Impact of climate change on maternal health outcomes: An evidence gap map review.

Climate change poses unique challenges to maternal well-being and increases complications during pregnancy and childbirth globally. This evidence gap map (EGM) aims to identify gaps in existing knowledge and areas where further research related to climate change and its impact on maternal health is required. The following databases were searched individually from inception to present: Medline, EMBASE, and Global Health via OVID; Cumulative Index to Nursing and Allied Health Literature (CINAHL) via EBSCOhost; Scopus; and organizational websites. In this EGM, we integrated 133 studies published in English, including qualitative, quantitative, reviews and grey literature that examined the impact of climate change on maternal health (women aged 15-45). We used Covidence to screen studies and Evidence for Policy and Practice Information (Eppi reviewer)/Eppi Mapper software to generate the EGM. Data extraction and qualitative appraisal of the studies was done using critical appraisal tools. The study protocol was registered in International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY) # INPLASY202370085. Out of 133 included studies, forty seven studies were of high quality, seventy nine moderate equality and seven low quality. This EGM found notable gaps in the literature regarding the distribution of research across regions. We found significant research in North America (51) and Asia (40 studies). However, Africa and the Caribbean had fewer studies, highlighting potential disparities in research attention and resources. Moreover, while the impact of extreme heat emerged as a prominent factor impacting maternal well-being, there is a need for further investigation into other climate-related factors such as drought. Additionally, while preterm stillbirth and maternal mortality have gained attention, there is an overlook of malnutrition and food insecurity indicators that require attention in future research. The EGM identifies existing research gaps in climate change and maternal health. It emphasizes the need for global collaboration and targeted interventions to address disparities and inform climate-responsive policies.

Facilitators and Barriers to Developing a Research Program: A Focused Ethnography of New Tenure-Track PhD-Prepared Nursing Faculty.

BACKGROUND: Creating a research program is a critical requirement for new PhD-prepared tenure-track nursing faculty in Canada. PURPOSE: The purpose of this article is to present key findings of new faculty members focusing on facilitators and barriers to development of their research program. METHOD: We conducted focused ethnography research examining the experience of 17 new faculty members from across Canada. RESULTS: The following themes were identified: teaching release, preparation from PhD program, intense feelings, supports and processes, mentoring, obtaining grants, and effects of the COVID-19 pandemic. CONCLUSIONS: Implications for practice include identifying ways to facilitate faculty retention as they develop their research program. This research will be of interest to deans of nursing and new faculty members.

Interventions impacting the accessibility of sexual reproductive health services for head porters in sub-Saharan Africa- A scoping review protocol.

Head porters working in markets in sub-Saharan Africa (SSA) are one of the world's most vulnerable and socioeconomically disadvantaged groups. They consist predominantly of uneducated women and girls seeking to escape poverty, early marriage, and other issues of domestic violence. Most female head porters are in their reproductive years and often lack access to sexual reproductive health services (SRHS) despite being at high risk for sexually transmitted infections (STIs), unplanned pregnancies, and gender-based violence. The low priority for women and girls' SRH in many SSA countries highlights the need to explore the factors influencing the accessibility of services for failure to do so restrains human development. An initial search of the literature was conducted and revealed no current scoping or systematic reviews on the accessibility to SRHS for female head porters in SSA. We outline a scoping review protocol, using the Joanna Briggs Institute methodology, to determine the interventions that influence the accessibility of SRHS for female head porters in SSA. The protocol is registered with Open Science Framework (https://osf.io/hjfkd). Findings will not only be valuable for female head porters but for all vulnerable female groups in SSA who experience high SRH risks and social disparities.

Barriers to Timely Administration of Hepatitis B Birth Dose Vaccine to Neonates of Mothers With Hepatitis B in Ghana: Midwives' Perspectives.

