Janet M. Turan, PhD¹, Ayşen Bulut, MD², Hacer Nalbant, MA², Nuriye Ortaylı, MD², and A. Arzu Koloğlu Akalın, MD². (1) Institute for Research on Women and Gender, Stanford University, 556 Salvatierra Walk, Serra House, Stanford, CA 94305, (650) 497-9229, jmturan@stanford.edu, (2) Institute of Child Health, Istanbul University, Kadın ve Çocuk Sağlığı Eğitim ve Araştırma Birimi, Cerrahi Monoblok karşısı, Çapa, Istanbul, 34390, Turkey

Several recent studies have identified problems with the quality of maternity care and the lack of evidence-based practice in developing countries. Maternity care in urban hospitals in the developing world is often characterized by overuse of technical procedures, unnecessary use of procedures, inappropriate use of pain medications, lack of social support and humane treatment, and separation of mother and baby after the birth. There is also experience from the field indicating that simply giving maternity care providers information on evidence-based practices may not be enough to change behavior. Thus it is important to examine the current state of maternity care, as well as knowledge and attitudes of maternity care providers and women before attempting to implement new practices. This study uses data from three large maternity hospitals in Istanbul, Turkey to identify challenges for adoption of evidence-based maternity care. Methods included semi-structured interviews with 150 pregnant and 150 postpartum women, in-depth interviews with 45 maternity care providers, and structured observations of 125 births and 176 antenatal visits. The findings indicate that, in addition to information and evidence, Turkish maternity care providers may need addition clinical training in new practices recommended by evidence-based medicine, such as active management of the third stage of labor and restrictive use of episiotomy. Changes in the physical infrastructure of delivery rooms, as well as preparation for lay companions, would make allowing companionship during labor and delivery more acceptable. Training on patients’ rights and involving women in decision-making is necessary for both providers and women.

Learning Objectives: At the conclusion of this session the participant in this session will be able to

• List the maternity practices targeted for change by the Better Births Initiative, a program for action in middle- and low-income countries endorsed by the World Health Organization.
• Describe qualitative and quantitative research methods that can be used to identify challenges for adoption of evidence-based maternity care in different settings.
• Recognize that there are complex factors behind current maternity practices and that multi-faceted strategies are needed in order to bring about change.

Keywords: Quality of Care, Evidence Based Practice

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.