Arwa Oweis | Jordan University of Science and Technology (original) (raw)
Papers by Arwa Oweis
Family Practice In The Eastern Mediterranean Region, 2018
A descriptive qualitative approach was used to develop a cultural definition of quality of care i... more A descriptive qualitative approach was used to develop a cultural definition of quality of care in clinical settings, and understand the phenomena of quality of care from Jordanian patients’ perspectives. The study was conducted in two major teaching hospitals located in the north of Jordan during the period of May–August 2008. The sample consisted of 26 patients who agreed to participate in the study. Understanding the phenomena of quality of care from a cultural perspective will help health care providers, locally and internationally, provide care to Jordanian and Arab immigrants in Western countries. Four main themes emerged from the data to reflect on patients ’ perspectives of the quality of care. These themes were: (a) quality as excellence; (b) being caring and concerned; (c) the demonstration of ethical and professional conduct by health care providers; and (d) reflecting on negative experiences during hospitalisation. Findings from this study reflect what is important for J...
Eastern Mediterranean Health Journal, 2020
Eastern Mediterranean Health Journal, 2020
The Lancet, 2019
WHO is entering a new era in its recognition of the vital domains of nursing and midwifery. After... more WHO is entering a new era in its recognition of the vital domains of nursing and midwifery. After the appointment of WHO's Chief Nursing Officer in 2017, the Director-General has endorsed the establishment of the WHO Task Force on Nursing and Midwifery. The taskforce is engaging the global nursing and midwifery community to accelerate collaboration and progress on the health-related Sustainable Development Goals (SDGs). 1 Comprising almost 50% of the global health-care workforce, nurses and midwives are at the forefront of providing care and services across the health spectrum. 2 They are often the principal interface between patients, families, and communities, and have a pivotal role in the coordination and continuity of care, all of which are central to improving outcomes. 3,4 From emergencies and conflicts, to serving communities throughout the life course, nurses and midwives work at all levels of health systems, in diverse settings, and across wide geographical areas. When integrated into interdisciplinary teams and supported by enabling environments, nurses and midwives deliver high-quality, patient-centred services that translate into positive health outcomes. 5,6 As such, it is hard to imagine achieving primary health care (PHC) and universal health coverage (UHC) without a qualified and motivated nursing and midwifery workforce. 7,8 The WHO Task Force on Nursing and Midwifery is convened by the office of the WHO Chief Nursing Officer and provides an interdisciplinary platform to strengthen nursing leadership, advocate for political commitment, develop research and evidence, improve coordination, and embed nursing and midwifery perspectives in WHO's work and global health initiatives. The task force is working on improving access to WHO technical guidelines and resources relevant to mainstreaming the contribu tions of nurses and midwives. Establishment of formal mechanisms that bring together WHO nurses and midwives who work directly with technical programmes will ensure that their perspectives are made visible and explicitly addressed across strategy, policy, and programming at WHO. This is important as WHO moves into detailed to draw from and build on, and we look forward to the Commission doing so in its next stage of work.
Midwifery, 2019
BACKGROUND Effective woman-nurse interaction is critical in providing quality nursing care and wo... more BACKGROUND Effective woman-nurse interaction is critical in providing quality nursing care and would improve the health outcomes and the level of women's satisfaction with health and nursing services. AIM To explore how Jordanian nurses and pregnant women perceive their interaction during antenatal visits. METHODS A descriptive qualitative study was conducted using a purposive sample of twelve pregnant women and twelve nurses. Data were collected through four focus group discussions organized at an antenatal clinic of a large hospital in Jordan. The data were analyzed using Giorgi's four stages of data analysis. FINDINGS Approaches to interaction; barriers to interaction; quality of interaction were the main themes emerged from the data. Nurses and pregnant women also provided suggestions for strengthening the womannurse interaction during antenatal visits. CONCLUSION The different aspects of interaction described by the participants of this study may raise awareness and appreciation of the important roles health care providers can play in promoting the health outcomes of pregnant women when effective interaction is built and strengthened. Relevant policies and guidelines on improving appointment systems, and continuing education on communication skills and health education would be needed. More attention is required to adopt appropriate antenatal clinical guidelines and protocols to meet women's needs in Jordan.