Background: The global health sector strategy on viral hepatitis aims to reduce new hepatitis B infections by 90% by 2030. Yet, hepatitis B birth dose (HepB-BD) vaccination, which is effective in preventing mother-to-child transmission of hepatitis B, remains low in sub-Saharan Africa. Given the essential role that midwives play in infants' birth dose immunisation, we explore their perspectives on the reasons for delays and non-administration of HepB-BD to eligible neonates in Ghana. Methods: We conducted interviews with 18 midwives, stratified by region (Greater Accra and Northern regions). Participants were selected purposively. The data were transcribed, coded, and analysed following the Braun and Clarke data analysis procedure. Results: The participants conveyed a broad range of barriers to HepB-BD vaccination in Ghana. These include the mother's denial of hepatitis B seropositivity; the mother's ignorance of the impact of hepatitis B on their newborn; partners' non-involvement in post-test counselling; and the high cost of hepatitis B immunoglobulin and hepatitis B monovalent vaccine. Other reasons included vaccine unavailability and midwives' oversight and documentation lapses. Conclusion: We recommend educating expectant mothers on the importance and effectiveness of HepB-BD vaccination during antenatal care (ANC) visits, as well as educating midwives on HepB-BD vaccination procedures. In addition, ensuring sufficient supplies and administering hepatitis B vaccines in the delivery ward should be done to guarantee that babies receive the vaccines on time. Importantly, Ghana needs policies that require HepB-BD vaccination as part of the Expanded Programme on Immunisation (EPI) to ensure the investments and funding it needs.

Experiences of new tenure-track PhD-prepared faculty: a scoping review.

The purpose of this scoping review was to assess the state of the literature concerning the experiences of new PhD-prepared tenure-track faculty, with a keen interest in nursing faculty. Effective recruitment and retention strategies for new nursing academic faculty need to be found and implemented. A literature review based on Arksey and O'Malley's five-stage framework for scoping reviews was undertaken. Using the PRISMA protocol, a systematic literature search was conducted in seven databases of studies published in English. Based upon inclusion criteria and relevance, 13 studies out of 90 papers were included in this study. Themes identified from the studies were transitioning to academia, developing a research program, balancing work and life, and perceived inequity. The research was predominately American and Canadian based. Several gaps in the literature were identified. Further research is critical to make recommendations to key stakeholders for recruitment and retention strategies.

Hot fomentation of newborn fontanelles as an indigenous practice in Ghana: implications for policy and integrated community-based health care in Covid-19 pandemic and beyond.

OBJECTIVE: African newborns undergo numerous traditional and religious practices ranging from fontanelle fomentation to total head shaving, scalp molding, skin scarification and ano-genital irrigation which can negatively impact the health of neonates. Hot fomentation of fontanelles has been a predominant indigenous home-based postnatal practice in Ghana and among Africans in the diaspora. Mobility restrictions during the Covid-19 pandemic has impacted direct access to facility-based care as well as home care. The flourishing of newborn traditional practices among African populations during this Covid-19 pandemic offers opportunities to rethink the provision of family healthcare support for newborns during the ongoing pandemic and beyond. Hence, the aim of this critical review was to examine and describe a common indigenous practice-hot fontanelle fomentation to inform home birth support, discharge planning, and the delivery of optimal home-based care support. STUDY DESIGN: This study is a review of literature on hot fomentation of newborn fontanelles. METHODS: Literature search in CINAHL, PubMed, African Index Medicus and Scopus, was conducted and evidence synthesised from articles ranging from 1983-2022. Sixty articles were reviewed; however, 10 manuscripts were excluded prior to screening. The other 19 were exempted because they were either below 1983 or were not the best fit for the study purpose. In all, 31 studies were included in the study. The study was guided by Madeleine Leininger's Culture Care Diversity and Universality care theory. RESULTS: The current study identifies hot fomentation of newborn fontanelles practices in Ghana, the description of hot fomentation practices and the dangers associated with it. The findings and suggested ways to help overcome this challenge. CONCLUSION: There are several neonatal indigenous practices including fontanelle fomentation which pose threat to the health of the neonate as discussed in this study. Future research needs to investigate innovative ways of fontanelle fomentation where necessary instead of the use of hot water by mothers, especially in this Covid-19 pandemic where health and mobility restrictions impact physical access to timely health care. This research will help educate mothers about the dangers of fontanel fomentation and reduce the practice, especially in rural areas of developing countries. This could help reduce neonatal mortality and unnecessary healthcare costs.

