A common pathway toward women's health

Abstract

This paper calls for an alternate approach to studying the aetiology of women's health conditions. Instead of the long-established disease-specific, compartmentalized approach, it recommends focusing on risk exposures that allows for the identification of multiple disease conditions that stem from the same risk factors. Identifying common risk factors and the related pathways to adverse health outcomes can lead to the development of interventions that would favourably affect more than one disease condition. The utility of such an approach is illustrated by a review of literature from across the globe on the association between gender inequity-related exposures and women's health (namely, three health conditions: sexually transmitted infections [STIs], including Human Immunodeficiency Virus [HIV], blindness, and depression; as well as two risk behaviours: eating disorders and tobacco use). The review demonstrates how women's health cannot be viewed independently from the larger social, economic, and political context in which women are situated. Promoting women's health necessitates more comprehensive approaches, such as gender-sensitization of other family members, and the development of more creative and flexible mechanisms of healthcare delivery, that acknowledge the gender inequity-related constraints that women face in their daily lives.     

Experiences of social work intervention among mothers with perinatal mental health needs

Perinatal mental health difficulties are prevalent among women, and the vulnerability of young infants makes this a time when families experiencing multiple adversities may be particularly likely to attract state intervention. However, very little is known about how mothers experience social work intervention during the perinatal period. This study explored experiences of social work intervention among women with perinatal mental health difficulties. Qualitative semi‐structured interviews were carried out with 18 women with 6‐ to 9‐month‐old babies, who had been treated in England for a perinatal mental health difficulty and also had social services intervention. Interviews were analysed using thematic analysis. Findings suggested that mothers had a predominantly negative view of children's social services, especially when social workers had significant child protection concerns. The fear of being judged an unfit mother and having their babies taken away overshadowed their encounters. Mothers felt that social workers would not accept they could be good mothers in spite of their difficulties and set them up to fail. Some felt that social workers focused exclusively on the risks to the baby and did not acknowledge the mother's own needs or understand perinatal mental health. In some cases, social work intervention was described as intensifying pressure on mothers’ mental health, leading to escalating difficulties and increased likelihood of care proceedings. At the same time, our study also included examples of mothers forming positive relationships with social workers, and of ‘turning points’ where initially negative interactions stabilised and child protection concerns lessened. Women's accounts highlighted the importance of feeling ‘known’ by social workers who understood and respected them. The findings also suggested there may be value in improving collaboration between social workers and mental health professionals to create more space for representation of women's needs as well as those of their babies.     

Global frameworks,local strategies: Women's rights,health, and the tobacco control movement in Argentina

ABSTRACT

The article examines how civil society organisations in Argentina used the United Nations Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) to frame the country's failure to enact strong national tobacco control legislation as a violation of women's rights in the late 2000s. We analyze this case study through the politics of scale, namely the social processes that produce, reproduce, and contest the boundaries of policies and socio-economic relations. This approach understands how multiple scales overlap and connect to obstruct or enhance the right to health in Latin America. In Argentina, the global organisation of tobacco companies, the reach of international financial institutions and the national dynamics of economic austerity and export-orientation promoted the local production and use of tobacco (leaf and cigarettes) and reproduced health inequalities in the country throughout the 1990s and the early 2000s. Yet, the visible legacy of local and national human rights struggles in the adoption of international human rights treaties into Argentina's national constitution allowed the tobacco control movement to link the scale of women's bodies to the right to health through the use of CEDAW to change national legislation, tackling the social determinants of the tobacco epidemic.     

Women's health theorizing: a call for epistemic action

The women's health community is challenged by global social and economic pressures. In order to ensure the salience of their empirical and theoretical research, women's health researchers are struggling with an analysis of what has successfully typified women's health and a critical awareness of the pressures that will mark its future. For many researchers, this has provoked a quest for new women's health paradigms to inform and spur action regarding the future of women's health. Re-theorizing women's health cannot be successful in the absence of an analysis of the epistemological orientation of women's health research. However, little has been done to examine these epistemological roots. This paper examines the historic epistemological foundation of women's health research in order to facilitate an understanding of the theoretical and conceptual underpinnings of women's health. This review is intended to guide future epistemic action necessary to advance the field of women's health research and highlight current efforts that may support work in this field.     

