female university students to males has
increased to 97.6% in 2011.
National Review on
Women's Status in the Islamic Republic of Iran
(Beijing+20)
Health
• Improvement in women's life expectancy: This
indicator has increased from 63 years in 1991 to more
than 74 years in 2012.
• Reducing maternal death: The Islamic Republic of Iran
has been able to reduce maternal mortality ratio
(caused due to complications of pregnancy and child
birth) by 75%. This indicator has improved from 91
deaths (per 100,000 live births) in 1988 to about 20
deaths (per 100,000 live births) in 2012.
National Review on
Women's Status in the Islamic Republic of Iran
(Beijing+20)
Women's political participation
• Increased women's participation as voters and candidates:
The percentage of women's seats in the Islamic
Consultative Assembly shows an increase of 350% in the
interval between the first to the eighth parliamentary
elections, while the female candidacy rate for the
parliament indicates a 355% increase during the same
period, namely it has risen up from 1.8 percent to 8.2.
• Awareness-raising of women on their right to political
participation through public training and media as well as
their political empowerment.
Doan Thi Ngoc
Empowerment has been used in many disciplines,
the onset of Social Work, Community Development,
Gender and Development, Psychology, Education,
Economics, Health, etc.
Empowerment is the process of building awareness
and the ability to participate, make decisions, and to
obtain more control in order to make changes in
one’s life, one’s community, one’s society, and the
universe.
Women's Empowerment,
Naila Kabeer.
IDS Bulletin. Vol 41, 6, p: 105–113, 2010
Theory of Change in
Women's Empowerment
 It suggests that attention needs to be given to
strengthening women's capacity for voice and
action at different stages of the planning cycle.
In particular, there are certain ‘critical moments’ in
the life of any intervention when the ideas, values
and knowledge of key decision-making actors
have a deep impact on how the intervention plays
out in practice.
SARAH MOSEDALE. ASSESSING WOMEN’S EMPOWERMENT:
TOWARDS A CONCEPTUAL FRAMEWORK. Manchester University, UK. J. Int.
Dev. 17, 243–257 (2005).
4 Aspects on Women’s Empowerment
1. To be empowered one must have been
disempowered.
2. Empowerment cannot be bestowed by a third one.
3. Empowerment usually include a sense of people
making decisions on matters which are important in
their lives and being able to carry them out.
4. Empowerment is an ongoing process rather than a
product. There is no final goal.
Samantha Lynne Roux
Dissertation Magister Scientiae in Clinical Psychology
School of Psycho-Social Behavioral Sciences. 2010
Pregnancy is an important life experience in a
woman's psychosocial and psychological
development.
 Childbirth is viewed as a journey, shared between
mother and baby.
The memory and experience of it, vivid and intense,
will stay with a woman throughout her life.
Empowering Women in Childbirth
Rebirth of Birth
Empowered For Birth
Canberra Doula Service 2007-2013
It's important for women to feel empowered; first as
a woman, then as a birthing woman, and finally as a
mother.
Women should never be made to feel that a choice
has been made for them.
 9 months is a good portion of time to really prepare.
Empowerment in Birth
Thoughts from a Midwife
on International Women’s Day 2013
How does Empowering women in Birth?
 “Empowering women to have the birth they want”.
“Empowering women through choice”.
 “Empowering women to make informed decisions” .
We cannot make promises that if women do it “our”
way using our knowledge they will have the birth they
want.
Preparing Women for Birth
We cannot supply women with a list of things they
must gather, learn or achieve to have the birth they
want. Because, for every woman it is different.
Every support person, relationship and family is
different.
 Every birth attendant, midwife, doctor, hospital room,
protocol, policy, culture is different.
 Every woman’s birth story is different.
Empowerment in birth is not determined by an
outsider or an onlooker.
Shared decision-making and evidence-based practice
in childbirth. Maureen Corry, MPH,2013
The first decision a woman should be able to make
with regard to her labor and birth preferences is
choosing her practitioner.
Beyond the choice, birthing women make many other
decisions along the way about their birth preferences
– location, comfort measures, support people,
medications, etc.
Effectively system is where women make decisions
with the help of practitioners who provide them with
the evidence-based information they need to do.
Birth of a Mother: Empowered Birth,
Empowered Motherhood
Tracy McDaniel 2012
 Reproductive choice is often considered synonymous
with contraception and abortion rights, but reproductive
choice does not end when a woman chooses not to
terminate her pregnancy.
 A woman’s reproductive journey continues throughout
gestation, birth and the post-partum period.
It is a journey that can be either empowering or
victimizing.
Reproductive Rights
Empowerment isn’t about getting the “ideal” birth.
 It is about mothers knowing that they worked hard,
were well supported, and made good informed
decisions for themselves and their babies.
It is about knowing that they are strong, knowledgeable
, and capable of anything.
How To Have An Empowered Pregnancy
Megan Davidson, Ph.D. on Jan 04, 2012 with
To be empowered is to have the knowledge needed
to make choices,
The power and authority to have those choices
respected,
And the confidence in your own capacities to realize
your desires.
Am J Public Health. 2011 February; 101(2).
Toward a Model of Health Care Empowerment
Mallory O. Johnson,
The construct of health care empowerment is
defined as the process and state of being engaged,
informed, collaborative, committed, and tolerant of
uncertainty regarding health care.
A model in which health care empowerment is
influenced by an interplay of cultural, social, and
environmental factors; personal resources; and
intrapersonal factors.
Am J Public Health. 2011 February; 101(2): 265–270.
Toward a Model of Health Care Empowerment
Mallory O. Johnson,
The model offers a framework to understand patient
and provider roles in facilitating health care
empowerment and presents opportunities for
investigation into the role of health care
empowerment in multiple outcomes across
populations and settings, including inquiries into the
sources and consequences of health disparities.
A vital interaction between the role of the patient
and the provider in the process and state of
health care empowerment.
• There is a wide range of factors that influence provider
behavior in medical encounters.
• To move toward greater health care empowerment,
the provider must acknowledge, foster, and respect
the patient's autonomy and value to the collaborative
process while maintaining a role as an expert.
• Likewise, patients must be able to accurately gauge the
credibility and expertise of their providers, knowing
when to trust and when to challenge their health care
partners or seek outside consultation.
Midwifery. Volume 27, Issue 6 , Pages 811-816, December 2011.
Empowerment in the midwifery context a concept analysis.
Hermansson, Mårtensson,
A concept analysis according to the hybrid model.
• The following tentative criteria and attributes of
empowerment in the midwifery context are
described:
Developing a trustful relationship; starting an
awareness process, making it possible to reflect on
the changing situation; acting based on the
parents' situation, getting them involved and able
to make informed choices.