Young women and sexually transmitted diseases: the issues for public health

Abstract: This paper reports on a recent research project which explored the social meaning of heterosexual relationships for young women aged 16 to 18. Drawing on intensive interviews with 95 young women from a diverse range of backgrounds, the study provided evidence that young women remain relatively ignorant about all aspects of sexually transmitted diseases (STDs), that the provision of health services to young women is far from adequate and that public health measures have failed to address the issue of the social and political context in which young women operate. Furthermore, there is evidence that the public health campaign to reduce infection with the human immunodeficiency virus has had a counter productive effect on the prevention of STDs. There are three key dimensions to the prevention of STDs through public health measures: ensuring that young women have adequate knowledge to prevent STDs; provision of adequate health services for young women and fostering a social and political milieu which will support women's control over their sexuality.     

Trade-off between local access and safety considerations in childbirth: rural Tasmanian women's perspectives

Objectives: This study investigates: (i) Tasmanian rural women's preferences for different models of intrapartum care; (ii) their preferences for travel time to safe delivery; and (iii) factors which influence these preferences. Design: Mixed‐methods study using a survey questionnaire and semistructured interviews was adopted. A questionnaire explored women's preferences for different models of care and preferred travel time. Interviews were conducted to validate the survey results and provide insightful information on their preferences on the models of care. Women who have had rural childbirth experiences from six Tasmanian rural communities were invited to participate in the study. Results: Two hundred and ten women completed the questionnaire with a response rate of 35%. Twenty‐two follow‐up interviews were conducted. The survey found that women preferred to give birth in a hospital setting to homebirth despite having to travel for two hours. Midwifery‐led care with one hour travel time was the second preferred model of care. Women were willing to travel to access the regional hospital but within limit. Their preferences suggest that women have to trade‐off between local access and safety considerations. The interviews validate the survey results. Three main themes emerged from the interview data namely (i) safety; (ii) distance from hospital; and (iii) type of delivery. Their preferences were associated with their maternal care experiences in the past. Conclusion: In order to achieve the maternity services that are woman centred and respond to the needs and preferences of women, the service design and provision should take into account these women's preferences.     

The paradoxical portrayal of the risk of sexually transmitted infections and sexuality in US magazines Glamour and Cosmopolitan 2000–2007

This paper reports on an exploratory, qualitative content analysis of the portrayal of the risk of sexually transmitted infections or diseases (STIs or STDs) and sexuality in the United States (US) versions of the most popular women's magazines in the world, the English language magazines for young women Cosmopolitan (Cosmo) and Glamour from 2000–2007. The data studied here demonstrate contradictory messages. On the one hand, there is a frequent and powerful portrayal of STIs and STDs as ubiquitous, dangerous, and disgusting, and on the other, there are numerous stories promoting casual sex for women's pleasure. Biomedicine is positioned as the most appropriate system of knowledge for understanding and explaining sexuality and STIs/STDs. The substantive, theoretical, and practical consequences of this paradoxical and contradictory social construction of sexuality and the risk of STIs or STDs are discussed as the major contributions of this paper.     

Nursing,therapy, and social control: Feminist science and systems‐based family therapy

This paper discusses the implications of the feminist critique of science for the treatment of women in the context of systems‐based family therapy (SFT). The issues raised are of special concern to nurses interested in women's health. As recent critiques of mainstream science have repeatedly demonstrated, there is no neutral, value‐free position from which to do science or to put science to work in clinical practice (Bleier, 1986; Keller, 1985; Cartwright, 1983; Habermas, 1971; Allen, 1985; Chinn, 1985; Ehrenreich, 1978). The theoretical position one adopts for research and practice carries important value implications. Nowhere is this more evident than in the field of women's health, which was born out of dissatisfaction with current medical science and the clinical practice it spawned (Ehrenreich & English, 1979; Boston Women's Health Collective, 1976). Consequently, for a practice area like women's health, consciousness of feminist critiques of science and systems therapy is a necessity.

The discussion is in three main sections: the first is a brief overview of the feminist critiques of science, the second focuses on how those critiques impact on systems‐based family therapy, and the third discusses implications for research and practice.     