Don't let the suffering make you fade away: An ethnographic study of resilience among survivors of genocide-rape in southern Rwanda

Rape has been used in contemporary armed conflicts to inflict physical, psychological, cultural and social damage. In endeavoring to address the psychological damage of collective violence, some researchers and global health practitioners are turning toward post-conflict mental health promotion approaches that centrally feature resilience. Though previous findings from resilience and coping research are robust, few studies have actually investigated resilience among genocide-rape survivors in cultural context in non-Western settings. This paper presents ethnographic data gathered over 14 months (September 2005 to November 2006) in southern Rwanda on resilience among genocide-rape survivors who were members of two women's genocide survivor associations. Study methods included a content analysis of a stratified purposive sample of 44 semi-structured interviews, as well as participant-, and non-participant-observation. Resilience among genocide-rape survivors in this context was found to be shaped by the cultural-linguistic specific concepts of kwihangana (withstanding), kwongera kubaho (living again), and gukomeza ubuzima (continuing life/health), and comprised of multiple sociocultural processes that enabled ongoing social connection with like others in order to make meaning, establish normalcy, and endure suffering in daily life. The results of this research show that the process of resilience among genocide-rape survivors was the same regardless of whether genocide survivor association membership was organized around the identity of genocide-rape survivorship or the identity of widowhood. However, the genocide-rape survivors' association members were more involved with directing resilience specifically toward addressing problems associated with genocide-rape compared to the members of the genocide widows' association. The findings from this research suggest that ethnographic methods can be employed to support resilience-based post-conflict mental health promotion efforts through facilitating collective sexual violence survivors to safely socially connect around their shared experiences of rape, neutralizing social threats of stigma and marginalization.     

Male farmers with mental health disorders: A scoping review

The issue of male farmers' mental health raises many concerns including high rates of psychological distress and suicide amid the poor uptake of health services among this subgroup. Gender is an important social determinant of health, and this paper provides an overview of connections between farming and masculinities in the context of men's mental health disorders. This scoping review summarises findings drawn from 46 studies to discuss male farmers' mental health disorders, psychosocial interventions and barriers to help‐seeking. In providing the review, recommendations are made including the need for an array of study and intervention approaches to advance the mental health and well‐being of male farmers and their families.     

Beyond “toxic bodies”: Multiplied rationalities of women's reproductive health in a high-risk environmental area (Taranto,Italy)

This study investigates women's reproductive health concerns in Taranto, a steel town and a “high-risk environmental area” in Italy. It draws on participatory ethnographic research (body mapping, interviews and fieldnotes) and analyses political and social aspects of women's reproductive health in relation to pollution. I argue that in highly polluted environments, both political rationalities and women's health concerns over their bodies are multiplied, extending beyond a focus on their bodies as shaped by toxic exposure. Women make sense of knowledge about their reproductive health and questions of responsibility in relation not only to societal norms, but also through reference to the wider polluted environment and the political-economic structures they inhabit. By focusing on women's own experiences, the study contributes to our understanding of women's agency over their environment-health relations and seeks to complicate women's role as environmental subjects beyond “toxic bodies”.     

(Not) talking about sex: couple reports of sexual discussion and expression in Bangalore,India

Adolescent marriage is common in India, placing young women at risk of HIV, early pregnancy and poor birth outcomes. Young women's capacity to express their sexual desires is central to negotiating safe and mutually consensual sexuality. Men, too, play an important role in shaping women's sexual and reproductive health outcomes, but little research has examined how men influence women's sexual expression. Using paired husband and wife data, this paper reports on a preliminary investigation into the patterns of and concurrence between women's sexual expression and their husbands' attitudes about it, as well as the influence of men's approval of their wives' sexual expression on women's actual expression of sexual desire. The results suggest that, among this sample, men are more open to sexual expression than their wives and that, for women, expressing desire not to have sex is far more common than expressing desire to have sex. Further, men's approval of sexual expression from wives appears to positively influence women's actual expression. These findings suggest that men may be resources for women to draw upon as they negotiate sexuality in adolescence and early adulthood.     