Midwifery, 2018
Women's relationship with health care providers in maternity settings during childbirth has a... more Women's relationship with health care providers in maternity settings during childbirth has a significant impact on their wellbeing and lives. The current study aims to explore women exposure to neglect and verbal abuse during childbirth METHOD: a retrospective cross-sectional descriptive design was conducted at four governmental Maternal and Child Health Centers (MCHCs). A final sample of 390 Jordanian women who gave birth within the last 1-3 months was included in the study. Childbirth Verbal Abuse and Neglect Questionnaire (CVANQ) were developed to collect the data. women's age ranged between 18-45 years, and the mean age was 28 year. 32.2% women reported neglect during their last childbirth, 37.7% women reported verbal abuse during last childbirth. Women who reported being neglected also reported being verbally abused. An inverse relationship was found between age and neglect and verbal abuse. Neglect was significantly associated with women's receiving information re...
Journal of Nursing Scholarship, 2017
Purpose: As the shortage of nurses and midwives is expected to worsen in the Eastern Mediterranea... more Purpose: As the shortage of nurses and midwives is expected to worsen in the Eastern Mediterranean region concomitantly with a growing focus on achievement of universal health coverage, nurses and midwives are expected to fill major gaps in health care. Hence, the need for a solid evidence base for nursing practice and a clear direction for clinical nursing research are paramount. Therefore, a Delphi survey was conducted to determine clinical (research focused on patient outcomes) nursing and midwifery priorities for research within this region. Design: A Delphi survey, using iterative rounds of an online survey of regional clinical nursing and midwifery research experts, was conducted between January and April 2016. Methods: Consensus was determined by percentage agreement on level of priority for topics as determined by participants. Additionally, results were compared between countries within the region by income and mortality levels using Kendall's tau. Findings: Critical research topics were focused on public/community/primary care as well as emergency preparedness for disasters, and these priorities are well aligned with gaps in the literature for this region. There were statistically significant differences between priority level and country mortality group for geriatrics, self-management of disease, and sexually transmitted infections. Conclusions: Critical research priorities should focus on population-based health topics. Between-country differences should be analyzed further. A clinical research database for the region may help improve research access for nurses and midwives. Clinical Relevance: Practicing nurses and midwives lack extensive evidence (including culturally relevant evidence) on which to practice. Increasing research in areas identified in this survey may improve patient outcomes and quality of care regionally.
Journal of International Women S Studies, Oct 1, 2012
This journal and its contents may be used for research, teaching and private study purposes. Any ... more This journal and its contents may be used for research, teaching and private study purposes. Any substantial or systematic reproduction, redistribution , reselling , loan or sub-licensing, systematic supply or distribution in any form to anyone is expressly forbidden.
PLOS ONE, 2016
Introduction The influx of Syrian refugees into Jordan presents an immense burden to the Jordania... more Introduction The influx of Syrian refugees into Jordan presents an immense burden to the Jordanian health system, particularly in treating chronic health conditions. This study was undertaken to assess utilization of health services for chronic health conditions among Syrian refugees in non-camp settings. Methods A survey of Syrian refugees in Jordan was undertaken in June 2014 to characterize health seeking behaviors and issues related to accessing care for hypertension, diabetes, cardiovascular diseases, chronic respiratory diseases, and arthritis. A cluster design with probability proportional to size sampling was used to attain a nationally representative sample of 1550 non-camp Syrian refugee households. Results Of 1363 cases with a chronic health condition diagnosis, 84.7% had received care in Jordan. Public facilities faced a heavy burden serving over half (53.9%) of care-seekers; the remainder received care in the private (29.6%) and NGO/charity (16.6%) sectors. Individuals with non-communicable diseases (NCDs) in the central region of Jordan and with arthritis had the lowest rates of care-seeking when compared to other regions and conditions. Overall, 31.6% of care-seekers had an out-of-pocket payment for the most recent careseeking event which averaged 18.8 USD (median = 0 USD), excluding cost of medications. Discussion Forced displacement presents major challenges to those with NCDs, which have the potential to seriously impact both the quality of life and life expectancy amongst refugees. NCD patterns among Syrian refugees indicate the importance of continuing support to public PLOS ONE |
BMC public health, Jan 31, 2015
There are currently more people displaced by conflict than at any time since World War II. The pr... more There are currently more people displaced by conflict than at any time since World War II. The profile of displaced populations has evolved with displacement increasingly occurring in urban and middle-income settings. Consequently, an epidemiological shift away from communicable diseases that have historically characterized refugee populations has occurred. The high prevalence of non-communicable diseases (NCDs) poses a challenge to in terms of provision of appropriate secondary and tertiary services, continuity of care, access to medications, and costs. In light of the increasing burden of NCDs faced by refugees, we undertook this study to characterize the prevalence of NCDs and better understand issues related to care-seeking for NCDs among Syrian refugees in non-camp settings in Jordan. A cross-sectional survey of 1550 refugees was conducted using a multi-stage cluster design with probability proportional to size sampling to obtain a nationally representative sample of Syrian ref...
