ICPD: in whose interest?

The International Conference on Population and Development (ICPD) is set for September 1994. Arms control and control of military interests are as crucial as population control. The expenditure on the military and arms should go to social measures and true socioeconomic development. Women are leading the movement against war and towards peace. Women make up 70% of current refugees of ethnic conflicts. The conquest of free trade with little or no restriction and globalization trends forces developing countries to accept nonessential luxury items which tend to be irrational, hazardous consumer articles and technologies from industrialized countries. The privileged elite in developing countries and the industrialized countries overconsume, while the basic needs of the poor majority are not being met. The rich view the poor as a global threat and a threat for environmental degradation. They believe that free trade will solve all problems, yet it only marginalizes the poor and the vulnerable. The pattern of overconsumption is the threat. The poor are characterized as demons responsible for the population explosion. Women are angry that population control policies are attempts to control women's fertility. Specifically, most contraceptive technologies and most family planning programs target women. Male responsibility is ignored. Religious fundamentalists tell women not to become pregnant, not to use contraception, and not to seek abortion, yet they allow male sex behavior, e.g., sexual violence. This attitude leaves women vulnerable to unwanted pregnancies, sexually transmitted diseases, and AIDS. Developing countries should be concerned about chapter III on Population, Environment, and Development in the ICPD text. Most countries, including India, have formed a consensus on this chapter. The Vatican and some Latin American countries have objections, however. The meeting in Cairo will likely continue to promote the view that the fertility of women in developing countries and of women of color must be controlled.     

Abortion and anxiety: What's the relationship?

Using data from the United States National Survey of Family Growth (NSFG) and the National Comorbidity Survey (NCS), we conducted secondary data analyses to examine the relationship of abortion, including multiple abortions, to anxiety after first pregnancy outcome in two studies. First, when analyzing the NSFG, we found that pre-pregnancy anxiety symptoms, rape history, age at first pregnancy outcome (abortion vs. delivery), race, marital status, income, education, subsequent abortions, and subsequent deliveries accounted for a significant association initially found between first pregnancy outcome and experiencing subsequent anxiety symptoms. We then tested the relationship of abortion to clinically diagnosed generalized anxiety disorder (GAD), post-traumatic stress disorder (PTSD), and social anxiety disorder, using NCS data. Contrary to findings from our analyses of the NSFG, in the NCS analyses we did not find a significant relationship between first pregnancy outcome and subsequent rates of GAD, social anxiety, or PTSD. However, multiple abortions were found to be associated with much higher rates of PTSD and social anxiety; this relationship was largely explained by pre-pregnancy mental health disorders and their association with higher rates of violence. Researchers and clinicians need to learn more about the relations of violence exposure, mental health, and pregnancy outcome to avoid attributing poor mental health solely to pregnancy outcomes.     

Apology for errors: whose responsibility?

When things go wrong during a medical procedure, patients' expectations are fairly straightforward: They expect an explanation of what happened, an apology if an error was made, and assurance that something will be done to prevent it from happening to another patient. Patients have a right to full disclosure; it is also therapeutic in relieving their anxiety. But if they have been harmed by our mistake, they also need an apology to maintain trust. Apology conveys respect, mutual suffering, and responsibility. Meaningful apology requires that the patient's physician and the institution both take responsibility, show remorse, and make amends. As the patient's advocate, the physician must play the lead role. However, as custodian of the systems, the hospital has primary responsibility for the mishap, for preventing that error in the future, and for compensation. The responsibility for making all this happen rests with the CEO. The hospital must have policies and practices that ensure that every injured patient is treated the way we would want to be treated ourselves--openly, honestly, with compassion, and, when indicated, with an apology and compensation. To make that happen, hospitals need to greatly expand training of physicians and others, and develop support programs for patients and caregivers.     

Abortion utilization: does travel distance matter?

The further a woman must travel in order to obtain an abortion, the less likely she is to get one. Distance is especially disadvantageous to blacks, and most so to black teenagers. Distance discourages use among rural as well as urban women. Opening new clinics increases abortion use in nearby communities.     

Smart care technologies: meeting whose needs?

Recent funding programmes supporting research and development in telecare have argued for a shift in perspective from a technology-driven approach to one that is needs-led. While this is in the interests of both users and technologists, achieving this goal is not straightforward. This paper outlines some of the conceptual, methodological and practical problems that potentially constrain a needs-led approach and illustrates the emergent issues with a case study of the development of an intelligent home monitoring system to support the independent living of older people. The research indicates clear differences between users and technologists in the way problems, needs and requirements are understood and defined. This in turn has consequences for the way assistive technologies are developed and implemented.     

MMR--public policy in crisis: whose tragedy?

PURPOSE: To explore the issues surrounding the falling rates of MMR vaccination followingthe publication of a controversial study by Wakefield et al. DESIGN/METHODOLOGY/APPROACH: In order to take a fresh look at the MMR crisis, theGreek tragedy, Antigone, was used as a "strong plot" to de-contextualise the underlying social and political issues. In this short paper, two themes are explored that emerge from reading Antigone with respect to the unfolding crisis of public confidence in the MMR vaccine: first, the challenge to government inthe form of a decrease in public trust in government and government policies; and second, how such a challenge assumes significance and, arising from that, the question of how one might respond to the challenge. FINDINGS: The MMR debate throws issues of importance to society into relief--for example,public trust in government and science; and notions of public good versus rational choice in public policy on vaccination, However, much of the debate has been polarised into good versus evil--good and evil being subjective positions that are interchangeable, depending on the side one favours. It is argued that the issues are more complex than this, and are as much to do with political consent and the bargain between citizen and state. ORIGINALITY/VALUE: Using "strong plots" to theorise about current issues is powerful because it allows one to explore them from different angles and challenge one's understanding. Antigone provides us with a way of standing back from the MMR crisis and re-conceptualising the issues to capture the essence of the underlying debate.     

Teenage pregnancy: whose problem is it?

BACKGROUND: The UK has the highest rates of teenage conception in Europe. Teenage conception has been identified in medical literature as a problem for society and teenagers. However, little attempt has been made to see it from the perspective of the teenagers themselves. OBJECTIVE: To explore teenage women's attitudes to sexual health, contraception and pregnancy. METHODS: Ethnographic qualitative study based on in-depth interviews and participant observation. The study took place in young mothers' groups, young persons' clinics and general practices in Bristol. Subjects were 34 young women between the ages of 16 and 20, sampled purposefully in two groups to include young mothers and never-pregnant young women from advantaged and disadvantaged socioeconomic backgrounds. RESULTS: The two groups did not differ in their use of contraception at first intercourse. Young women from more socioeconomically advantaged backgrounds felt that motherhood would not be acceptable to them, but were more tolerant to others who became young mothers. The pregnant/ young mothers revealed more difficulties getting access to reliable contraceptive services, and dissatisfaction with sex education in schools. The pregnant/young mothers found abortion to be less acceptable than the more socially advantaged group. Both groups reported sexual behaviour that involved risks of becoming pregnant, but the more socially advantaged group were more likely to use emergency contraception. CONCLUSIONS: The study demonstrates the importance of taking the views of young people into account when planning both sex education and the provision of contraceptive services.