Sociocultural Factors Affecting Breastfeeding Practices of Mothers During Natural Disasters: A Critical Ethnography in Rural Pakistan.

Natural disasters affect the health and well-being of mothers with young children. During natural disasters, this population is at risk of discontinuation of their breastfeeding practices. Pakistan is a middle-income country that is susceptible to natural disasters. This study intended to examine sociocultural factors that shape the breastfeeding experiences and practices of internally displaced mothers in Pakistan. This critical ethnographic study was undertaken in disaster-affected villages of Chitral, Pakistan. Data were collected utilizing multiple methods, including in-depth interviews with 18 internally displaced mothers and field observations. Multiple sociocultural factors were identified as either barriers or facilitators to these mothers' capacities to breastfeed their children. Informal support, formal support, breastfeeding culture, and spiritual practices facilitated displaced mothers to sustain their breastfeeding practices. On the other hand, lack of privacy, cultural beliefs, practices and expectations, covert oppression, and lack of healthcare support served as barriers to the breastfeeding practices of displaced mothers.

Mothers' perspectives of physical and psychological issues associated with caring for Ghanaian children living with tuberculosis: A qualitative study.

AIM: The aim of the study was to explore and describe the mothers' perspectives on issues associated with caring for Ghanaian children aged 0-14 years living with tuberculosis. DESIGN: Exploratory descriptive qualitative design. METHODS: Semi-structured individual interviews were conducted face to face with 15 purposively sampled mothers from two health facilities in the Greater Accra area. Transcribed data were analysed using computer-enhanced thematic analysis. RESULTS: Findings were grouped into (1) physical burden on the mothers and (2) psychological burden on mothers. The eight subthemes indicate that mothers of children living with tuberculosis experienced tiredness, sleeplessness, body pains, weight loss and sicknesses as they cared for their children. In addition to worrying, mothers experienced stigma and negative emotions such as sadness, guilt, fear and loneliness. CONCLUSION: Mothers of children diagnosed with tuberculosis in Ghana experience physical and psychological health problems related to their caregiving roles. Nurses and other healthcare providers should identify specific problems and offer broad-based emotional and other support for these women.

Socio-cultural factors influencing teenage pregnancy in the East Mamprusi Municipality, Ghana.

Teenage pregnancy puts a heavy cost on the mother and newborn child, family and the wider society. Despite measures taken by the Ghana Health Service to tackle the issue of teenage pregnancy, the phenomenon remains a public health concern that is widespread throughout the country. The study investigated the socio-cultural factors influencing teenage pregnancy in the East Mamprusi Municipality using an exploratory descriptive design. The study was conducted in rural communities in the East Mamprusi Municipality, in the North East Region of Ghana. Eighteen (18) participants were purposively sampled. Data collection was done by face to face interviews using an interview guide. The study found that polygamous families, parents' desire for grandchildren, multiple sexual partners and poverty were reportedly influencing teenage pregnancy in the rural community. The bid to establish close family ties also accounted for early marriages. There is a culture of silence on matters of sexuality in the community. Teenage pregnancy is an observed phenomenon admitted by the participants and teenage girls are at risk of serious health complications. This phenomenon paints a gloomy picture of the girl child education in the municipality.

Experiences of nurse educators facilitating and teaching in an international setting.

