Yu Duan practices as embodying tradition, modernity and social change in Chiang Mai, Northern Thailand

In this paper I examine the traditional postpartum beliefs and practices which still exist in northern Thailand today. The paper is based on qualitative research involving in-depth interviews with 30 women in Chiang Mai province. Beliefs and practices remain an essential part for postpartum care for women and have important consequences for women's health and wellbeing in northern Thailand. Many Thai women see their reproductive health problems as the consequence of inadequate postpartum practices. Thai women also believe that the effects of postpartum taboos would continue for the rest of their lives. Although the traditional postpartum beliefs and practices abound, the level of adherence differs according to the social structure of the women and their families. Poor rural women seem to hold on to their traditions more strongly than their urban counterparts. Urban middle class women in particular embody modernity in their thinking and behaviours concerning postpartum practices. But modernization has brought with it medical dominance. Due to their medical knowledge, doctors retain authority over both knowledge and status. The consequence of this dominance is the attempt to dismiss local traditional knowledge and practices. Although the pattern of traditional postpartum beliefs and practices is changing, it is still observed in northern Thailand. I contend that postpartum care for women incorporates local traditions so that women's health can be optimized at the time when they are in the most vulnerable stage of their lives.     

African women act on AIDS

In Africa, normally women bear a disproportionate burden since they must perform their roles as individuals, mothers, and health care providers, but now they must also deal with their own HIV infection or that of family members. In 1988, the Society for Women and AIDS in Africa (SWAA) emerged because there was a need for women to address these concerns, specifically the gaps between men and women in information and education messages, interventions, AIDS policy and program development, and use in prevention initiatives. SWAA pursues prevention activities that consider the deeply rooted cultural beliefs and sensitivities of these women and their socioeconomic realities. It believes that once women have appropriate knowledge and are aware of their problem solving options, they will make decisions that bring about a change in actions which reduce their risk of HIV infection and risk behaviors of their partners and family members. Some of their activities involve motivating women to eliminate or modify practices that put them at risk of HIV infection, e.g., male promiscuity and wife sharing, change traditional norms that make women sexually submissive and nonassertive, and curb female prostitution. SWAA has 5 different regions and the country level is the operational base. Each of the 23 countries designs and executes its own programs, usually with women's health groups. It is branching out into women support networks, counseling, home and community care of AIDS patients, etc. It has been somewhat successful in reducing the misconception that prostitutes are the key transmitters of HIV. SWAA continues to work towards a positive working relationship with the basically male controlled institutions responsible for AIDS policy development.     

Promoting women's health: redefining the knowledge base and strategies for change.

Promoting women's health involves undertaking a critical gender-based analysis of women's health status and health needs and the knowledge bases which underlie health promotion action. The authors argue that professional and lay definitions of health problems often differ and that these differences stem from a differential emphasis on existing knowledge bases. Here the authors explore the focus of epidemiological, clinical, and experiential knowledge and suggest ways in which each does or does not address many key health issues which women themselves identify as important. Attention is also directed towards women's own suppressed and devalued knowledge as embodied in traditional folk practices and alternative care forms. Recommendations are made to improve existing knowledge bases by transforming some of the value orientations, priorities, methods and the social organization of research. The authors suggest that positive health promotion strategies must be based on an improved knowledge base and must incorporate three key concepts which women emphasize as central--self determination, women-centred values, and a gender-based political analysis. Strategies and methods to achieve these ends are suggested for health educators and policy-makers who wish to develop more positive approaches to promoting women's health.     

¿Voices of Fear and Safety¿ Women¿s ambivalence towards breast cancer and breast health: a qualitative study from Jordan

ABSTRACT: BACKGROUND: Breast cancer is the leading cause of cancer mortality among Jordanian women. Breast malignancies are detected at late stages as a result of deferred breast health-seeking behaviour. The aim of this study was to explore Jordanian women's views and perceptions about breast cancer and breast health. METHODS: We performed an explorative qualitative study with purposive sampling. Ten focus groups were conducted consisting of 64 women (aged 20 to 65 years) with no previous history and no symptoms of breast cancer from four governorates in Jordan. The transcribed data was analysed using latent content analysis. RESULTS: Three themes were constructed from the group discussions: a) Ambivalence in prioritizing own health; b) Feeling fear of breast cancer; and c) Feeling safe from breast cancer. The first theme was seen in women's prioritizing children and family needs and in their experiencing family and social support towards seeking breast health care. The second theme was building on women's perception of breast cancer as an incurable disease associated with suffering and death, their fear of the risk of diminished femininity, husband's rejection and social stigmatization, adding to their apprehensions about breast health examinations. The third theme emerged from the women's perceiving themselves as not being in the risk zone for breast cancer and in their accepting breast cancer as a test from God. In contrast, women also experienced comfort in acquiring breast health knowledge that soothed their fears and motivated them to seek early detection examinations. CONCLUSIONS: Women's ambivalence in prioritizing their own health and feelings of fear and safety could be better addressed by designing breast health interventions that emphasize the good prognosis for breast cancer when detected early, involve breast cancer survivors in breast health awareness campaigns and catalyse family support to encourage women to seek breast health care.     