My body,my self

This satirical paper gives the reader a tour of the author's own body with appropriate caveats regarding social emphasis on women's outward appearance at the expense of health, comfort, and creative work. The decision about whether a woman should give in to social pressure and follow fashion, or opt for mental and physical health is within the power of the body's owner; in other words, “my self.”;     

Locality,loneliness and lifestyle: a qualitative study of factors influencing women's health perceptions

The contribution of women to the achievement of global public health targets cannot be underestimated. It is well evidenced that within families, women are a key influence on the health and well‐being of their children and partners. However, geographical differences in women's health inequalities persist and research focusing specifically on women's perceptions of locality factors influencing their own health and well‐being is scarce. This paper presents an interpretive, qualitative research study undertaken in 2011 with a group of women living in one locality in the North East of England in the United Kingdom which aimed to better understand their health and well‐being perceptions and locality influences on it. Fifteen women participated in two focus groups and six individual, semi‐structured interviews. Thematic analysis yielded four key themes: health and well‐being perceptions; mental resilience; low income and choice; and influence of place. The influence of women's geographical location in relation to amenities and services and loneliness were recurring factors in the discussion, each influencing lifestyle. It was evident that women in their local context were themselves assets through which their own physical and mental health could be improved. However, women's perceptions of protective factors and their influences on health and well‐being varied. Connecting with women in the context of their immediate living circumstances and understanding their perceptions as individuals are important first steps in the process of gaining consensus and mobilising their assets to collectively build healthy local communities.     

Understanding gendered influences on women's reproductive health in Pakistan: Moving beyond the autonomy paradigm

Recent research and policy discourse commonly view the limited autonomy of women in developing countries as a key barrier to improvements in their reproductive health. Rarely, however, is the notion of women's autonomy interrogated for its conceptual adequacy or usefulness for understanding the determinants of women's reproductive health, effective policy formulation or program design. Using ethnographic data from 2001, including social mapping exercises, observation of daily life, interviews, case studies and focus group discussions, this paper draws attention to the incongruities between the concept of women's autonomy and the gendered social, cultural, economic and political realities of women's lives in rural Punjab, Pakistan. These inadequacies include: the concept's undue emphasis on women's independent, autonomous action; a lack of attention to men and masculinities; a disregard for the multi-sited constitution of gender relations and gender inequality; an erroneous assumption that uptake of reproductive health services is an indicator of autonomy; and a failure to explore the interplay of other axes of disadvantage such as caste, class or socio-economic position. This paper calls for alternative, more nuanced, theoretical approaches for conceptualizing gender inequalities in order to enhance our understanding of women's reproductive wellbeing in Pakistan. The extent to which our arguments may be relevant to the wider South Asian context, and women's lives in other parts of the world, is also discussed.     

Modelling the effects of intimate partner violence and access to resources on women's health in the early years after leaving an abusive partner

Although the negative health effects of intimate partner violence (IPV) are well documented, little is known about the mechanisms or determinants of health outcomes for women who had left their abusive partners. Using data collected from a community sample of 309 Canadian women who left an abusive partner, we examined whether women's personal, social and economic resources mediate the relationships between the severity of past IPV and current health using structural equation modelling. A good fit was found between the model and data for hypothesized models of mental and physical health. In the mental health model, both the direct and total indirect effects of IPV were significant. In the physical health model, the direct effect of IPV on physical health was about four times as large as the total indirect effects. In both models, more severe past IPV was associated with lower health and women's personal, social, and economic resources, when combined, mediated the relationship between IPV and health. These findings demonstrate that the health outcomes of IPV for women who have left an abusive partner must be understood in context of women's resources.     

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.     