Journal of Child Sexual Abuse, 2015
Sexual offenses are an important global health problem threatening people of all age groups. Ther... more Sexual offenses are an important global health problem threatening people of all age groups. There are no reported studies regarding sexual violence among children in Jordan. Therefore, this study aimed to examine the problem of sexual violence among children in the Northern region of Jordan. A retrospective design was adopted to review all reports from the Forensic Medicine Teaching Center of North of Jordan clinic on cases of sexual-related assaults that occurred between 2003 and 2007. Reports were reviewed for age, gender, toxicological analysis, and relevant information provided by victims and their relatives. Results indicated that 53% of the cases were male victims, with a male to female ratio of 1:1. Ages ranged from 3 to 18 years with a mean age of 12.5 years. Most cases were considered indecent assaults, while 37.1% were cases of rape. In most cases, offenders were strangers. It could be concluded that Jordanian children are as susceptible to sexual assaults as their counterparts worldwide. This study is the first to report sexual offenses among children in Jordan. As such, it provides baseline data that can be used to inform policy and prevention strategies focused on reducing sexual violence among this vulnerable segment of the Jordanian population.
International journal of nursing practice, 2005
The definition of a profession consists of contributing characteristics. Nursing must achieve the... more The definition of a profession consists of contributing characteristics. Nursing must achieve these characteristics in order to confirm its professional status. These characteristics include: a standard of education; professional organizations; commitment; autonomy; continuing education; body of knowledge and competencies; social value; and a code of ethics. Nursing in Jordan faces a unique set of challenges to meet these criteria. The purpose of this discussion is to bring the professional challenges of nursing in Jordan to light, to motivate collaborative efforts to remediate them and to discuss the value of evidence-based practice in this process. The key to confirming Jordanian nurses' professional status is for nurses to seek every opportunity to prove themselves, earn respect, take control over their work, support their colleagues and to make informed decisions. In addition, a more active and effective role for the nursing organizations is necessary to change the public...
International journal of nursing practice, 2005
In this descriptive study, 100 low-risk participants who delivered vaginally were recruited from ... more In this descriptive study, 100 low-risk participants who delivered vaginally were recruited from the postpartum unit of a major hospital in the city of Amman. Three instruments, the Numeric Pain Intensity Scale (NPIS), a pain assessment questionnaire and a demographic questionnaire were used to assess labour experiences and labour pain intensity levels. The majority of Jordanian parturients did not receive pain relief. Eighty-one women reported pain intensity levels of > or = 8 on the NPIS (ranging from 0-10). The mean pain intensity level during the second stage of labour was 8.83. A significant difference in age was found between primiparas and multiparas. Jordanian parturients reported painful labour experiences; therefore, re-evaluation of current maternity nursing and midwifery practices and roles regarding labour pain management are warranted. The roles of supporter and educator among maternity nurses and midwives in Jordan also need to improve considerably.
International journal of nursing practice, 2004
Limited numbers of studies have addressed Jordanian women's overall views and expectations of... more Limited numbers of studies have addressed Jordanian women's overall views and expectations of their first childbirth experience. A descriptive design using a convenience sample of 77 primigravid women was included in the analyses out of the total sample of 99 women. Participants responded to two valid and reliable questionnaires developed for the purpose of the study: the Expectations of Childbirth Experience questionnaire and the Expectations of Nursing Support During Labor and Birth questionnaire. The majority of primigravid women in this study expected a negative first childbirth experience. Findings indicated that the majority of women expected their overall childbirth experience to be frightening, very long, too difficult and painful. The expectations of a negative childbirth experience could be explained by limited labour preparation and advice given to women. Findings also indicated that women expected inadequate nursing and midwifery support during childbirth. Health-car...