BACKGROUND: Multiple studies focus on the experiences of visiting students from high resource regions that participated in clinical placements in lower resource countries but less focus on the experiences of the educators accompanying students. AIM: The purpose of this study was to explore the experiences of educators during an international clinical placement of nursing students in a country in West Africa. METHODS: We implemented a focussed ethnographic design. We purposively sampled educators who accompanied students on an international clinical placement. Data collection from 2018 to 2019 consisted of in-depth individual interviews. We utilized Roper and Shapira's (2000, 10.4135/9781483328294.) data analysis process, which includes coding keywords, identifying patterns and theorizing. FINDINGS: Three themes emerged from the data: rewards in accompanying students, challenges experienced and the need for mentoring and continuous support. Educators found it rewarding to see growth in students, how students developed as global citizens, how students developed critical thinking and problem-solving skills and create lifelong friendships. CONCLUSION: Educators who accompany nursing students to international clinical placement experience valuable learning and challenging issues. Educators must navigate, support and advance student learning when on an international placement. It is crucial to have adequate institutional support from both the home and host country.

Exploring the Background, Context, and Stressors of Caregiving to Elderly Burned Patients: A Qualitative Inquiry.

Elderly persons are at risk of experiencing burns and require support from both formal and informal caregivers. Informal caregiving in this situation has been minimally explored. Guided by the Stress Process Model, this study aimed at exploring the background, context, and stressors of informal caregivers of elderly burned persons during hospitalization. A qualitative descriptive design was utilized. Purposive sampling approach was used to recruit fourteen (14) informal caregivers who rendered care to elderly burned persons during hospitalization. Interviews were conducted and transcribed verbatim following which directed content analysis was undertaken deductively. Three categories and six subcategories emerged which characterize the background, context, and stressors of informal caregiving to elderly burn patients. All the injuries occurred in the home setting and its sudden nature led to varied postburn emotional responses which characterized the context of burns caregiving. Primary stressors that emerged were related to the injury, actual caregiving demand, and concerns regarding increasing frailty levels. Secondary stressors identified were financial concerns and lifestyle changes. The findings suggest that the occurrence of burn injury served as a precursor to postburn stress response among informal caregivers. Increasing frailty levels, adequacy of household safety measures, and financial issues were key concerns which emphasize the need for psychosocial/transitional support, innovative healthcare financing measures, and continuing education on burns prevention in the home setting.

Peer support for youth suicide prevention: a scoping review protocol.

INTRODUCTION: Youth suicide is a significant public health priority, and is the second leading cause of death among young people between 15 and 29 years of age. An emerging intervention in suicide prevention programming with youth is peer support. Although increasingly used in other settings, the evidence for peer support interventions in youth suicide prevention remains nascent. This article presents a protocol for a scoping review aimed at systematically mapping the current evidence on peer support for youth suicide prevention. METHODS AND ANALYSIS: Arksey and O'Malley's scoping review framework will guide the review methods. The search strategy will be developed with guidance from a health sciences librarian. Multiple databases (Medline, Embase, PsycINFO, Cumulative Index for Nursing and Allied Health Literature) and grey literature will be identified using terms related to peer support and youth suicide prevention. Publication date restrictions will not be applied. All identified records of published literature will be collated and uploaded to a systematic review management software, Covidence, for review and selection. Screening will be completed in duplicate by two reviewers using predefined inclusion and exclusion criteria. Conflicts during screening will be resolved by a third reviewer. The title and abstract screening and full-text review will be completed in Covidence. Two reviewers will complete data extraction from the selected records, using a tailored extraction form. Screening and data extraction will be completed between January and April 2021. A narrative summary will be completed to synthesise key findings as well as contextual information about the use of peer support interventions in youth suicide prevention programming. ETHICS AND DISSEMINATION: The results will be disseminated through a community research report, presentations of findings at relevant conferences and academic publications of the scoping review protocol and results. The data used for this scoping review will be derived from published resources; therefore, ethics approval is not required for this study.

Experience of Vulnerable Women Narrated through the Body-Mapping Technique.

