Conflicting public health discourses—tensions and dilemmas in practice: The case of the Norwegian mother and child health service

Abstract

In current Norwegian discourses and policy debates dealing with children's health and well-being ideas of appropriate methods vary, as do ideas regarding the role parents play in the improvement of their children's health. The present paper draws attention to these discourses, and it presents the findings of an empirical study that examined the everyday life of the Norwegian mother and child health service. The paper also addresses the dilemmas faced by practitioners as a result of expectations that they base their practice on inconsistent discourses. It argues that within this practical field there is a struggle for legitimacy between two sets of values, and that this in turn creates the dilemmas in question. The analysis is based on qualitative interviews with 30 Norwegian public health nurses.

Keywords:

• Norwegian mother and child health services
• contradictory discourses
• different rationalities
• quality improvement
• practical dilemmas

Acknowledgements

The author is particularly grateful to Professor Kari Wærness, Department of Sociology University of Bergen for her constructive comments. Thanks are also due to Senior Lecturer Berit Viken, Vestfold College, Norway, for valuable input on an earlier draft of the paper. Above all, gratitude is expressed to all the informants for their contribution. The study has been funded by the Norwegian Research Council and the University of Bergen, Norway.

Notes

Notes

1.  For a review on for instance: maternal and child health care in Finland, see Vehviläinen-Julkunen (1990); the mother and child health service in Norway, see Andrews (1999), Bjarnar (1995), Evang (1976), and Paulsen (1990); maternity and child health services in Sweden, see Bredmar (1999) and Olin Lauritzen (1990); health visiting in the UK, see Abbott and Sapsford (1990), Bloor and McIntosh (1990) and Cowley (1997), and child health surveillance, also in the UK, see Hall (1996) and Wright (1988).

2.  In other Western countries too these principles have become important as a guide for practice (see for instance Besner, 2000; Cowley, 1997; Hall, 1996; Twinn, 1991).

3.  A series of arguments and theories are offered to support the recommendation of group work. The first is a belief that this technique is an appropriate means to build parents’ self-confidence, and improve their ability to make their own decisions. Second, it is believed that group work will contribute to a reduction in the authority of health professionals, and, in turn, implicitly raise the status of lay knowledge. This argument is based on a philosophy suggesting that learning is best facilitated in a setting in which the relationship between participants is equalized (Bogen et al., 1982). Third, in a group of peers, it is argued that parents could improve parental skills and gain knowledge on child care by drawing on one another's experiences. They could also gain insight into the ‘normal’ variation of child development. Finally, there is the belief that groups provide the potential for support in the local community, both as a supplement to and a replacement for public services. By gathering parents in similar circumstances together, it is believed that parents could profit from reciprocal practical and emotional support, improve social integration, and thus solve problems related to social isolation and lack of social support (Bogen et al., 1982; NBH, 1998). Approaching parents collectively is, however, also considered to be an efficient way of providing information (Heian, 1996; NBH, 1998).

4.  Mothers are the most frequent users of the Norwegian mother and child health service. However, the term ‘parents’ is used throughout the presentation to include fathers as well, because in recent years they have become more involved.

5.  All quotations are kept as close as possible to the original statements. Some adjustments have, however, been necessary to ensure that the expression makes sense in English.

6.  All names are pseudonyms.

7.  In the mid-1990s on average 80% of mothers in Norway nursed their child for three months after the birth, and after six months 60% of them still breast-fed their child (NBH, 1995).

8.  The Ministry of Family and Children's Affairs, the Ministry of Health and Social Affairs, and the Ministry of Church, Education and Research (see Heian, 1996; NBH, 1998).

9.  Both the research findings and this specific programme were presented in the Norwegian public health magazine ‘SoHo-posten’ (1999:2).

10.  Bensing (2000) describes a similar tension within the field of medicine in terms of a gap and conflict between evidence-based medicine and patient-centered medicine.