Fragmentation and hierarchies in Argentina’s maternal health services as barriers to access, continuity and comprehensiveness of care

Abstract

This paper aims to uncover the ways in which institutional regulations of maternal care services offered by the public health system in Argentina generate various forms of fragmentation and hierarchical organization that create barriers to access, continuity, and comprehensiveness of care. The conceptual and methodological tools of institutional ethnography are used as a guide for analysis of interviews with women and health agents from a province of the country’s Western region, as well as participant observation at regional hospitals and local health centers. The barriers identified and analyzed are related to regulations of time(s), space(s), and hierarchies among the health professions involved in service provision related to maternal health.Keywords: maternal health; institutional ethnography; institutional time; institutional space; hierarchies; pregnancy; Argentina; public healthcare