Promoting women's health: Redefining the knowledge base and strategies for change

Promoting women's health involves undertaking a critical gender-basedanalysis of women's health status and health needs and the knowledgebases which underlie health promotion action. The authors arguethat professional and lay definitions of health problems oftendiffer and that these differences stem from a differential emphasison existing knowledge bases. Here the authors explore the focusof epidemiological, clinical, and experiential knowledge andsuggest ways in which each does or does not address many keyhealth issues which women themselves identify as important.Attention is also directed towards women's own suppressed anddevalued knowledge as embodied in traditional folk practicesand alternative care forms. Recommendations are made to improveexisting knowledge bases by transforming some of the value orientations,priorities, methods and the social organization of research.The authors suggest that positive health promotion strategiesmust be based on an improved knowledge base and must incorporatethree key concepts which women emphasize as central–selfdetermination, women-centred values, and a gender-based politicalanalysis. Strategies and methods to achieve these ends are suggestedfor health educators and policy-makers who wish to develop morepositive approaches to promoting women's health.     

"Without money you're nothing": poverty and health in Mexico from women's perspective

The objective of this qualitative study was to get to know poor Mexican women's experience of poverty in relation to health care. Forty-nine interviews were carried out with poor adult women in Mexico (between 35 and 65 years old). Three central elements were detected in relation to the women's experience of poverty and health care: their socio-economic dependence on their family; the notion of social belonging in their experience with health care rights, reflected in the idea and acceptance that, due to their poverty, they can only be attended at philanthropic institutions; and the existence of survival mechanisms when facing an illness. In recovering the experience of poor women in relation to their health care, we identified that there is a clear idea that, if women had had economic resources, their health problem would have been solved differently. They are also convinced that, due to being poor, they have to content themselves with bad-quality medical care. This conformity finally makes them resign to the fact of either loosing a part of their own body, or even just waiting for death.     

孕妇的保健需求及其家庭亲密度和适应性

目的:了解城市孕妇对保健知识的了解和需求以及其家庭亲密度和适应性特征。方法:采用自制问卷及家庭亲密度和适应性量表对15所省、市妇幼保健机构中接受产前检查的4998名健康孕妇进行调查。结果:孕妇对保健知识有一定了解;对新生儿护理等操作实习及孕期心理健康问题的教育有普遍的需求,希望开展丈夫体验怀孕感受的活动;希望宣教方式多样化;孕妇亲密度和适应性的实际值均低于理想值,孕妇亲密度高于一般人群而适应性远低于一般人群;孕妇的文化程度和家庭收入对孕妇家庭类型可能有影响。结论:有必要开展孕期心理保健知识的宣教,调整宣教的方式,并开展科学合理的协调孕妇家庭亲密和对环境适应的活动。     

产妇月子行为和传统习惯及其影响因素

目的:探讨产妇月子传统习惯及其影响因素。方法:问卷调查与定性研究结合,对本市区产后42天左右的产妇776例问卷调查;定性研究采用半结构性访谈、关键人物访谈及专题小组讨论共调查63人次,其中半结构性访谈有产妇及其家人(丈夫、婆婆或母亲)36人,关键人物访谈有社区产后访视人员4人、中医4人,专题小组讨论有从事或负责社区产后访视工作的护理保健人员及中医19人。结果:776例产妇中,月子期间不洗头洗澡的有54.9%、不刷牙的有36.3%、不吃蔬菜的有19.3%、不吃水果的有36.1%,活动范围只能局限在居室内走动的为100%。主要是长辈的意愿及其传统观念起主导作用;产后访视次数对吃蔬菜的影响有显著性;产妇的文化程度和保健知识掌握程度与月子健康行为呈正相关。结论:从孕期、住院分娩、直至产后1个月内的家庭访视,要不断地向产妇及其婆婆、妈妈、丈夫等负责照顾产妇的家庭成员进行健康宣教,使保健知识不断得到强化,确立并形成产妇坐月子的健康行为,以利母婴身心健康。     