Domestic conditions, paid employment and women's experience of ill-health

Traditionally, research concerned with the relationship between paid employment and women's experience of ill-health has focused on one or other of two competing explanatory models: the role enhancement model which postulates a positive health effect of paid employment and the role overload model which postulates a negative effect. Though a synthesis of these two models is becoming apparent in the literature (Arber 1990, 1991) a number of important issues remain neglected. This paper focuses on three of these neglected issues: the extent to which the relationship between employment and health is mediated by the nature and/or extent of the workload associated with both formal and domestic work; whether the relationship differs for different types of ill-health; and the role of health related selection into different social roles. Using data from the Health and Lifestyles survey, an innovative approach is taken to the measurement of domestic conditions, and separate measures of long-term health status, and of short-term physical and psychological health state are used. Proportional odds models are used to assess the relationship between employment status, domestic conditions and type of employment (measured in terms of the socio-economic group of a woman's own occupation) independent of underlying long-term health status. Our findings suggest that the presence of long-term illness is the single most powerful influence on present health state, but that this does not explain away the positive relationship between employment and women's health. They also suggest that this relationship is different for different types of ill health and is not the same for women in different types of occupation. In particular, our findings suggest that the association between paid work and better health is rather less apparent for physical than psychological health, and in women working full time in professional or managerial occupations. Domestic conditions appear to have an effect on women's health equal to or greater than employment status, depending on the health measure used. However, there was no evidence of an interaction between employment status and domestic conditions. We conclude with a discussion of the ways in which our findings fit in with those of previous research. We argue in particular for more attention to be given to the nature of both the dependent (‘health’) and explanatory (‘work’) variables used in research on the relationship between employment and women's health.     

Scaffolding young Australian women's journey to motherhood: a narrative understanding

Pregnant and young mothers' stories often go untold within community social and health service policy, planning and practice. Consequently, there is a significant gap between young women's experiences of motherhood and current service provision. This study was undertaken in response to a paucity of observational and contextually rich research that explores young women's experiences of pregnancy and motherhood, including the role a community service played in scaffolding their motherhood journeys. Fundamental to this study's purpose was the premise that to improve planning and delivery of more appropriate services for this group, we need to listen, consult and consider what life is like for young mothers. The purpose of this paper is to describe the role a community service played in scaffolding young women's experiences as they transitioned to motherhood. Using a narrative approach, this study draws on data collected from contextual observations of 31 informants and 11 in‐depth interviews over 7 months of fieldwork in 2010 at a community service in the Peel region of Western Australia. The integral role a community service played in the young women's transition to motherhood was analysed thematically and captured in three metaphorical themes, finding a circle of friends, weaving a tapestry and turning the page. The young women's storied experiences of motherhood present a strong argument for radical re‐visioning of community and social health policy, practice and service delivery for young mothers. The findings revealed that judgement‐free services that foster social and supportive relationships were integral in developing positive motherhood identities. The power of narrative and social learning when working with young mothers suggests that social models of health that foster a relational, narrative approach to practice are fundamental to young mothers finding their own voices and solutions and becoming active agents in re‐authoring future narratives of hope, autonomy and agency.     

The Influence of Neighbors' Family Size Preference on Progression to High Parity Births in Rural Nepal

Large families can have a negative impact on the health and well‐being of women, children, and their communities. Seventy‐three percent of the individuals in our rural Nepalese sample report that two children is their ideal number, yet about half of the married women continue childbearing after their second child. Using longitudinal data from the Chitwan Valley Family Study, we explore the influence of women's and neighbors' family size preferences on women's progression to high parity births, comparing this influence across two cohorts. We find that neighbors' family size preferences influence women's fertility, that older cohorts of women are more influenced by their neighbors' preferences than are younger cohorts of women, and that the influence of neighbors' preferences is independent of women's own preferences.     

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.     

