Pakistan's health policy: Appropriateness and relevance to women's health needs

The interface between national health policy and women's health needs is complex in developing countries like Pakistan. This paper aims to assess if Pakistan's national health policy 2001 is relevant and appropriate to women's health needs.Through review of existing data on women, a profile of women's health needs was developed which was transformed into framework of analysis. This framework indicates that Pakistani women's health needs are determined by gender disparities in health and health-related sectors.Comparison of national health policy with women's health needs framework reveals that although policy focuses on women's health through prioritization of gender equity, it is however addressed as an isolated theme without acknowledging the vital role gender inequalities in health and health-related sectors play in defining women's health needs. Moreover, gender equity is translated as provision of reproductive health services to married mothers, ignoring various critical overarching issues of women's life such as sexual abuse, violence, induced abortion, etc. Health systems strengthening strategies are though suggested but these fails to recognize main obstacles of utilization of healthcare services by women including non-availability of female healthcare providers and gender-based obstacles to healthcare utilization such as illiteracy, lack of empowerment to make decisions related to health, etc.In order to be relevant and appropriate to women's health needs the policy should: (1) use gender equity in health and health-related sectors as an approach to develop a healthy policy (2) expand the focus from reproductive health to life cycle approach to address all issues around women's life (3) strengthen health systems through creation of gender equity among all cadres of health providers (4) tailoring health interventions to counter gender-based obstacles to utilization of healthcare services and (5) dissemination interventions for behavior change.     

Lesbian and bisexual women's human rights,sexual rights and sexual citizenship: negotiating sexual health in England

Lesbian and bisexual women's sexual health is neglected in much Government policy and practice in England and Wales. This paper examines lesbian and bisexual women's negotiation of sexual health, drawing on findings from a small research project. Themes explored include invisibility and lack of information, influences on decision-making and sexual activities and experiences of services and barriers to sexual healthcare. Key issues of importance in this respect are homophobic and heterosexist social contexts. Drawing on understandings of lesbian, gay and bisexual human rights, sexual rights and sexual citizenship, it is argued that these are useful lenses through which to examine and address lesbian and bisexual women's sexual health and related inequalities.     

Theoretical Underpinnings for Women's Health

A theoretical framework for considerations of women's health is pro- posed, the central premise of which is that "women's health" at the core means taking women's lived experience as the staning point for all health efforts. Elaboration of this, thesis involves: (I) surveying our philosophical roots for an understanding of what the lived experience means, (2) exploring the methodological consequences of a focus on the lived experience, and (3) applying these insights to the situations of woman as mother and of the overweight woman.     

Institutionalizing women's oppression: The inherent risk in health policy that fosters community participation

Current Canadian health policy is based on the implicit assumption that women are available to provide care in the home to the dependent, the ill, the elderly, and the physically and mentally disabled. Women are socialized from birth to accept caring roles within a traditional family structure, and current societal expectations and social policy reinforce this value system. Women's health can only be understood within the context of their lived experience of social inequity, medicalization, and family caregiving. Health care professionals are complicit in sustaining women's oppression by reinforcing these institutions of social control. For health policy to be responsive to women's needs, it must be based on research that considers the social complexity of ordinary women's lives.     

Women,weight, poverty and menopause: understanding health practices in a context of chronic disease prevention

Socioeconomic inequalities in health persist despite major investments in illness prevention campaigns and universal healthcare systems. In this context, the increased risks of chronic diseases of specific sub‐groups of vulnerable populations should be further investigated. The objective of this qualitative study is to examine the interaction between socioeconomic status (SES) and body weight in order to understand underprivileged women's increased vulnerability to chronic diseases after menopause. By drawing specifically on Pierre Bourdieu's sociocultural theory of practice, 20 semi‐structured interviews were conducted from May to December of 2013 to investigate the health practices of clinically overweight, postmenopausal women living an underprivileged life in Canada. Findings emphasise that poor life conditions undermine personal investment in preventive health and weight loss, showing the importance for policy makers to bring stronger consideration on upstream determinants of health.     

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.     

A critical analysis of the Australian Defence Force policy on maternal health care

Objective: To critically analyse the Australian Defence Force (ADF) policy on maternal health care: Health Directive No 235 – Management of pregnant members in the Australian Defence Force. Method: Bacchi's ‘What's the problem represented to be’ framework was used to analyse Health Directive No 235. This paper critically examines the representation of pregnancy and birth, the resulting effects and considers alternate representations. Results: The ADF's policy on maternal healthcare considers pregnancy as a health issue that requires specialist intervention and care, also known as the medicalisation of birth. Current research emphasises women‐centred care; a model of care not contained in the ADF policy. Conclusion: The problematisation of pregnancy in the ADF restricts women's choices regarding their maternal healthcare provider. This is contrary to the healthcare rights of Australians and likely contributes to health inequalities of ADF women. Implications for public health: A research gap regarding ADF women's knowledge and wishes regarding their maternal health care has been identified. Future research can inform any alterations to the ADF policy on maternal healthcare.     

