Birgit Kvernflaten

• Kvernflaten, Birgit (2017). Conflicting Health Interventions: Participation in Health in Rural Nicaragua. Forum for Development Studies.  ISSN 0803-9410.  44(2), s 301- 322 . doi: 10.1080/08039410.2017.1307269 Full text in Research Archive. Show summary

  Nicaragua has a long history of health activism and government policies aimed at achieving various models of participation in health. Drawing on ethnographic research in rural Nicaragua, this article situates contemporary participation within this larger historical and political context and critically explores how participation in health is understood and practised. Contemporary health interventions focus on compliance in their endeavour to improve maternal health. This focus, I argue, creates a productive tension between health seekers’ and health workers’ understanding of themselves as citizens and the government’s attempt at achieving public health aims. My empirical focus is on the brigadistas (community health workers), women and expectant mothers. I describe how brigadistas work as interlocutors between the government and the people. In this relation, women and brigadistas express expectations of and dissatisfaction with the healthcare services offered. Drawing upon an extensive literature on participation, I suggest that within this particular relational space a new political space may appear where demands for improved healthcare services can be articulated and recognized.

• Kvernflaten, Birgit (2017). Reinforcing marginality? Maternal health interventions in rural Nicaragua. Anthropology & Medicine.  ISSN 1364-8470.  26(1), s 87- 103 . doi: 10.1080/13648470.2017.1333570 Full text in Research Archive. Show summary

  To achieve Millennium Development Goal 5 on maternal health, many countries have focused on marginalized women who lack access to care. Promoting facility-based deliveries to ensure skilled birth attendance and emergency obstetric care has become a main measure for preventing maternal deaths, so women who opt for home births are often considered ‘marginal’ and in need of targeted intervention. Drawing upon ethnographic data from Nicaragua, this paper critically examines the concept of marginality in the context of official efforts to increase institutional delivery amongst the rural poor, and discusses lack of access to health services among women living in peripheral areas as a process of marginalization. The promotion of facility birth as the new norm, in turn, generates a process of ‘re-marginalization’, whereby public health officials morally disapprove of women who give birth at home, viewing them as non-compliers and a problem to the system. In rural Nicaragua, there is a discrepancy between the public health norm and women's own preferences and desires for home birth. These women live at the margins also in spatial and societal terms, and must relate to a health system they find incapable of providing good, appropriate care. Strong public pressure for institutional delivery makes them feel distressed and pressured. Paradoxically then, the aim of including marginal groups in maternal health programmes engenders resistance to facility birth.

• Kvernflaten, Birgit (2013). Meeting targets or saving lives: maternal health policy and Millennium Development Goal 5 in Nicaragua. Reproductive Health Matters.  ISSN 0968-8080.  21(42), s 32- 40 . doi: 10.1016/S0968-8080(13)42728-3 Show summary

  In support of maternal health, disease-specific and target-oriented global policy initiatives, such as in Millennium Development Goal 5, have led to a prioritisation of narrow indicators at the expense of more comprehensive approaches. In line with global policy, Nicaragua has made skilled attendants and institutionalised delivery central to its efforts to achieving MDG5 on maternal health. Drawing on ethnographic fieldwork in Nicaragua, involving participant observation and interviews with hospital and community health workers, and women and their families, this paper critically discusses how target-oriented maternal health strategies were manifested in local realities. It shows that Nicaragua’s brigadistas (community health workers) and parteras (traditional birth attendants) have been driven to narrowing their own roles to identifying pregnant women and advocating that they have an institutional delivery as one their most important tasks, making them agents of MDG 5 target achievement. This has engendered fear among brigadistas and parteras of being held individually responsible in the event of a maternal death, creating dissatisfaction with their role and reducing their motivation. While intended to improve maternal health, the pressure to reach targets has unintended negative implications for the relationship between women, the local volunteers and the formal health system, which needs to be addressed.

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• Bjørvik, Eira & Kvernflaten, Birgit (2019). Ufrivillig barnløs? Henda i været!. Dagsavisen - Nye Meninger.
• Kvernflaten, Birgit & Solbrække, Kari Nyheim (2019). Derfor er eggdonasjon så kontroversielt. Forskning.no : nettavis med nyheter fra norsk og internasjonal forskning. . doi: https://forskning.no/bioteknologi-etikk-forskeren-forteller/derfor-er-eggdonasjon-sa-kontroversielt/1287991
• Kvernflaten, Birgit (2018, 08. august). Abortspørsmålet avgjøres i Argentina. Over en million kjemper for kvinners rettigheter.  Dagbladet.
• Kvernflaten, Birgit (2018, 08. august). Argentinas abortforbud kan snart være historie. Det kan påvirke livene til 345 millioner latinamerikanske kvinner..  Aftenposten.
• Kvernflaten, Birgit (2018). Maternal health at the margins: From global policies to local realities in rural Nicaragua.
• Kloster, Maren Olene; Thomsen, Yvonne; Kvernflaten, Birgit & Aguilar-Støen, Mariel (2017). Hadde hun 'the time of her life'? Dirty Dancing og retten til trygg abort.
• Kvernflaten, Birgit (2017, 14. desember). 30 års fengsel for dødfødsel. [Radio].  NRK P1.
• Kvernflaten, Birgit (2017). Maternal health at the margins in rural Nicaragua: Reaching the 'last 20 %'.
• Kvernflaten, Birgit (2016, 01. mars). Zikaviruset skaper abortdebatt i Latin-Amerika. [Radio].  NRKs radioprogram "Her og Nå.
• Kvernflaten, Birgit (2015). Maternal health policy and MDG 5 in rural Nicaragua: From global policies to local realities.
• Kvernflaten, Birgit (2013, 01. november). Voldtatte i Nicaragua nektes abort. [Fagblad].  Apollon.
• Kvernflaten, Birgit (2011). Progress or Neglect - Maternal Health at the Margins.
• Kvernflaten, Birgit (2011). Providing reproductive health services in Guatemala – When local is too local.
• Kvernflaten, Birgit (2010, 18. juli). De krenker kvinnene.  Aftenposten.
• Kvernflaten, Birgit (2009). Freedom of Choice. A study of women's capabilities and constraints in accessing contraceptive services in Guatemala.

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