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    Pregnancy outcomes in Nepal : an investigation of the relationships between socioeconomic factors, maternal factors and foetal and maternal outcomes in a Pokhara sample : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Nursing at Massey University
    (Massey University, 1999) Poudel, Pratima
    Good maternal reproductive health is a prerequisite for the health of babies and families. Social, cultural, economic and health systems also affect the wellbeing and survival of women during pregnancy and childbirth. In Nepal, a developing country, women are discriminated against in terms of legal status, access to education, access to food, and access to relevant health care services (Tuladhar, 1996). Where women do not have access to such services, maternal, perinatal, and infant mortality rates are comparatively high (The Ministry of Health & UNICEF, 1996). There is a scarcity of research on the relationships between socioeconomic and maternal factors and pregnancy outcomes in the Nepalese context. The intention of the present study was to gain a greater understanding of factors affecting the health and behaviour of pregnant women in Nepal. Based on Mosley & Chen's (1984) and Maine's (1995) models of maternal and child survival, these factors were investigated to examine the relationships between socioeconomic and proximate determinants and pregnancy outcomes. Data were collected on a cross-sectional basis from 215 women who gave birth at Western Regional Hospital, Pokhara, Nepal. Analyses revealed that, antenatal care utilisation, and nutritional intake were related to socioeconomic determinants such as income, residence, parental qualifications, maternal occupation, ethnicity and religion. Furthermore, socioeconomic factors explained the greatest variance in birth weight, followed by general health behaviour and obstetric condition variables. The addition of reproductive health and behaviour variables did not add significantly to the explanation of variance in birth weight. Obstructed labour was studied in terms of length of labour, and the result revealed that, mode of delivery (normal or instrumental), gestational age, mother's age, and age at marriage were significantly related to the length of labour. Maternal mortality of 14.15 and perinatal mortality of 29 per 1000 live birth were reported during the study period of two months. Findings are discussed in relation to previous literature. Limitations of the study and implications for future research are also discussed. Findings suggest that, the maternal and child health care services in the Western Region of Nepal need improvement. Strategic development of health care services with cost-effective and quality health services through primary health care and the Safe Motherhood programme are found to be a necessity for this region.
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    Bonded caring : health care choices of women with dependent children : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Nursing Studies at Massey University
    (Massey University, 1991) Enslow, Beverly Ann
    The question for this study arose from the observation that health care often does not match the client's self-determined needs and desires, and hence is wasted care. As a result, the study proposed to discover what elements are involved when women with dependent children make health care choices and what they want in the way of health care. The exploratory study was conducted using strategies of grounded theory. Fourteen indepth interviews, involving eleven women, were conducted. The selection of participants and of the questions for the interviews was based on theoretical sampling. Constant comparative analysis and integrative diagramming were used to analyse the data. The theory that emerged from the data was Bonded Caring and its two essential categories; Interconnectedness and Caring. Bonded Caring requires an intimate and ongoing relationship in which there is development of indepth knowledge of the unique characteristics of the person(s) involved. it is characterised by a strong and enduring affective quality, and by concern, worry and serious attention to the needs of the person(s) involved. This concern necessitates the gathering of information about the nature of the needs, and making the best possible choices concerning their management. During this search for knowledge and skills needed to carry out health care, women assess their own knowledge and experience; the level(s) of health care needed by each individual; the availability, competence and expected response of the resource person or health care consultant; the perception of risk associated with a health concern; and the family's culture and life style. The women considered these elements within a structural framework of finite material and personal resources. The women juggled the distribution of these resources in a way that allowed them to select the avenues of health care that provided the best degree of safety and protection of development within the context of their circumstances.