Vulnerable women are considered a priority in public policies and research agendas. It is necessary to understand better the specificities of their daily lives and the meanings they attribute to their experiences, as this undoubtedly contributes to more grounded and culturally appropriate practices. Additionally, innovative techniques in qualitative research are demanded in academia. This narrative research study was carried out with fourteen women from a Brazilian socioeconomically vulnerable neighborhood. We used the body-mapping technique to investigate the experiences of women with mental health disorders or psychosocial distress. The aim was to analyze the self-perception about daily stressors and discuss the feasibility of this technique to facilitate this group's storytelling. Data collection was performed through focus groups, guided by the body-mapping technique steps, and supplemented with individual interviews. Interpersonal conflicts and violence were the main stressors. These strongly impacted the well-being of these women and their children. Some important personal qualities and resilience were identified. Body-mapping played a fundamental role in facilitating storytelling. It amplified the linguistic possibilities for participants to express their feelings and promoted reflections about the present, past, and glimpses into the future.

Impact of the COVID-19 Pandemic on Adolescents' Sexual and Reproductive Health in Low- and Middle-Income Countries.

Adolescents living in low- and middle-income countries (LMICs) are struggling with accessing sexual and reproductive health (SRH) services, and COVID-19 has escalated the problem. The purpose of this review was to identify and assess the existing literature on the impact of the pandemic on SRH needs and access to services by adolescents in LMICs. A scoping review was conducted to collate findings on the topic. Searches were performed on eight databases. Data were extracted and categorized into various themes. After removing duplicates and performing a full-text reading of all articles, nine articles were included in our review. Our findings generated several themes related to adolescents' sexual and reproductive health during the COVID-19 pandemic. These include (1) limited access to sexual and reproductive health services, (2) school closure and increased rate of early marriages, (3) sexual or intimate partner violence during COVID-19, (4) disruption in maternity care, (5) adolescents' involvement in risky or exploitative work, (6) intervention to improve sexual and reproductive health services during COVID-19, and (7) policy development related to adolescent sexual and reproductive health. Several recommendations were made on policies-for instance, the use of telemedicine and community-based programs as a way to deliver SRH services to adolescents during and after a pandemic.

Mentorship programs for nurse educators accompanying nursing students on international placements to low-middle-income countries: a scoping review protocol.

OBJECTIVE: This scoping review will synthesize literature on mentorship programs for nurse educators who accompany nursing students on international placements to low-middle-income countries. INTRODUCTION: University nursing programs have been increasingly incorporating global health education into their curricula. Nurse educators play a significant role in the provision of international clinical experiences for nursing students by supporting and developing confidence and clinical competence. The contribution of nurse educators can affect a student's decision to remain in the profession, suggesting that providing quality professional development for nurse educators is a worthwhile investment. The challenges that come with this role require the development of a mentorship program for nurse educators who accompany nursing students on international placements to low-middle-income countries. INCLUSION CRITERIA: This scoping review will include studies that consider mentorship programs for nurse educators who accompany nursing students on clinical placements in low-middle-income countries. This scoping review will consider experimental and quasi-experimental studies, qualitative studies, text and opinion papers, dissertations, theses, conference reports, and gray literature. Studies published within the previous 40 years will be included as a systematic approach to global education started in the early 1980s. METHODS: Databases to be searched include MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCO), PsycINFO (Ovid), Sociological Abstracts (ProQuest), and Global Health (Ovid). Following screening, all identified citations will be collated. Titles and abstracts will be screened by two independent reviewers. Potentially relevant studies will be retrieved in full and assessed for inclusion. Data will be extracted by two independent reviewers and presented in diagrammatic or tabular format and accompanied by a narrative summary.

Relationship of the type of breastfeeding in the sexual function of women.

