Choice as a risk to women's health

“Choice” has long been a principal demand of the women's health movement. This paper explores some ways in which current trends in biomedicine and health care may be transforming the concept of choice, and the choices provided to women, into risks to our well-being. The trends examined include the continuing neglect of structural constraints on women's abilities to choose; the framing of choice solely as an expression of individualism; and a vision of health care choices for women as ways to stimulate the economy. These trends present special risks for women because they co-opt our demands for gender-based health policies to support the commercialisation of health and health care. To counter these trends_' women will have to participate actively in the processes that determine what options are developed and made available to us, ensuring that the contexts of women's lives and our understandings of risks are addressed. Only then might choice be authentic, and not a risk for health.     

Improving health in deprived communities: What can residents teach us?

The purpose of this paper is to illustrate how residents of disadvantaged communities believe where they live influences their health. The authors describe focus group work they have undertaken with older and younger adults resident in three neighbourhoods in the West Midlands region of England, which are participating in the New Deal for Communities initiative. Drawing on the narratives of residents, examples are given of specific ‘pathways’ they described linking place to health experiences. Resident discussions highlight a number of key points. First, health was conceived in physical and non-physical terms: participants spoke of health not only in terms of physical disease or illness, but also as ‘being happy’, ‘having confidence’, ‘contentment’ and ‘peace of mind’. Second, place was seen by residents to impact on health through three core levers—physical structures (for example housing quality, visual amenity), social structures (for example, friendliness of neighbours, community norms) and service provision (for example, public transport, local police). Although the influence of each lever was described separately in certain instances, their interplay with health was often complex and intertwined. Third, although groups were not prompted to compare themselves with others, discussions frequently included comparison with other areas, and also consideration of what ‘others’ must think of them. Finally, it was noted that ‘fear’ was a common node in many of the pathways that residents described linking aspects of place with their health.     

Pesticide exposure and women's health

BACKGROUND: Research on pesticide-related health effects has been mostly focused in industrialized countries and in men. This paper discusses critical issues related to women's pesticide exposure and its effects on women's health. METHODS: The literature on pesticides was reviewed with emphasis on data related to women. Attention was focused on research suggesting different conditions of exposure or different response to pesticides by sex. Studies on cancer and reproductive effects were used as illustrative examples. RESULTS: Women are increasingly exposed to pesticides in developing countries, where women's poisoning and other pesticide-related injuries seem to be greatly underestimated. Many of the effects of pesticides in human health will be the same for men and women, but not always. Some organochlorine pesticides have been related to breast cancer in post-menopausal women. However, knowledge about other pesticides is much more limited. Epidemiological studies assessing maternal exposure to individual pesticides and abortion, fetal death, or congenital defects are not conclusive, although some suggestive associations have been observed. CONCLUSIONS: Gender-sensitive research is needed to properly address the study of women's pesticide exposures and related adverse outcomes. A better understanding of potential gender-environment and sex-environment interactions related to pesticide exposure and health effects in women is needed.     

Bedouin-Arab women's access to antenatal care at the interface of physical and structural barriers: A pilot study

Since 2000, the Israeli Public Health Services have established eight Maternal-and-Child-Health (MCH) stations in unrecognised Bedouin-Arab villages in South Israel in order to reduce barriers to healthcare.

The goals of this pilot study were: (1) to explore the new MCH stations’ impact on antenatal care (ANC) accessibility; and (2) to compare access to ANC between women from villages with MCH stations and women from villages without MCH stations.

The study combined quantitative and qualitative methods including structured interviews with 174 MCH service users, review of 158 ANC records and 16 in-depth interviews with Bedouin-Arab women.

The establishment of MCH stations in unrecognised villages has improved physical access to ANC and secondarily diminished other barriers related to financial and sociocultural dimensions of women's access to healthcare, thus enhancing women's options for independent healthcare-seeking; yet, limited opening hours, staff shortages and communication problems hamper ANC delivery at the new MCH stations.

This pilot study indicates that the MCH stations’ establishment in unrecognised villages was a successful intervention, which improved women's access to ANC. Even though current service delivery challenges need to be overcome to achieve the intervention's full potential, its replication should be considered in further villages.     