Exploring explanatory models of women's reproductive health in rural Bangladesh

This study illustrates the use of systematic elicitation techniques for cultural domain analysis, including free listing, pile sorting and severity ratings to identify salient illness categories and perceptions of illness severity among rural Bangladeshi women. The complementary strategies of in-depth interviewing and collecting of case studies were also employed for delineating explanatory models. Illnesses in the domain of women's reproductive health-for example, reproductive tract infections (RTI)-were found to be among the most salient and serious health problems for which care is sought. Data gathered through pile sorting demonstrate that women in this rural community have clear conceptions of illness groups, with different strategies of treatment for various categories. While concerns relating to reproductive tract infections, including those attributed to sexual transmission, and vaginal discharge are important to women, none of the available health facilities is particularly attuned to addressing these needs. Developing health care services taking women's explanatory models into consideration could be of importance for reducing the spread of RTI and sexually transmitted/HIV infection in rural Bangladesh.     

WORK LIFE AND PSYCHOLOGICAL HEALTH: THE EXPERIENCES OF THAI WOMEN IN DEPRIVED COMMUNITIES

I discuss women's work life and the psychological health of women in low-income communities in Northeast Thailand. Previous research has shown that low-income women are part of a disadvantaged group who struggle against several problems in their everyday life, and who work hard to survive. These women worked as either manual laborers in agriculture or factories or as self-employed vendors, and were busy Ha Yoo Ha Kin (working and earning a living). The women's way of life was complex and involved being responsible for their children, husband, extended family, work, and themselves. Understanding women's beliefs and practice relating to work life and health is essential in designing effective intervention programmes to promote the health and well-being of low-income women in Thailand.     

INFORMED CONSENT AND THE HISTORY OF INCLUSION OF WOMEN IN CLINICAL RESEARCH

The purposes of this paper are to (a) discuss the troubled history of informed consent for research on women and its ramifications for women's participation in clinical trials; (b) interrogate current informed consent practices as to their accountability and justice in the treatment of women; and (c) recommend to nurse researchers and clinical nurses ways of improving the practice of informed consent in research with women.     

Consistent and Inconsistent Contraception Among Young Women: Insights from Qualitative Interviews

Qualitative interviews with young women attending community colleges were used to address why women who do not desire pregnancy vary in how consistently they use contraception. Based on our analysis of the women's sexual histories, we argue that five factors are key to promoting or discouraging consistent use of contraception: efficacy (women's ability to put an intention to contracept into practice), the actions and attitudes of male partners, being in a long‐term relationship, whether women experience side effects, and misinformation or erroneous reasoning about pregnancy risk. Variations in how these factors combine at different times in women's lives explain much about their patterns of contraceptive consistency.     

FACTORS THAT SUPPORT WOMEN'S SUCCESSFUL TRANSITION TO THE COMMUNITY FOLLOWING JAIL/PRISON

The purpose of this study was to describe factors that support women's successful transition to the community following incarceration. The design is qualitative, utilizing open-ended data generating interview questions of women who participate in Welcome Home Ministries (WHM), a new community faith-based program for women released from jail/prison. A multitude of factors are necessary to support women's successful transition to the community following incarceration. Although no questions were asked about religion or spirituality, the rank-ordered dominant factors were a spiritual belief and practice and freedom from addiction. The role of support groups and their "sisters" in WHM, the nurse-chaplain's jail visit and support, and the role of supportive friends (not former drug using friends) were additional key factors. The study findings may be used to support the design of new interventions based upon women's needs and capacities to empower them to create their own and their children's healthy future.     

Determinants of support for female genital cutting among ever-married women in Egypt

Abstract

This study examines the effect of exposure to communication messages on support for female genital cutting (FGC) in Egypt. Data from the 2005 Egypt Demographic and Health Survey are analysed using logistic regression (n=19,106; ever-married women aged 15–49). The analysis reveals that high levels of exposure to FGC-related media messages are essential in reducing support for FGC. Women exposed to two or more FGC media messages are 1.6 times more likely than unexposed women to support discontinuing FGC. Moreover, women's belief that men want the practice discontinued, and their belief that FGC can cause fatal complications, are both positively associated with women's support for discontinuing FGC. By contrast, women's belief that FGC is an important part of religion, and their belief that FGC prevents adultery, are negatively associated with women's support for discontinuing FGC. Almost identical factors affect women's intention to circumcise their daughters. High exposure to FGC-related messages, and women's belief that men want the practice discontinued, are negatively associated with the outcome. Women's belief that FGC is an important part of religion, and their belief that FGC prevents adultery, are positively associated with it. Women's belief that a husband prefers a circumcised wife is not associated with women's intention to circumcise their daughters after controlling for all other variables in the model. Given that high level of exposure to FGC-related messages is key in reducing support for FGC, communication campaigns should be continued and intensified. Campaigns should also aim to change men's perception and support for the practice.     