OBJECTIVE: to relate the type of breastfeeding in the women's sexual function. METHOD: a cross-sectional study conducted with 150 women in the postpartum period registered in the Family Health Strategy of a large Brazilian municipality. Two instruments were used: one for characterizing sociodemographic, obstetric and breastfeeding variables, and the Female Sexual Function Index for the sexual function. Descriptive data analysis was performed, comparing the variables of interest using the Analysis of Variance, Brown-Forsythe and Tukey tests. RESULTS: there was statistical significance between the groups that practiced different types of breastfeeding in the vaginal lubrication domain (p = 0.015), with the mothers in mixed or partial breastfeeding presenting a higher score for this domain (3.8). CONCLUSION: there is a difference in the female sexual function between different types of breastfeeding. Women who presented better vaginal lubrication belonged to the mixed breastfeeding group.

A Scoping Review of the Health of African Immigrant and Refugee Children.

Migration is a growing phenomenon around the world, including within the African continent. Many migrants, especially African children, face challenges related to health and social inclusion and can face increased health risks. A systematic scoping review of available literature on the health of African migrant children across the globe was conducted to offer insight into these health risks. The review was conducted over a 15-month period from January 2019 to April 2020, yielding 6602 articles once duplicates were removed. This search included electronic databases, reference lists of articles reviewed, and searches of libraries of relevant organisations. A total of 187 studies met the inclusion criteria, of which 159 were quantitative, 22 were qualitative, and 6 used mixed methods. The findings reveal decreased health in this population in areas of nutrition, infectious diseases, mental health, birth outcomes, sexual and reproductive health, physical and developmental health, parasitic infections, oral health, respiratory health, preventative health, endocrine disorders, health care services, and haematological conditions. The findings offer insights into factors influencing the health of African immigrant and refugee children. Further studies, especially qualitative studies, are needed to determine barriers to service access after migration and to investigate other underexplored and overlooked health concerns of African migrant children, including pneumonia and child maltreatment.

A review of the literature on sexual and reproductive health of African migrant and refugee children.

BACKGROUND: Migration and involuntary displacement of children and young people have recently become common features of many African countries due to widespread poverty, rapid urbanization, joblessness, and instability that motivate them to seek livelihoods away from their places of origin. With limited education and skills, children become vulnerable socioeconomically, thereby exposing themselves to sexual and reproductive health (SRH) risks. METHODS: Against this background, the authors undertook a scoping review of the existing literature between January and June 2019 to highlight current knowledge on SRH of African migrant and refugee children. Twenty-two studies that met the inclusion criteria were reviewed. RESULTS: The results identified overcrowding and sexual exploitation of children within refugee camps where reproductive health services are often limited and underutilized. They also reveal language barriers as key obstacles towards young migrants' access to SRH information and services because local languages used to deliver these services are alien to the migrants. Further, cultural practices like genital cutting, which survived migration could have serious reproductive health implications for young migrants. A major gap identified is about SRH risk factors of unaccompanied migrant minors, which have received limited study, and calls for more quantitative and qualitative SRH studies on unaccompanied child migrants. Studies should also focus on the different dimensions of SRH challenges among child migrants differentiated by gender, documented or undocumented, within or across national borders, and within or outside refugee camps to properly inform and situate policies, keeping in mind the economic motive and spatial displacement of children as major considerations. CONCLUSION: The conditions that necessitate economic-driven migration of children will continue to exist in sub-Saharan Africa. This will provide fertile grounds for child migration to continue to thrive, with diverse sexual and reproductive health risks among the child migrants. There is need for further quantitative and qualitative research on child migrants' sexual and reproductive health experiences paying special attention to their differentiation by gender, documented or undocumented, within or across national borders and within or outside refugee camps.