Family Practice In The Eastern Mediterranean Region, 2018
A descriptive qualitative approach was used to develop a cultural definition of quality of care i... more A descriptive qualitative approach was used to develop a cultural definition of quality of care in clinical settings, and understand the phenomena of quality of care from Jordanian patients’ perspectives. The study was conducted in two major teaching hospitals located in the north of Jordan during the period of May–August 2008. The sample consisted of 26 patients who agreed to participate in the study. Understanding the phenomena of quality of care from a cultural perspective will help health care providers, locally and internationally, provide care to Jordanian and Arab immigrants in Western countries. Four main themes emerged from the data to reflect on patients ’ perspectives of the quality of care. These themes were: (a) quality as excellence; (b) being caring and concerned; (c) the demonstration of ethical and professional conduct by health care providers; and (d) reflecting on negative experiences during hospitalisation. Findings from this study reflect what is important for J...
Eastern Mediterranean Health Journal, 2020
Eastern Mediterranean Health Journal, 2020
The Lancet, 2019
WHO is entering a new era in its recognition of the vital domains of nursing and midwifery. After... more WHO is entering a new era in its recognition of the vital domains of nursing and midwifery. After the appointment of WHO's Chief Nursing Officer in 2017, the Director-General has endorsed the establishment of the WHO Task Force on Nursing and Midwifery. The taskforce is engaging the global nursing and midwifery community to accelerate collaboration and progress on the health-related Sustainable Development Goals (SDGs). 1 Comprising almost 50% of the global health-care workforce, nurses and midwives are at the forefront of providing care and services across the health spectrum. 2 They are often the principal interface between patients, families, and communities, and have a pivotal role in the coordination and continuity of care, all of which are central to improving outcomes. 3,4 From emergencies and conflicts, to serving communities throughout the life course, nurses and midwives work at all levels of health systems, in diverse settings, and across wide geographical areas. When integrated into interdisciplinary teams and supported by enabling environments, nurses and midwives deliver high-quality, patient-centred services that translate into positive health outcomes. 5,6 As such, it is hard to imagine achieving primary health care (PHC) and universal health coverage (UHC) without a qualified and motivated nursing and midwifery workforce. 7,8 The WHO Task Force on Nursing and Midwifery is convened by the office of the WHO Chief Nursing Officer and provides an interdisciplinary platform to strengthen nursing leadership, advocate for political commitment, develop research and evidence, improve coordination, and embed nursing and midwifery perspectives in WHO's work and global health initiatives. The task force is working on improving access to WHO technical guidelines and resources relevant to mainstreaming the contribu tions of nurses and midwives. Establishment of formal mechanisms that bring together WHO nurses and midwives who work directly with technical programmes will ensure that their perspectives are made visible and explicitly addressed across strategy, policy, and programming at WHO. This is important as WHO moves into detailed to draw from and build on, and we look forward to the Commission doing so in its next stage of work.
Midwifery, 2019
BACKGROUND Effective woman-nurse interaction is critical in providing quality nursing care and wo... more BACKGROUND Effective woman-nurse interaction is critical in providing quality nursing care and would improve the health outcomes and the level of women's satisfaction with health and nursing services. AIM To explore how Jordanian nurses and pregnant women perceive their interaction during antenatal visits. METHODS A descriptive qualitative study was conducted using a purposive sample of twelve pregnant women and twelve nurses. Data were collected through four focus group discussions organized at an antenatal clinic of a large hospital in Jordan. The data were analyzed using Giorgi's four stages of data analysis. FINDINGS Approaches to interaction; barriers to interaction; quality of interaction were the main themes emerged from the data. Nurses and pregnant women also provided suggestions for strengthening the womannurse interaction during antenatal visits. CONCLUSION The different aspects of interaction described by the participants of this study may raise awareness and appreciation of the important roles health care providers can play in promoting the health outcomes of pregnant women when effective interaction is built and strengthened. Relevant policies and guidelines on improving appointment systems, and continuing education on communication skills and health education would be needed. More attention is required to adopt appropriate antenatal clinical guidelines and protocols to meet women's needs in Jordan.
