Adoption of policies to improve respectful maternity care in Timor-Leste.

INTRODUCTION: There are now well-established global standards for supporting improvement in women's experience of maternity services, including frameworks for the prevention of mistreatment during childbirth. To support initiatives to improve the quality of care in maternal health services in Timor-Leste, we examine the adoption of global respectful maternity care standards in the national intrapartum care policy and in three urban birth facilities in Dili. METHODS: From May to July 2022, we conducted a desk review of the Timor-Leste National Intrapartum Care Standards and Clinical Protocols for Referral Facilities and Community Health Centres. This was followed by a health-facility audit of policies, guidelines and procedures in three main maternity facilities in the capital, Dili to examine the extent to which the WHO (2016) standards for women's experiences of care have been adopted. RESULTS: Despite the availability of global guidelines, key standards to improve women's experience of care have not been included in the National Intrapartum Care guidelines in Timor-Leste. There was no mention of avoiding mistreatment of women, needing informed consent for procedures, or strengthening women's own capability and confidence. In the policy wording, women tended to be distanced from the care 'procedures' and the protocols could be improved by taking a more woman-centred approach. The results of the health facility assessment showed extremely low use of standards that improve women's experiences of care. Health Facility 1 and 2 met two of the 21 quality measures, while Health Facility 3 met none of them. CONCLUSION: The discourse communicated through policy fundamentally affects how health care issues are framed and how policies are enacted. Given the findings of this study, combined with previously documented issues around quality of care and low satisfaction with maternal health services, there is a need for a fundamental shift in the culture of care for women. This will require an immediate focus on leadership, training and policy-frameworks to increase respectful care for women in health facilities. It will also require longer-term effort to address the power imbalances that drive mistreatment of women within and across social systems, and to support models of care that inherently foster understanding and compassion.

Academic self-concept and sense of school belonging of adolescent siblings of autistic children.

BACKGROUND: Whilst there is a growing body of research on the psychological outcomes for siblings of autistic children (autism siblings), few studies have considered the school context. AIMS: To explore group differences on two school-related self-reported outcomes for autism siblings and siblings of non-autistic children: sense of school belonging, and academic self-concept. Data on self- and parent/carer-reported behavioural and emotional problems were also collected. METHODS AND PROCEDURES: 65 autism siblings and a comparison group of 57 siblings of non-autistic children aged 11-16 years completed questionnaires measuring sense of school belonging, academic self concept, and behaviour problems. 73 parents in the autism sibling and 67 parents in the comparison sibling group completed the behaviour problems measure. OUTCOMES AND RESULTS: Autism siblings reported significantly lower school belonging and academic self-concept, and had significantly poorer self- and parent- reported behaviour problems. When controlling for demographic variables and internalising and externalizing behaviour, robust sibling group differences on academic variables remained. CONCLUSIONS AND IMPLICATIONS: Autism siblings reported poorer school-related outcomes and increased behavioural difficulties relative to siblings of non-autistic children. There was wide variation in autism siblings' outcomes, highlighting the importance of taking an individualised and contextualised approach to understanding the varying needs of autism siblings.