As we have clearly stated throughout the course, maternity care should center on the needs of the pregnant person. Midwives and other health professionals should be empowered as well, and be supported in their personal and professional needs. Another aspect of care values that should not be overlooked is how to meet the needs of families and communities. In this lesson, you will learn four factors to consider when developing culturally appropriate care. Involving families and communities in the design process will reveal distinct needs of the local population and there are problems with the existing services. After all, care solutions that work in one environment might not be successful in another one. Well each environment comes with its own set of unique challenges and opportunities. A systematic review of research focusing on the implementation of culturally appropriate services identified four key areas of consideration from Jones et al: accessibility, community participation, respectful, person-centered care, and cohesiveness along the care continuum. To expand each of these factors, determining accessibility within the community means evaluating factors like: poverty, physical proximity to care, local transportation capacity, and gender-based restrictions. For example, travel restrictions on women, along with individuals social circumstances such as: education, literacy, experiences with health services, social support and childcare. Community participation is key to establishing effective services and includes factors like: dialogue between health care providers and communities, dialogue between health facilities and communities, developing community controlled services, building grassroots health coalitions, including participatory approaches in maternal and newborn services. Respectful care, as already discussed, is at the heart of culturally appropriate care. Some ways to operationalize respectful care include: employing staff who share linguistic and cultural backgrounds with the individuals that care for, implementing strategies to overcome linguistic barriers, gender alignment, offering the option of female providers when preferred, supporting patient choice, continuity of care, and an inclusive philosophy of care. Finally, it is important to build cohesiveness along the care continuum, so that the same care values and practices drive all aspects of care, and are experienced equally at all points of care as women move, for example, from primary care to specialty care, from antenatal care to labor and birth and to postpartum care. Building cohesiveness along the care continuum includes, commitment to culturally appropriate care at all levels of care. Building a seamless care experience between facilities, forging links between care providers, streamlined referrals, and a system for timely information sharing between providers and facilities. The World Health Organization's published recommendations on providing culturally appropriate, skilled maternity care echoes these factors, particularly community involvement in respectful care. ''Ongoing dialogue with communities is recommended as an essential component in defining the characteristics of culturally appropriate quality maternity care services that address the needs of women and newborns, and incorporate their cultural preferences." Mechanisms that ensure women's voices are meaningfully included in these dialogues are also recommended. According to the recommendations, respectful community dialogue should recognize and address power dynamics, make links to respectful maternity care and recognize gender hierarchies in institutions include, cultural awareness models, and pre-service and in-service training, and recognized language is an important part of cultural considerations. Respectful, responsive care is not limited to the treatment of individuals at discrete points of care like during birth or an antenatal visit. Rather, high-quality care depends on designing services that respond to the individual within the context of their families and communities in a way that is mindful of and responsive to the full spectrum of economic, geographical, and socio-cultural factors that affect access and uptake of services over their lifespan.