Typologies of rural lay-health advocacy among rural women in Australia

BACKGROUND: Public health advocacy effects changes in health behaviors and outcomes through applying health promotion expertise to specific groups. Advocacy occurs through the provision of tools to empower those who are either experiencing, or at risk of, a particular health status. RESEARCH OBJECTIVES: Health-care experiences of women living in rural Victoria, Australia, were explored in the context of generally poor access to reproductive health services. Women's experiences are investigated within the theoretical framework of lay-health advocacy, i.e. relying on individual health care experience and knowledge to promote and improve the health care of others. METHODOLOGY: The study applied a qualitative design, and a self-identified sample of women was recruited through network sampling techniques. Fifty-seven women participated in in-depth interviews. RESULTS: Three types of lay-health advocacy emerged. Advocacy-seekers expected the researchers to use their experiences of poor health-care to educate health professionals to provide better quality care. Advocacy providers used their knowledge and experiences to take an active part in promoting the health-care of other women. Story-tellers expected their narratives to empower other women or unidentified social groups to feel less isolated in their health care experiences. DISCUSSION: In providing narratives of their health-care, women were critical of social inequalities facing people living in rural Australia. Lay-health advocates offer a cost-effective and appropriate option for reducing adverse health outcomes within resource-poor settings. Informed by women's narratives, we suggest strategies to enhance rural women's health-care.     

重庆市农村未婚年轻成人父母对给未婚青年提供生殖健康服务的态度调查

目的：通过向未婚年轻成人的父母了解未婚年轻成人未得到生殖健康需求服务的成因，以确定给未婚年轻成人提供生殖健康服务的最佳途径和可行方法。方法：采用小组访谈法，对重庆市农村地区18-24岁有婚前性行为年轻成人的父母分别访谈，讨论的内容包括父母对未婚年轻成人婚前性行为的态度，父母对婚前性行为和人工流产影响未婚年轻成人健康的认识，父母对给未婚年轻成人提供教育和服务的态度等。结果：农村父母也给子女提一些忠告，但对子女因婚前性行为导致未婚先孕，普遍采取事后补救等被动措施表现出极大忧虑。父母赞成向子女提供有针对性的相关教育和服务，希望政府和社会机构给予重视，结论：农村未婚年轻成人婚前性行为和人工流产的普遍，与其自身文化水平和科学知识不足，家庭观念落后，如父母，教师和社会相关人员生殖健康知识水平不高及社会未重视有关，建议成立青少年生殖健康促进中心，制订相应的媒体法规及将青少年生殖健康教育和生殖健康服务纳入计划生育服务范畴，将有利于保障青少年生殖健康的需求。     

Self-efficacy and rural women's performance of breast and cervical cancer detection practices

Self-efficacy has become an important variable in multiple areas of human performance, including health behavior modification (Bandura, 1997). This study explores variables that lead to women's perceived self-efficacy in performing regular detection practices for breast and cervical cancer. A sample of southeastern U.S. farm women (N = 206) completed surveys that assessed their perceived and actual knowledge of women's cancer detection practices, as well as their perceived social norms and perceived barriers related to obtaining these tests. Regression analyses of these data revealed that perceived peer norms and the barriers of time and embarrassment were significant predictors of women's confidence in their ability to follow through with cancer detection practices. Perceived knowledge and perceived family norms significantly predicted women's perceptions of difficulty associated with cancer detection practices as well as women's confidence in their skills to perform breast self-examination (BSE). Time was also a significant barrier to confidence in performing BSE. Implications for health communication campaigns are discussed.     

Use of alternative folk medicine by Mexican American women

Nontraditional health care resources available to Mexican Americans are many. The Mexican culture is rich with alternative health and illness beliefs and remedies which have their origins in ancient Mestizo/Indian folklore which viewed the causes of illness to include social, spiritual, and physical forces. This perception calls for culturally relevant folk practitioners who can treat all aspects of the perceived illness. This study of 70-Mexican American women explored their knowledge of and use of alternative Mexican folk medical practitioners in their own health maintenance. Results provided some evidence that, even among highly assimilated Mexican American women, there persist traditional, indigenous beliefs, and practices.     