Women's health as an ideological and political issue: Restricting the right to abortion,access to in vitro fertilization procedures,and prenatal testing in Poland

The authors describe the problems of women in Poland, who have limited access to abortion, in vitro fertilization procedures, and prenatal tests. The current situation stems from ideological pressure, which affects women's health issues. This is part of a broader syndrome of the conservative approach to women's health in Eastern Europe, as well as the factor that strengthens the extreme right in Europe. As women's sexual health is demonized, women less often undergo preventive examinations. Making the debate about health more rational requires radical sociocultural changes in this part of the world.     

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.     

新中国70年初级卫生保健回顾与展望

新中国成立70年以来,我国一直在丰富着初级卫生保健（PHC）的内涵和实践,用较小的投入取得了较好的健康绩效。本文将我国70年来初级卫生保健发展历程分四个阶段,总结了在基层卫生服务体系、医保覆盖、基层卫生人力、基本公共卫生服务项目、妇幼保健、健康扶贫等方面取得的成效,并提炼出中国初级卫生保健的经验,分析了面临的问题与挑战,提出了未来的发展建议。     

Narratives of risk: Women at midlife,medical 'experts' and health technologies

The 'management' of midlife women's bodies is becoming an increasingly important focus for both themselves and medical 'experts'. Health technologies play a major part in this process, given health promotion messages about their usefulness for maintaining and enhancing the quality of life. But how do individual women interpret such messages? This paper explores the factors that impact upon health decision making in relation to a group of these technologies. In particular, we examine how related risks are assessed by women themselves and jointly with health professionals, in the clinical context. Drawing upon literature from the sociology of the body and embodiment, debates about risk and feminist research on the menopause, we argue that midlife needs to be understood as an embodied experience and that women's decisions about technology-based health interventions need to be contextualised. The paper draws upon research data from interviews with individual women and health professionals, and recordings of clinical consultations which relate to the specific technologies of HRT, bone densitometry and breast screening. The data reveal the emergence of two major risk narratives within consultations and interviews, health risks and social risks. We conclude that the health decisions and practices of both lay women and health professionals reflect a complex mixture of expert knowledge and advice, and embodied cultural experience.     

Some traditional methods are more modern than others: Rhythm,withdrawal and the changing meanings of sexual intimacy in Mexican companionate marriage

This paper discusses distinctions made by married Mexican women in the USA and Mexico between withdrawal and rhythm, as well as differences between women who use these traditional methods and those who use more 'modern' ones. Findings derive from an ethnographic study of gender and reproductive health in a Mexican transnational community. The primary method used was life histories, complemented by 15 months of participant observation. The sample consisted of 13 systematically selected pairs of women; one woman in each pair lived in Atlanta and the other lived in the sending community in western Mexico. While research on fertility regulation frequently classifies rhythm and coitus interruptus as traditional methods, this study showed that those who use these methods may base their classificatory system on other conceptions, including a contraceptive method's ideal properties. Generational changes in ideologies of marriage and intimacy and migration-related changes shape women's ideas about the meaning of sexual intimacy and the symbolic properties of contraceptive methods. This research shows, therefore, that ideology and social context need to be taken into account when exploring how women interpret shared ideas about sexuality.     

Women's strategies to achieve access to healthcare in Ontario,Canada: a meta‐synthesis

As part of a mixed methods study on women's access to the healthcare system in Ontario, Canada, we undertook a qualitative meta‐synthesis to better understand the contextual conditions under which women access healthcare. An earlier phase of the synthesis demonstrated a series of factors that complicate women's access to healthcare in Ontario. Here, we consider women's agency in responding to these factors. We used meta‐study methods to synthesise findings from qualitative studies published between January 2002 and December 2010. Studies were identified by searches of numerous databases, including CINAHL, MEDLINE, Scopus, Gender Studies Database and LGBT Life. Inclusion criteria included use of a qualitative research design; published in a peer‐reviewed journal during the specified time period; included a sample at least partially recruited in Ontario; included distinct findings for women participants; and in English language. Studies were included in the final sample after appraisals using a qualitative research appraisal tool. We found that women utilised a spectrum of responses to forces limiting access to healthcare: mobilising financial, social and interpersonal resources; living out shortfalls by making do, doing without, and emotional self‐management; and avoiding illness and maintaining health. Across the studies, women described their efforts to overcome challenges to accessing healthcare. However, there were evident limits to women's agency and many of their strategies represented temporary measures rather than viable long‐term solutions. While women can be resourceful and resilient in overcoming access disparities, systemic problems still need to be addressed. Women need to be involved in designing and implementing interventions to improve access to healthcare, and to address the root problems of these issues.     