BEING FEMALE: THE PORTRAYAL OF WOMEN'S HEALTH IN PRINT MEDIA

In this article, we examine the portrayal of women's health issues in two of Melbourne's print media: The Age and the Herald Sun . In particular, we aim to examine the patterns of coverage of women's health and the underlying message in articles on women's health issues. We employed an unobtrusive method, and the study was conducted over a three-month period: May to July 1998. We found that many of the articles and public reactions centred on women and reproduction. This implies that women are still seen in relation to their reproductive role in Australian society. In addition, there are many issues regarding women and their health missing from the media's publication during the research period. The message emerging from the analysis implies that if women do not fit into the "ideal women" framework of the society, their health needs are given little attention by the print media and, therefore, their health is likely to suffer. This can be interpreted as one form of women's oppression in Australian society.     

Dependent ‐care by battered women: Protecting their children

The phenomenon of battered women's dependent‐care (Orem, 1991), that is, their efforts to prevent hazards to the life, health, and well‐being of their children, was examined. Open‐ended, semi‐structured interviews were conducted with mothers (N = 50) at battered women's shelters in a metropolitan area in the Midwest. The women demonstrated deliberate, creative, and diverse dependent‐care. Caring action and timing provided the basis for patterns of dependent‐care. Health care providers need to recognize these caring actions and consider their value from the perspective of battered women.     

Concordance between Women's Self-Reported Reasons for Cesarean Delivery and Hospital Discharge Records

BackgroundWomen's self-reports of whether they had a cesarean delivery are nearly 100% accurate, but there is little extant research on how accurately women self-report reasons for cesarean delivery when asked to recall this information in the postpartum period.ObjectiveWe compared women's self-reported reasons for cesarean with their hospital discharge records and examined correlates of variability in agreement between sources.MethodsData are from the First Baby Study, a cohort of 3,006 women who gave birth to their first baby between 2009 and 2011. Survey data were linked to hospital discharge records. Among women who delivered by cesarean (n = 846), we assessed the probability that women's self-reported reasons for cesarean delivery were confirmed by hospital discharge records (positive predictive value [PPV]), and whether agreement differed by reason for cesarean or by women's characteristics.ResultsOverall, 91% of women reported a reason for their cesarean that was present in the discharge data. PPV varied by reason for cesarean, with high PPV for dystocia, macrosomia, and cephalopelvic disproportion (91.1%), and lower PPV for malposition (81.7%). In multivariable models, women with more education and higher family income had higher odds of concordance.ConclusionsDespite some variation in the probability that women's self-reported reason for cesarean is supported by the hospital discharge record, more than 90% of women reported a reason that was found in their discharge record. Accurate recall of reasons for prior cesarean may help women and clinicians to manage future pregnancies.     

Women,Menopause, and (Ms.)Information: Communication About the Climacteric

This research utilizes a communication perspective to examine the dissemination of information about menopause in terms of women's attitudes, beliefs, and knowledge. Specifically, this study uses a grounded theory approach (Glaser & Strauss, 1967) to explore the communicative processes of misinformation concerning women's lived experiences in relation to the climacteric. Five emergent themes extracted from premenopausal, perimenopausal, and postmenopausal women's discourse are identified and described through qualitative data analysis. Findings suggest that due to a lack of consistent communication, women are generally either unknowledgeable or misinformed about menopause and its related issues. Inaccurate information concerning a health-related experience that all women undergo has negative implications for women, their practitioners, and society. Moreover, a clearer understanding of women's experiences concerning menopause may enhance communication in physician-patient interactions (PPIs).