Maternity and child health care in transition. Institutional ethnography on Finnish changing care practices
Department of Social Research University of Tampere Tampere, Finland
The Finnish maternity and child health care (MCH) system is undergoing a vast organizational change that stems from challenging prevailing policy guide-lines. It has been recommended that instead of focusing on medical screening and children already born, care work should direct attention to the social and psychological environment of the child(-to-be), in this case the social unit of ?the family?, to prevent future problems. Furthermore, increasing emphasis has been placed on the benefits of multi-professional team work. That is, pooling together experts from the fields of early social and health care of children. Various interventions have been developed and implemented in an effort to bring about change in the existing work practices of MCH.
This paper examines the various ways in which the idea of a family-oriented and multi-professional care is realized in the work practices of MCH by focusing on one specific intervention. The purpose is to explore, from the viewpoint of the clients? agency, the implementation of the so-called family-oriented MCH clinic in one large city in Finland. In the model in question the changes that the MCH system has been subjected to include: the integration of the so-far separate clinics of maternity and child health care, the utilization of the expertise of multi-professional teams in solving the problems of families, and other new working methods to focus on psycho-social support.
The methodological orientation of the study is institutional ethnography, and the primary data analyzed are transcribed video tapes and observations from MCH clinics. Analysis of the data shows that that care work in general is organized in terms of temporality, practicality and taking into account the differences amongst clients. This further suggests that the implementation of new working methods is equally as complex in practice. These kind of multiple ?logics? produce multiple ?clients?, who are granted different kinds of agency in accordance with a given situation and site. For example, clients may be produced as mere bodies in a medically defined natural process in some instance, and more like consumer clients with citizen rights or a social family context in another instance.