WHEALTH STUDY: WOMEN'S REPORTS OF CHILDHOOD ABUSE

Most samples of adult women will contain a significant proportion who have been or are currently in abusive relationships. While past research has linked childhood abuse of girls to adult health concerns, little is known about the process through which women retrospectively reconcile these experiences. This article reports on data collected in an ongoing project on midlife women's health. Twenty-seven of 50 urban, middle-class participants in this phase of the project reported childhood abuse experiences. In the analysis, several aspects of these experiences were identified: definitions of abuse; recontextualizing abuse; responsibility for abuse; abuse avoidance; and experiences of multiple abuse. The women's discourse reflected a number of ideologies that provide a context in which women negotiate their understandings of these childhood experiences. This article provides insight into our understanding of abuse. It addresses the fundamental issue of promoting a worldview that precludes child abuse while leaving adult survivors with options for "moving on."     

Women's empowerment and its differential impact on health in low-income communities in Mumbai,India

This paper examines the relationship of empowerment to women's self-reported general health status and women's self-reported health during pregnancy in low-income communities in Mumbai. The data on which this paper is based were collected in three study communities located in a marginalised area of Mumbai. We draw on two data sources: in-depth qualitative interviews conducted with 66 married women and a survey sample of 260 married women. Our analysis shows that empowerment functions differently in relation to women's reproductive status. Non-pregnant women with higher levels of empowerment experience greater general health problems, while pregnant women with higher levels of empowerment are less likely to experience pregnancy-related health problems. We explain this non-intuitive finding and suggest that a globally defined empowerment measure for women may be less useful that one that is contextually and situationally defined.     

PRECARIOUS ORDERING: TOWARD A FORMAL THEORY OF WOMEN'S CARING

Given the current societal and political trends toward increasing demands on women to provide care, a conceptualization of caring that captures the common processes of diverse women's caring experiences, and makes the consequences of caring for women's health visible, is critical for the development of a health and social policy that is responsive to women. The findings of this feminist grounded theory study go beyond the current theoretical understandings of women's caring, framed as either burden or fulfilment. The complex strategies women use to manage the dissonance created by competing and changing caring demands are revealed as a process I have named precarious ordering. This middle range theory demonstrates the power and resilience in women's management through the interdependent processes of setting boundaries, negotiating, and repatterning care. In addition, the method of theoretical sampling used in this study is explicated to move toward a formal theory applicable to diverse women's caring in a wide range of health, illness, and developmental situations.     

The postconventional body: Retheorising women's health

We propose that women's health—both theory and practice—is a powerful arena in which to re-align and change the modernist theoretical underpinnings of current biomedical paradigms, which limit our understanding both of concepts of health and illness and of the impact of health care technologies on the body. We highlight the necessity of a move to a more dynamic paradigm for health and illness in the clinic, as well as a theoretical fluidity that allows for the real messiness of lived bodies. We argue that postmodernist thought, within wider feminist theory, is one of many perspectives that can contribute to contemporary biomedicine by providing theoretical underpinnings to develop 1) an understanding of bodies in context, 2) an epistemology of ignorance, and 3) an openness to the risk of the unknown. While these all entail a commitment to self-reflection and a willingness to be unsettled, which may not seem practical in the context of medical practice, we argue that self-reflection and unsettledness will provide pathways for grappling with chronic conditions and global bodies. Overall, we suggest that women's health practice can serve as a site in which both sides of the humanistic/scientific divide can engage with a human self in all its corporeal variety, contingency, and instability. More specifically, by providing a space within the clinic to examine underlying ontological, epistemological, and ethical assumptions, women's health can continue to contribute to new forms of biomedical practice.     

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.     

Reframing health and illness: a collaborative autoethnography on the experience of health and illness transformations in the life course

In this collaborative autoethnography, we examine the processes whereby people may reframe their interpretations and understandings of health and illness as a result of new diagnostic information. In so doing, we utilise the first author's experience receiving a conclusive diagnosis of cystic fibrosis after years of misdiagnosis to outline some ways changes in diagnosis facilitate shifts in illness management, the nature of health and illness and the experience of the self in relation to health and medicine. Furthermore, we discuss the ways this case reveals the importance of examining and comparing the social construction and transformation of health and illness within and between different individual and collective lived experiences over time. In closing, we draw out theoretical and empirical implications for understanding transformations in the nature of health and illness over the life course as well as future directions for research investigating shifts in illness management and understanding over time (A virtual abstract of this paper is available to view at: https://www.youtube.com/channel/UC_979cmCmR9rLrKuD7z0ycA ).