Gender bias in health research: implications for women's health in Kerala (India) and Sri Lanka

Indian state of Kerala, and Sri Lanka have a special place in global health discourses, although there has been a relatively little systematic analysis of women's health in these societies. Moreover, there are a number of dimensions of women's health that have been underappreciated by public health researchers and development experts due to systematic gender biases in health research. This article seeks to provide a more complete picture of women's health in Kerala and Sri Lanka by explicitly addressing three key gender biases: inattention to health issues that particularly affect women, incomplete approaches to understanding the health of women and insufficient attention paid to the interactions between gender and other social stratification, such as class, ethnicity or caste.     

An ecological model for understanding culture as a determinant of women's health

In combination with gender and culture, the authors argue that the migratory experience must be considered as a determinant of the health of immigrant women in its own right. Gender and other symbolic institutions are seen as intertwined in an ecological model of health. Bronfenbrenner's (1986 Bronfenbrenner, U. 1986. Ecology of the family as a context for human development: research perspectives. Developmental Psychology, 22(6): 723–742. [Crossref], [Web of Science ®] [Google Scholar]) systems theory and a combination of theories of social cognition, social exchange and symbolic interaction articulated by Howard and Hollander (1997 Howard, JA and Hollander, J. 1997. Gendered Situations, Gendered Selves, Thousand Oaks, CA: Sage.  [Google Scholar]) expand the ecological model. Cognitive schemas of gender and culture help explain the process of integration in a new locality over time. Success in addressing the health of immigrant women will be limited if the impact of migration and at the meso- and macro-levels is ignored in favour of a focus on the individual.     

Empirical evidence suggests adverse climate events have not affected Australian women's health and well‐being

Objective: To compare the health and well‐being of women by exposure to adverse climate events. An Exceptional Circumstance declaration (EC) was used as a proxy for adverse climate events. The Australian government may provide financial support to people living in EC areas, i.e. areas experiencing a one in 20–25 year event (drought, flood or fire) that results in a severe, extended downturn in farm or farm‐related income. Methods: Data from 6,584 53–58 year old non‐metropolitan women participating in the 2004 survey of the Australian Longitudinal Study on Women's Health (ALSWH) were linked to EC data. Generalised linear models were used to analyse differences in SF‐36 General Health (GH) and Mental Health (MH) and perceived stress by EC for all women. Models were adjusted for demographic, health‐related and psychosocial factors potentially on the pathway between EC and health. Given that the effects on health were expected to be greater in vulnerable people, analyses were repeated for women with worse socioeconomic circumstances. Results: GH, MH and stress did not differ for the 3,366 women in EC areas and 3,218 women in non‐EC areas. GH, MH and stress were worse among vulnerable women (who had difficulty managing on available income) regardless of EC. Conclusion and implications: This research adds to the existing literature on climate change, associated adverse climate events and health, by suggesting that multiple resources available in high income countries, including government support and individual psychosocial resources may mitigate some of the health impacts of adverse climate events, even among vulnerable people.     

Social disparities in women's health service use in the United States: a population-based analysis

PurposePoor and disparate reproductive health outcomes in the United States may be related to inadequate and differential receipt of women's health care. We investigated trends in and determinants of adult U.S. women's health service use, 2006–2010.MethodsWe analyzed population data from 7897 women aged 25–44 years in the National Survey of Family Growth from 2006 to 2010 using multivariable logistic regression.ResultsWomen's health service use in the past year was reported by 74% of the sample. Among noninfertile, sexually active women, 47% used contraceptive services; fewer used pregnancy (21%) and sexually transmitted infection (14%) services. In multivariable models, the odds of service use were greater among older, poor, unemployed women and women with less educational attainment than younger and socioeconomically advantaged women. Black women had greater odds of using pregnancy, sexually transmitted infection and gynecologic examination services than white women (odds ratio, 1.4–1.6). Lack of insurance was associated with service use in all models (odds ratio, 0.4–0.8).ConclusionsAlthough age-related differences in women's health service use may reflect fertility transitions, social disparities mirror reproductive inequalities among U.S. women. Research on women's health service use and outcomes across the reproductive life course and forthcoming sociopolitical climates is needed.     