Investigating global mental health: Contributions from political science

ABSTRACT

This article outlines an agenda for political science engagement with global mental health. Other social sciences have tackled the topic, investigating such questions as the link between poverty and mental health disorders. Political science is noticeably absent from these explorations. This is striking because mental health disorders affect one billion people globally, governments spend only about 2% of their health budgets on these disorders, and most people lack access to treatment. With its focus on power, political science could deepen knowledge on vulnerabilities to mental illness and explain weak policy responses. By illustrating how various forms of power pertaining to governance, knowledge, and moral authority work through the concepts of issue framing, collective action, and institutions, the article shows that political science can deepen knowledge on this global health issue. Political science can analyse how incomplete knowledge leads to contentious framing, thus hobbling advocacy. It can explain why states shirk their obligations in mental health, and it can question how incentives drive mental health mobilisation. The discipline can uncover how power undergirds institutional responses to global mental health at the international, national, and community levels. Political science should collaborate with other social sciences in research networks to improve policy outcomes.     

Socio-economic status and overall and cause-specific mortality in Sweden

Background

HIV prevalence in north-east India is high and injecting drug use (IDU) is common. Due to HIV-related deaths there are increasing numbers of IDU widows, many of whom are HIV infected, and experiencing poor health, social isolation, discrimination and poverty, all factors likely to be compromising their mental health. There is increasing recognition of the links between HIV and mental health.

Methods

The aim of this study was to pilot a peer-facilitated, participatory action group (PAG) process and assess the impact of the intervention on the mental health of participants. The intervention consisted of 10 PAG meetings involving 74 IDU widows. Changes in quality of life (WHOQOL-BREF), mental health (GHQ12) and somatic symptoms were assessed. The value of the intervention from the perspective of the participants was captured using a qualitative evaluation method (Most Significant Change).

Results

Participants' quality of life, mental health and experience of somatic symptoms improved significantly over the course of the intervention, and the women told stories reflecting a range of 'significant changes'.

Conclusion

This pilot intervention study demonstrated that a participatory approach to mental health promotion can have a positive impact on the lives of vulnerable women, and the potential to contribute to HIV prevention. Further investigation is warranted.     

Implementing Health Policy: Lessons from the Scottish Well Men's Policy Initiative

BackgroundLittle is known about how health professionals translate national government health policy directives into action. This paper examines that process using the so-called Well Men''s Services (WMS) policy initiative as a ‘real world’ case study. The WMS were launched by the Scottish Government to address men''s health inequalities. Our analysis aimed to develop a deeper understanding of policy implementation as it naturally occurred, used an analytical framework that was developed to reflect the ‘rational planning’ principles health professionals are commonly encouraged to use for implementation purposes.Methods and materialsA mixed-methods qualitative enquiry using a data archive generated during the WMS policy evaluation was used to critically analyze (post hoc) the perspectives of national policy makers, and local health and social care professionals about the: (a) ‘policy problem’, (b) interventions intended to address the problem, and (c) anticipated policy outcomes.Results and conclusionsThis analysis revealed four key themes: (1) ambiguity regarding the policy problem and means of intervention; (2) behavioral framing of the policy problem and intervention; (3) uncertainty about the policy evidence base and outcomes, and; (4) a focus on intervention as outcome. This study found that mechanistic planning heuristics (as a means of supporting implementation) fails to grapple with the indeterminate nature of population health problems. A new approach to planning and implementing public health interventions is required that recognises the complex and political nature of health problems; the inevitability of imperfect and contested evidence regarding intervention, and, future associated uncertainties.     

Polygamy and poor mental health among Arab Bedouin women: do socioeconomic position and social support matter?

Objectives. Polygamy is a complex phenomenon and a product of power relations, with deep cultural, social, economic, and political roots. Despite being banned in many countries, the practice persists and has been associated with women's marginalization and mental health sequelae. In this study, we sought to improve understanding of this ongoing, complex phenomenon by examining the contribution of socioeconomic position (SEP) and social support to the excess of depressive symptoms (DS) and poor self-rated health (SRH) among women in polygamous marriages compared to women in monogamous marriages. Measuring the contribution of these factors could facilitate policies and interventions aimed at protecting women's mental health.