Midwifery, 2018
Women's relationship with health care providers in maternity settings during childbirth has a... more Women's relationship with health care providers in maternity settings during childbirth has a significant impact on their wellbeing and lives. The current study aims to explore women exposure to neglect and verbal abuse during childbirth METHOD: a retrospective cross-sectional descriptive design was conducted at four governmental Maternal and Child Health Centers (MCHCs). A final sample of 390 Jordanian women who gave birth within the last 1-3 months was included in the study. Childbirth Verbal Abuse and Neglect Questionnaire (CVANQ) were developed to collect the data. women's age ranged between 18-45 years, and the mean age was 28 year. 32.2% women reported neglect during their last childbirth, 37.7% women reported verbal abuse during last childbirth. Women who reported being neglected also reported being verbally abused. An inverse relationship was found between age and neglect and verbal abuse. Neglect was significantly associated with women's receiving information re...
Journal of Nursing Scholarship, 2017
Purpose: As the shortage of nurses and midwives is expected to worsen in the Eastern Mediterranea... more Purpose: As the shortage of nurses and midwives is expected to worsen in the Eastern Mediterranean region concomitantly with a growing focus on achievement of universal health coverage, nurses and midwives are expected to fill major gaps in health care. Hence, the need for a solid evidence base for nursing practice and a clear direction for clinical nursing research are paramount. Therefore, a Delphi survey was conducted to determine clinical (research focused on patient outcomes) nursing and midwifery priorities for research within this region. Design: A Delphi survey, using iterative rounds of an online survey of regional clinical nursing and midwifery research experts, was conducted between January and April 2016. Methods: Consensus was determined by percentage agreement on level of priority for topics as determined by participants. Additionally, results were compared between countries within the region by income and mortality levels using Kendall's tau. Findings: Critical research topics were focused on public/community/primary care as well as emergency preparedness for disasters, and these priorities are well aligned with gaps in the literature for this region. There were statistically significant differences between priority level and country mortality group for geriatrics, self-management of disease, and sexually transmitted infections. Conclusions: Critical research priorities should focus on population-based health topics. Between-country differences should be analyzed further. A clinical research database for the region may help improve research access for nurses and midwives. Clinical Relevance: Practicing nurses and midwives lack extensive evidence (including culturally relevant evidence) on which to practice. Increasing research in areas identified in this survey may improve patient outcomes and quality of care regionally.
Journal of International Women S Studies, Oct 1, 2012
This journal and its contents may be used for research, teaching and private study purposes. Any ... more This journal and its contents may be used for research, teaching and private study purposes. Any substantial or systematic reproduction, redistribution , reselling , loan or sub-licensing, systematic supply or distribution in any form to anyone is expressly forbidden.
PLOS ONE, 2016
Introduction The influx of Syrian refugees into Jordan presents an immense burden to the Jordania... more Introduction The influx of Syrian refugees into Jordan presents an immense burden to the Jordanian health system, particularly in treating chronic health conditions. This study was undertaken to assess utilization of health services for chronic health conditions among Syrian refugees in non-camp settings. Methods A survey of Syrian refugees in Jordan was undertaken in June 2014 to characterize health seeking behaviors and issues related to accessing care for hypertension, diabetes, cardiovascular diseases, chronic respiratory diseases, and arthritis. A cluster design with probability proportional to size sampling was used to attain a nationally representative sample of 1550 non-camp Syrian refugee households. Results Of 1363 cases with a chronic health condition diagnosis, 84.7% had received care in Jordan. Public facilities faced a heavy burden serving over half (53.9%) of care-seekers; the remainder received care in the private (29.6%) and NGO/charity (16.6%) sectors. Individuals with non-communicable diseases (NCDs) in the central region of Jordan and with arthritis had the lowest rates of care-seeking when compared to other regions and conditions. Overall, 31.6% of care-seekers had an out-of-pocket payment for the most recent careseeking event which averaged 18.8 USD (median = 0 USD), excluding cost of medications. Discussion Forced displacement presents major challenges to those with NCDs, which have the potential to seriously impact both the quality of life and life expectancy amongst refugees. NCD patterns among Syrian refugees indicate the importance of continuing support to public PLOS ONE |
BMC public health, Jan 31, 2015
There are currently more people displaced by conflict than at any time since World War II. The pr... more There are currently more people displaced by conflict than at any time since World War II. The profile of displaced populations has evolved with displacement increasingly occurring in urban and middle-income settings. Consequently, an epidemiological shift away from communicable diseases that have historically characterized refugee populations has occurred. The high prevalence of non-communicable diseases (NCDs) poses a challenge to in terms of provision of appropriate secondary and tertiary services, continuity of care, access to medications, and costs. In light of the increasing burden of NCDs faced by refugees, we undertook this study to characterize the prevalence of NCDs and better understand issues related to care-seeking for NCDs among Syrian refugees in non-camp settings in Jordan. A cross-sectional survey of 1550 refugees was conducted using a multi-stage cluster design with probability proportional to size sampling to obtain a nationally representative sample of Syrian ref...