Gender relations, prostate cancer and diet: re-inscribing hetero-normative food practices

Although diet might be a valuable adjunct to prostate cancer care, men typically have poorer diets than women and are less likely to change the way they eat after a cancer diagnosis. Gender theory suggests that dominant ideals of masculinity shape men's health and food practices; however, the role of female partners in men's diets is poorly understood. Through qualitative analysis of in-depth interviews, this article explores accounts of 14 Canadian couples' food practices guided by a gender relations framework to expose how tacit performances of masculinity and femininity interact to shape the diets of men with prostate cancer. Findings show that many men became more interested and involved in their diets after a prostate cancer diagnosis, practices that might be theorized as a counter hegemonic project or 'feminization', adding to other prostate cancer induced emasculations (i.e., treatment induced incontinence and impotence). At the same time, however, couples mutually limited men's engagement with diet while concurrently reinforcing women's traditional femininities in nurturing the men in their lives through food provision. Also embedded here were women's attempts to mitigate subordinate productions of masculinity by catering to their partner's tastes as well as monitoring their diets. Most couples mutually maintained traditional gender food 'roles' by positioning women as proficient leaders in domestic food provision and men as unskilled 'try-hard' and sometimes uninterested assistants. Findings also revealed complex gender power dynamics that predominated as complicit in sustaining hegemonic masculinity through women's deference to men's preferences and careful negotiation of instrumental support for men's diet changes. Overall men and women jointly worked to re-inscribe hetero-normative family food practices that shaped men's diets and nutritional health.     

Delivery and postpartum practices among new mothers in Laputta,Myanmar: intersecting traditional and modern practices and beliefs

Myanmar is witnessing increased access to modern maternity care, along with shifting norms and practices. Past research has documented low rates of facility-based deliveries in the country, along with adverse maternal and child health outcomes. Research has also documented diverse traditional practices in the postpartum period, related to maternity care and maternal food intake. Through 34 qualitative interviews with women who recently gave birth and their mothers-in-law in one township in Myanmar (Laputta), we explore factors influencing decision-making around postpartum care and the practices that women engage in. We find that women use both modern and traditional providers because different types of providers play particular roles in the delivery and postpartum period. Despite knowledge of about healthy foods to eat postpartum, many women restrict the intake of certain foods, and mothers-in-laws’ beliefs in these practices are particularly strong. Findings suggest that women and their families are balancing two different sets of practices and beliefs, which at times come in conflict. Educational campaigns and programmes should address both modern and traditional beliefs and practices to help women be better able to access safe care and improve their own and their children’s health.     

Giving birth in the hospital: childbirth experiences of Thai women in northern Thailand

In this article, I examine how Thai women perceive and experience childbirth in hospitals. The article is based on in-depth interviews with 30 women living in Chiang Mai, Thailand. The women's narratives reveal that childbirth was managed within the medical system. The women believed that safety was the primary reason for their choice of birth in the hospital. Women's embodied experiences with hospital birth reveal the "passivity" discourse; women accord total trust to their doctors and very rarely question the many routine procedures in hospitals. It seems that in northern Thai hospitals the involvement of women's partners or their significant others is kept to a minimum. Of interest among postpartum care provided in Thai hospitals in the north is the use of a spotlight to help heal the episiotomy wound. This is an adaptation of Thai traditional confinement practices in the era of modernity. The use of a spotlight in hospital not only provides the women with symbolic ritual but also is believed to assist them in the healing process. Women in general were satisfied with postpartum care received during their hospital stay, except for rooming-in practice. The data suggest some differences between rural poor and urban middle-class women in terms of hospitals of birth, the opportunity to have a family member at birth, and so on. It is clear that middle-class educated women are able to exercise their choices and control over their childbirth experiences much more than rural poor women. I argue that care provided to women during birth needs to take into account women's emotional and subjective experience so that sensitive birthing care can be achieved. This will only make childbirth of many women a more positive one.     

Critical elements of Health for All strategies: population and women's issues

Critical to the attainment of "health for all by the year 2000" is recognition that women are key to any strategy to achieve this goal. Family planning programs are now actively promoted in most developing countries, whether for demographic purposes (to slow population growth), health reasons (the declines in infant and maternal mortality that result from child spacing), or human rights rationales. If development is defined as increasing control over one's environment, family planning programs that give women control over their own bodies are essential. From that beginning, women can exercise control over broader environments, resulting in true economic and social development in a family, a community, and ultimately a country. Since women are the providers of most health care, the decision makers about utilization of the health care system, and caregivers for the young and elderly, their own health and their role in promoting health care are keys to health for everyone. However, women's capabilities to play such a role are compromised by malnutrition, excessive childbearing, and the unmet need for accessible family planning programs of acceptable quality. Women are more likely than men to be malnourished, poor, illiterate, to work more hours each day, and to have less access to education and medical care--a situation that affects not only women's health, but the health of their children and families. Thus, attention must be given to improving these factors if women are indeed to contribute to "health for all" strategies.