Child migration is increasingly becoming a common feature of many African countries as children migrate within and away from their countries of origin in search of better livelihoods due to widespread poverty, instability and rapid urbanisation. Many of the migrating children have little or no education and limited employable skills, thereby exposing themselves to sexual and reproductive health (SRH) risks. This paper is a scoping review of existing literature from 2000 to 2019 to document relevant findings on SRH of African migrant and refugee children.The review identified migrant children within refugee camps to experience overcrowding and sexual exploitation amidst limited and underutilized reproductive health services. Language barriers are also key obstacles against young migrants' access to SRH information and services as these services are delivered in local languages unfamiliar to them. Child migrants continue to suffer from cultural practices including genital cutting with serious reproductive health implications. SRH risk factors of unaccompanied migrant minors remain as a gap in the review and, therefore, more SRH studies on unaccompanied child migrants are needed. Attention should also be paid to the different dimensions of SRH challenges among child migrants to reflect gender differences, whether documented or undocumented, within or across national borders, and within or outside refugee camps for better understanding.In conclusion, child migration in Africa will continue to be economic-driven and will expose the actors to diverse sexual and reproductive health risks. Further in-depth quantitative and qualitative research is required to inform relevant policies on child migrants' SRH.

An examination of the moral habitability of resource-constrained obstetrical settings.

BACKGROUND: While there have been studies exploring moral habitability and its impact on the work environments of nurses in Western countries, little is known about the moral habitability of the work environments of nurses and midwives in resource-constrained settings. RESEARCH OBJECTIVE: The purpose of this research was to examine the moral habitability of the work environment of nurses and midwives in Ghana and its influence on their moral agency using the philosophical works of Margaret Urban Walker. RESEARCH DESIGN AND PARTICIPANTS: A critical moral ethnography was conducted through the analysis of interviews with 30 nurses and midwives, along with observation, and documentary materials. ETHICAL CONSIDERATIONS: After receiving ethics approval, signed informed consent was obtained from participants before data collection. RESULTS: Five themes were identified: (1) holding onto the values, identities, and responsibilities of being a midwife/nurse; (2) scarcity of resources as limiting capacity to meet caring responsibilities; (3) gender and socio-economic inequities shaping the moral-social context of practice; (4) working with incoherent moral understandings and damaged identities in the context of inter- and intra-professional relationships; and (5) surviving through adversity with renewed commitment and courage. DISCUSSION: The nurses and midwives were found to work in an environment that was morally uninhabitable and dominated by the scarcity of resources, overwhelming and incoherent moral responsibilities, oppressive conditions, and workplace violence. These situations constrained their moral agency and provoked suffering and distress. The nurses and midwives negotiated their practice and navigated through morally uninhabitable work environment by holding onto their moral values and commitments to childbearing women. CONCLUSION: Creating morally habitable workplaces through the provision of adequate resources and instituting interprofessional practice guidelines and workplace violence prevention policies may promote safe and ethical nursing and midwifery practice.

Humanitarian aid and breastfeeding practices of displaced mothers: a qualitative study in disaster relief camps.

BACKGROUND: During disasters and displacement, affected families often receive humanitarian aid from governmental and nongovernmental organizations and donor agencies. Little information is available on the effects of humanitarian aid on the breastfeeding practices of mothers affected by disaster and displacement. AIMS: The aim of this study was to explore the effects of humanitarian aid on the breastfeeding practices of displaced mothers affected by natural disasters in Chitral, Pakistan. METHODS: This was qualitative study of residents of four villages of Chitral who had experienced a recent flood and later an earthquake. Data were collected through field observations, analysis of various documents (e.g. aid-agency documents, published reports and newspaper articles) and in-depth interviews with 18 internally displaced mothers living in disaster relief camps in Chitral. RESULTS: Three main themes developed from the data: humanitarian aid as a life saver, insufficient humanitarian aid affecting breastfeeding, and systemic injustices in the distribution of humanitarian aid. CONCLUSION: Although humanitarian aid facilitated the survival, health and well-being of the displaced mothers and their family members, there were various problems with the humanitarian aid that increased the vulnerability of the displaced mothers and negatively affected their breastfeeding practices. Humanitarian aid must be gender-sensitive, thoughtful, timely, needs-based, equitable and context-specific. A systematic process of aid allocation and restricted donation of formula milk or any other form of breast-milk substitute is recommended during disasters.