Journal of Child Sexual Abuse, 2015
Sexual offenses are an important global health problem threatening people of all age groups. Ther... more Sexual offenses are an important global health problem threatening people of all age groups. There are no reported studies regarding sexual violence among children in Jordan. Therefore, this study aimed to examine the problem of sexual violence among children in the Northern region of Jordan. A retrospective design was adopted to review all reports from the Forensic Medicine Teaching Center of North of Jordan clinic on cases of sexual-related assaults that occurred between 2003 and 2007. Reports were reviewed for age, gender, toxicological analysis, and relevant information provided by victims and their relatives. Results indicated that 53% of the cases were male victims, with a male to female ratio of 1:1. Ages ranged from 3 to 18 years with a mean age of 12.5 years. Most cases were considered indecent assaults, while 37.1% were cases of rape. In most cases, offenders were strangers. It could be concluded that Jordanian children are as susceptible to sexual assaults as their counterparts worldwide. This study is the first to report sexual offenses among children in Jordan. As such, it provides baseline data that can be used to inform policy and prevention strategies focused on reducing sexual violence among this vulnerable segment of the Jordanian population.
International journal of nursing practice, 2005
The definition of a profession consists of contributing characteristics. Nursing must achieve the... more The definition of a profession consists of contributing characteristics. Nursing must achieve these characteristics in order to confirm its professional status. These characteristics include: a standard of education; professional organizations; commitment; autonomy; continuing education; body of knowledge and competencies; social value; and a code of ethics. Nursing in Jordan faces a unique set of challenges to meet these criteria. The purpose of this discussion is to bring the professional challenges of nursing in Jordan to light, to motivate collaborative efforts to remediate them and to discuss the value of evidence-based practice in this process. The key to confirming Jordanian nurses' professional status is for nurses to seek every opportunity to prove themselves, earn respect, take control over their work, support their colleagues and to make informed decisions. In addition, a more active and effective role for the nursing organizations is necessary to change the public...
International journal of nursing practice, 2005
In this descriptive study, 100 low-risk participants who delivered vaginally were recruited from ... more In this descriptive study, 100 low-risk participants who delivered vaginally were recruited from the postpartum unit of a major hospital in the city of Amman. Three instruments, the Numeric Pain Intensity Scale (NPIS), a pain assessment questionnaire and a demographic questionnaire were used to assess labour experiences and labour pain intensity levels. The majority of Jordanian parturients did not receive pain relief. Eighty-one women reported pain intensity levels of > or = 8 on the NPIS (ranging from 0-10). The mean pain intensity level during the second stage of labour was 8.83. A significant difference in age was found between primiparas and multiparas. Jordanian parturients reported painful labour experiences; therefore, re-evaluation of current maternity nursing and midwifery practices and roles regarding labour pain management are warranted. The roles of supporter and educator among maternity nurses and midwives in Jordan also need to improve considerably.
International journal of nursing practice, 2004
Limited numbers of studies have addressed Jordanian women's overall views and expectations of... more Limited numbers of studies have addressed Jordanian women's overall views and expectations of their first childbirth experience. A descriptive design using a convenience sample of 77 primigravid women was included in the analyses out of the total sample of 99 women. Participants responded to two valid and reliable questionnaires developed for the purpose of the study: the Expectations of Childbirth Experience questionnaire and the Expectations of Nursing Support During Labor and Birth questionnaire. The majority of primigravid women in this study expected a negative first childbirth experience. Findings indicated that the majority of women expected their overall childbirth experience to be frightening, very long, too difficult and painful. The expectations of a negative childbirth experience could be explained by limited labour preparation and advice given to women. Findings also indicated that women expected inadequate nursing and midwifery support during childbirth. Health-car...