The flip-side of social capital: the distinctive influences of trust and mistrust on health in rural China

Despite increasing evidence that social capital is positively associated with health, the pathways that link social capital to health are not definitive and invite further investigation. This paper uses household survey data from 22 villages in China in 2002 to test the relationship between social capital and the self-reported health status of the rural population. Focusing on the cognitive dimension of social capital, this paper complements current social capital research by introducing an overlooked distinction between trust and mistrust. Trust and mistrust are measured at the individual and aggregate levels, and the distinct ways in which they affect general and mental health are explored. We adopt an ordered logistic regression using survey procedures in SAS version 9.1 to account for the stratified and clustered data structure. The results suggest that: (1) individual-level trust and mistrust are both associated with self-reported health in rural China--trust is positively associated with both general health and mental health, while mistrust is more powerfully associated with worse mental health; and (2) the effects of individual-level trust and mistrust are dependent on village context--village-level trust substitutes for individual-level trust, while individual-level mistrust interacts positively with village-level mistrust to affect health. However, an unexpected protective health effect of mistrust is found in certain types of villages, and this unique result has yet to be examined. Overall, this study suggests the conceptual difference between trust and mistrust and the differential mechanisms by which trust and mistrust affect health in rural China. It also suggests that effective policies should aim at enhancing trust collectively or reducing mistrust at the personal level to improve health status in rural areas of China.     

中国农村基本卫生保健工作发展与思考

目的：了解我国农村地区基本卫生保健工作的现状,以及在新世纪第一个十年中取得的成绩和存在的问题,为进一步推进农村基本卫生保健工作提出有针对性的政策建议。方法：按照分层抽样的方法,在全国选择400个县级行政单位,收集当地农村基本卫生保健工作的相关数据。结果与发现：（1）农村基本卫生保健工作得到政府重视,但财政保障仍不足;（2）乡村两级医疗卫生服务体系建设仍需不断完善;（3）基本公共卫生服务在医改政策推动下进展明显,后续要加大力度推进;（4）新型农村合作医疗制度不断完善;（5）基本药物制度实施使基层医疗卫生机构面临发展困境。     

Condom use as situated in a risk context: women's experiences in the massage parlour industry in Vancouver,Canada

Investigation into condom use in sex work has aroused interest in health promotion and illness prevention. Yet there remains a dearth of inquiry into condom use practices in the indoor sex industry, particularly in North America. We performed a thematic analysis of one aspect of the indoor sex work by drawing on data from a larger mixed-methods study that investigated women's health issues in the massage parlour industry in Vancouver, Canada. Using a risk context framework, condom use was approached as a socially situated practice constituted by supportive and constraining dynamics. Three analytic categories were identified: (1) the process of condom negotiation, (2) the availability of condoms and accessibility to information on STI and (3) financial vulnerability. Within these categories, several supportive dynamics (industry experience and personal ingenuity) and constraining dynamics (lack of agency support, client preferences, limited language proficiency and the legal system) were explored as interfacing influences on condom use. Initiatives to encourage condom use must recognise the role of context in order to more effectively support the health-promoting efforts of women in sex work.     

Stability in women's experiences of hassles and uplifts: A five-year follow-up survey

Hassles and uplifts, a concept used in measuring daily stress events, was applied to working mothers’ everyday life. The aim was to explore the stability in working mothers’ experiences in patterns of daily occupations, operationalized as hassles and uplifts, between the year 2000 (baseline) and the year 2005 (follow-up). Further, the intention was to reveal possible differences in the number, origins, and ratings of hassles or uplifts between baseline and follow-up. The baseline study comprised 100 women, of whom 77 agreed to participate in the follow-up study. At baseline the questionnaire THU-5 was applied in the form of an interview, and at follow-up it was adapted to a self-response questionnaire sent home to the respondents. Stability was explored qualitatively by investigating the reported causes of hassles and uplifts, and quantitatively by comparing the numbers and ratings of the experiences at baseline and at follow-up. The results indicate a certain amount of stability, although the cause of the experiences changes in line with changes in life stage. It was concluded that the methodology used (THU-5 and THU-3) was sensitive to these changes and could be applied in clinical settings, providing occupational therapists with a tool for detecting daily hassles that could be dealt with. Likewise, detected uplifts can be useful in the process of re-designing patterns of daily occupations affected by stress.     

