In Latin America, where abortions later in pregnancy are legally and socially restricted, many individuals turn to the support of feminist accompaniment collectives. These accompaniment collectives provide practical information, access to medications, and emotional and physical support to individuals seeking to self-manage their abortions outside of clinical settings. Little research, however, has examined how people having abortions later in pregnancy experience the emotional and physical support provided by accompaniers. This study draws on 26 in-depth interviews to explore the lived experiences of individuals who received in-person accompaniment support for abortions after 17 weeks of pregnancy in Argentina, Chile, and Ecuador. Our findings reveal how participants experienced later accompanied abortion as safe and emotionally supportive, which countered the stigma and violence associated with medical care in the formal health system. Our analysis centres the model of abortion accompaniment as a feminist practice of care that not only reshapes the lived experiences of later abortion, but also presents a radically distinct, and preferable, model of abortion provision. This study demonstrates that accompanied abortions offer a meaningful alternative to accessing safe, supportive abortion care, while offering potential improvements to clinic-supported abortion care.
To address infectious diseases such as dengue, the World Health organization advocates a ‘whole-of-government’ approach that promotes coordination across all levels of government within the health sector and across related sectors. Yet not all health systems have the organizational arrangements needed to facilitate such coordination. This paper examines Peru’s dengue control program to investigate how the organization of the health system shapes the government’s capacity to respond to public health threats. Drawing on the sociology of organizations and qualitative analysis, the study examines how decentralization and performance-based management—legacies of adopting New Public Management (NPM) principles and neoliberal reforms in the 1990s and early 2000s—shape the organizational culture and design of Peru’s health system. The findings identify several barriers to coordination across government levels and policy sectors. These include cultural factors such as context-blind universalism and organizational environments that discourage public-sector entrepreneurship, as well as organizational design features such as fragmented data systems, a lack of incentives to pursue a public health career, and rigid performance-based budgeting. Together, these factors limit coordination within the health sector and hinder intersectoral collaboration. The study proposes that improving the government’s capacity to respond to health threats requires integrating whole-of-government principles into existing NPM arrangements to strengthen both hierarchical and horizontal coordination.
This study aimed to map key stakeholders involved in a prospective dengue EWS and explore their expectations to inform its design and implementation in Vietnam. The study employed an exploratory qualitative design, beginning with a stakeholder inception workshop involving 48 participants to identify key actors across governance levels and sectors. This was followed by 15 in-depth interviews and three focus group discussions with national experts, representatives of local health agencies, and community members in the Mekong Delta Region. Stakeholders were grouped into government health agencies, government non-health agencies, local health agencies, and professional institutions. Expectations consistently emphasised a user-friendly system integrated with existing workflows, reliable forecasts, supportive policy and governance, cross-sectoral data integration, and adequate workforce capacity. Differences in forecast lead time and intended end-users reflected stakeholders' distinct responsibilities rather than conflicting priorities. Power–interest analysis identified national agencies as key strategic actors and local health agencies as central to implementation. These findings provide practical considerations for designing and implementing a dengue EWS aligned with Vietnam's governance structures, routine health system processes, and stakeholder needs, thereby supporting a more sustainable implementation of climate-informed dengue EWS.
This article examines how frontline health care workers in Kenya navigate the end of HIV exceptionalism as donor-funded comprehensive HIV care unravels. Drawing on ethnographic fieldwork conducted in Kisumu between August and December 2024 and in November 2025, the paper traces how the sudden withdrawal of USAID/PEPFAR support accelerated an already planned integration of HIV services into the public health system. Through the experiences of three health care workers, Mary, Dan and Samuel, the analysis shows how the erosion of psychosocial support, specialised labour and long-term care relationships transformed both HIV care and the work of providing it. Health care workers attempted to sustain continuity through improvisation, moral labour and unpaid support even as their own employment became precarious. The paper argues that the end of HIV exceptionalism is experienced not as the normalisation of HIV, but as the unravelling of comprehensive care, accompanied by a gradual shift from therapeutic clientship toward patienthood and a redistribution of responsibility onto both clients and frontline workers.
Food security is difficult to obtain for many families seeking asylum in the UK. Sufficient food and diet quality are integral to health. This study aims to explore descriptions of food insecurity amongst these families, to identify barriers to food security and consider how to mitigate them. We recruited parents or parents-to-be seeking asylum (or who had recently received refugee status) and stakeholders working or volunteering at organisations that support asylum seekers. We conducted eight semi-structured interviews; four with stakeholders, and four with mothers seeking asylum. We inductively coded the qualitative data, and iteratively derived common themes from them using thematic analysis. Five themes were constructed: lack of income, culturally inappropriate food interventions, inaccessibility due to cost of transport services, lack of support settling in and resulting poor mental and physical health. The situation is so bleak that some families are forced to choose between food or necessities like nappies. Tackling food insecurity amongst families seeking asylum is essential to enabling a healthy start in the host country. Potential interventions to consider include matching the money allowance to inflation and giving monthly rather than weekly instalments, allowing families to budget. Families seeking asylum also need more support through culturally-appropriate services.
