PhD defence T.I. (Tanneke) Herklots

Below is a brief summary of the dissertation:

In this thesis, the burden of complications related to pregnancy or childbirth in Zanzibar’s referral hospital is studied. 

Part 1 shows that the quality of care in the hospital is too low to prevent severely sick patients from dying. Then, it shows that the World Health Organization’s ‘near-miss approach’ is a valid manner to identify patients who are at highest risk of dying once they develop complications. The next studies help to understand the challenges of working in under-staffed, low-supplied settings, and they show how this affects maternal health outcomes. Each study discusses how the quality of care can be improved, within the difficult circumstances.

Part 2, the individuals, who are the users of the health system, the ‘patients’, speak and share. The first study shows how challenging it is for a woman in Zanzibar to reach and receive good maternal health care. The next two studies display the long-term impact of having survived a severe obstetric complication, including on the woman’s physical, social and economic status. 

The general discussion discusses all findings from perspectives of human rights and morality and ethics. It suggests explanations for poor maternal health care today are: lack of human agency, the concept of adaptive preferences, lack of political will, lack of bioethics and lack of global consciousness. Then, it describes how these pitfalls could be turned into tools for improvement. It hopes to stimulate a debate on more complex and intangible concepts and to help leave a world with poor maternal health care behind.