Disability and health status: ethnic differences among women in the United States

STUDY OBJECTIVES: There are few data describing disability and health status for ethnic groups. The disablement process involves social influences, which may include minority status. Cross sectional data were examined to investigate the relation of ethnicity to disability. DESIGN: A stratified random digit dialled sample of women aged 40 and older. Disability and health status were measured as functional and activity limitations, work disability, and days of poor physical and mental health. SETTING: United States. PARTICIPANTS: Women interviewed by telephone included 774 white, 749 African-American, 660 Hispanic, and 739 Native American women. MAIN RESULTS: The prevalence of disability was higher among minority women when classified by general health status, and the need for personal care assistance. There was a striking excess of work disability: 3.5% of white women compared with 7.1% to 10.3% for minority women. The differences were reduced when adjusted for other risk factors and socioeconomic status. White and minority women reported more similar disability when it was defined by poor mental and physical health days. CONCLUSIONS: Disability is correlated with social and demographic characteristics as well as medical diagnoses. Ethnicity also is associated with disability and may be part of a social context for disablement. Future research should concentrate on the temporal sequence of disability. Consistent definitions of disability will facilitate this research.     

Planning for Future Care Needs: Experiences of Unmarried Heterosexual and Sexual Minority Women

This study examined the experiences of legally unmarried, middle-aged and older sexual minority (e.g., lesbian, bisexual) and heterosexual women in planning for future care needs and long-term assistance. A total of 215 women (90 sexual minority women and 125 heterosexual women) 41–78 years of age completed a survey about long-term care planning strategies, including: (1) executing a will; (2) naming a health care proxy; (3) purchasing long-term care insurance; and (4) discussing potential living arrangements with at least one family member. Overall, 18.5% of women reported completing zero of the strategies, and 3.4% reported completing all four. Over half (59%) had completed at least two strategies. Women were most likely to have executed a will (68%) and named a health care proxy (61%). Both sexual minority women and heterosexual women were most likely to have talked to a family member of choice, rather than a biological family member about living with them if they were unable to care for themselves. Currently, serving as a health care proxy was an important correlate for having made long-term care plans and was particularly important for sexual minority women. Women who are not in traditional marriage relationships tend to adopt long-term care planning strategies that legally clarify and establish the nature of their important relationships.     

What anatomy shall we teach medical and dental students in a primary health care curriculum?

The opinions of 142 doctors on the relevance of anatomy to the diagnosis and management of common clinical problems in their current medical and dental practice were analysed. This was in a bid to determine the relevant anatomy course content for the new primary health care oriented medical and dental curriculum of the College of Medicine, University of Lagos. The respondents gave high scores to the relevance of anatomy knowledge to the management of acute abdomen (mean = 3.5), dislocated shoulder (3.3), Colles' fracture (3.2), palmar space abscess (3.2), obstructed labour (3.2), carcinoma of the breast (3.2), ectopic pregnancy (3.1), flail chest (3.1) and upper respiratory obstruction (3.0). They gave minimal scores to helminthiasis (mean = 1.5) common cold and anaemia (1.6), sickle cell disease (1.7), gastroenteritis (1.8), dental abscess (2.0), hypertension (2.2) and asthma (2.2). A basis for selecting relevant anatomy course content is deduced for an undergraduate curriculum in which the responsibilities and competence of the graduates is known. A nationwide extension of the study, especially amongst general practitioners and first-line doctors in rural areas, would be useful for identification of health problems that require little or no knowledge of anatomy and which can be safely managed by lower cadres of health personnel, traditional practitioners and members of the lay community.