Design. The study was conducted among a sample of Arab Bedouin women living in a marginalized community in southern Israel (N=464, age 18–50). The women were personally interviewed in 2008–2009. We then used logistic regression models to calculate the contribution of SEP (as defined by the women's education, family SEP, and household characteristics) and social support to excess of depressive symptoms and poor SRH among participants in polygamous versus monogamous marriages.

Results. About 23% of the participants were in polygamous marriages. These women reported almost twice the odds of depressive symptoms (OR=1.91, 95%CI=1.22, 2.99) and poorer SRH (OR=1.73, 95%CI=1.10, 2.72) than those in monogamous marriages. Women's education changed these associations slightly, but family SEP and household characteristics resulted in virtually no further change. Social support reduced the odds for poor SRH and DS by about 23% and 28%, respectively.

Conclusion. Polygamy is associated with higher risk for poor mental health of women regardless of their SEP and education. Social support seems to have some protective effect.     

Función familiar y salud mental del cuidador de familiares con dependencia

ObjectiveTo analyse the influence of family function on the caregiver's perceived mental health.DesignCross-sectional study.SettingTwo primary care urban health centres.Participants153 caregivers of dependent people.MeasurementSociodemographic variables of caregiver and dependent relative and psychoactive drugs prescribed to caregiver. Caregiver questionnaires: mental health evaluated with General Health Questionnaire (GHQ-12), family function with adaptation, partnership, growth, affection and resolve (APGAR), and Duke University-University of North Carolina functional social support questionnaire. Care-recipient questionnaires: cognitive disorders with Pfeiffer and functional dependence level with Barthel.ResultsCaregiver's mean age was 63.8 years; 72.5% (n=111) were female; 57.5% have only primary school studies; and 37.1% take psychoactive drugs. More than 40% of the care-receivers have cognitive disorders and 49.7% have total functional impairment. According to the GHQ-12, 27% of the caregivers had mental health disorders; 31.3% of the families were dysfunctional and 32.7% had poor social support. The variables that significantly contributed to the explanation of caregiver's mental health have been: psychoactive drug intake, family function, social support and educational level.ConclusionFamily function is an important predictor of caregiver's mental health.     

Climate change,women's workload in smallholder agriculture,and embodied political ecologies of undernutrition in northern Ghana

The burden of child undernutrition across Africa remains extraordinarily high. Among children under age five, chronic and acute undernutrition is responsible for more ill-health than any other cause. While climate change exacerbates the multiple burdens of undernutrition, we know very little about the embodied effects on women's workload in agriculture and implications for feeding practices, especially for infants whose nutrition depends on mothers' time. In this article, political ecologies of health, with its nested, place-based analysis, is used as a framework to address this knowledge gap. The study took place in Ghana's Upper West Region, a semi-arid and resource-poor setting with higher undernutrition rates. In-depth interviews were conducted with smallholder farmers (n = 33) whose infants have sub-optimal growth, and key informants (n = 7) with expertise in nutrition and health. Findings from the study demonstrate how climate change puts pressure on women's productive time, leading to poor child feeding practices and undernutrition. Ultimately, the article argues that there are hidden impacts of climate change on undernutrition. Global undernutrition interventions should therefore move beyond biomedical solutions to address these hidden impacts, some of which are social, gendered, and structural in nature.     

Disrupted Lives,Fragmented Care: Illness Experiences of Criminalized Women

ABSTRACT

Thirty-three women recently released from a Massachusetts correctional facility were included in a qualitative study, carried out between January and July 2007, in which semi-structured, open-ended, individual interviews were conducted. The women described lives repeatedly disrupted, typically by sexual and physical violence, and then again by homelessness, joblessness, bad relationships, loss of their children, legal troubles, fractured physical and mental health, and fragmented medical attention by a large, disjointed variety of providers and facilities. This article argues that rather than repairing life disruptions, the women's fragmented health care histories tended to echo or even become part of that fragmentation. We suggest that criminalization and medicalization actually served as two sides of the same coin in the women's life experiences.