Brutal neglect: Australian rural women's access to health services

Access to health services in rural Australia has been particularly problematic because of the vast geographical areas and the sparse population distribution across the inland. The focus on health servicing has been very much on primary health care with most attention being giving to the distribution of doctors in rural Australia. This study takes a closer look at rural health servicing through the eyes of women in rural Australia. Drawing on a survey of 820 women, the study revealed that a focus on primary health care may be resulting in a lack of attention to women's health in areas, such as maternity models of care, domestic violence and mental health. The study also reveals the disquiet of Australian rural women at the poor state of health services.     

"I try to take care of it myself." how rural women search for health information

Rural living poses special challenges (and opportunities) for the significant health information intermediary role that women enact. The authors describe interviews with 40 women living in a rural, medically underserved county in south-western Ontario, Canada, who discussed their information-seeking experiences and the strategies used to find information about a chronic health concern or an acute medical problem. The women's stories reveal that they define health very broadly and that their information seeking is influenced by contextual factors, such as rural living and gender roles, that interplay with their self-reliance, health literacy, and the availability and willingness of others in professional and non-professional roles to give support within relationships of care. The authors discuss themes emerging from the interviews in connection with the apparent mismatch between women's lived realities and the policy assumptions supporting the development of e-health strategies for providing health information to people living in rural and remote communities.     

A consultation with Canadian rural women with breast cancer

Objective Relatively little research has been carried out on the health and supportive care needs of rural women living with breast cancer. In this study, results from a Canadian focus group study are used to highlight issues of importance to rural women. Setting and participants A total of 276 rural women with breast cancer divided into 17 focus groups participated in the study conducted across Canada. A standardized protocol for discussion was employed. Issues of access to information, support and services were discussed, with women describing their experiences in trying to find appropriate programmes and services. Main results The major theme identified through analysis of qualitative data was ‘becoming aware of and/or gaining access to health care information, support and services.’ Other major themes included: (1) dealing with isolation; (2) having to travel; (3) feeling the financial burden and (4) coping with changing work. Conclusions Rural women with breast cancer have supportive care challenges related to their circumstances. A series of recommendations were generated through the consultation process which are contributing to the development of a national strategy focusing on the development and extension of programmes for rural women with breast cancer. Although the research on the project was not to specified standards, and suffered from less attention than community capacity building and advocacy, it proved to be of worth and revealed potential benefits from collaborations between researchers and community organizations.     

Negotiating care: reproductive tract infections in Vietnam

Through case studies of two women, this paper uses a taskonomy approach to analyze rural Vietnamese women's narratives of prevention, treatment and management of vaginal discharge to illustrate care seeking, health practice and the pragmatism of their action. The research is based upon ethnographic research undertaken by the author between 1995 and 1997 in a rural district in northern Vietnam. This exploration illustrates the complexities of women's rationalities and the web of influences upon their choices-the health seeking culture as practiced. The women's narratives are also placed within the broader context of gender, power and health systems that structure their decision making. The author discusses how social and economic resource factors influence the choices women make regarding when to begin treatment for vaginal discharge and where to seek care. She concludes that women use their understanding of the relationships between health, living conditions and diseases on a day-to-day basis and that the practice of managing vaginal discharge is mediated by concepts of body, self and the body politic in Vietnam.     

Do empowerment strategies facilitate knowledge and behavioral change? The impact of family health advocacy on health outcomes

This study evaluates the impact of a Family Health Advocacy (FHA) intervention on 46 African American women ages 13 to 35 living in a rural southern community. FHA utilizes empowerment strategies to provide education and social support to reduce risk factors for poor pregnancy outcomes. Use of a paired t test demonstrated a statistically significant difference between pretest and posttest scores in the acquisition of knowledge of safer sex practices, alcohol consumption, early prenatal care, maternal infection, and nutrition. Behavioral change was not realized in the areas of nutrition or behaviors that cause risk of maternal infection. Social workers can influence behavioral change for at-risk populations by addressing microlevel barriers such as education and resources and macrolevel barriers such as advocacy for expanded health and social services.     

Shifting landscapes: immigrant women and postpartum depression

Utilizing an ethnographic narrative approach, we explored in the Canadian context the experiences of three groups of first-generation Punjabi-speaking, Cantonese-speaking, and Mandarin-speaking immigrant women with depression after childbirth. The information emerging from women's narratives of their experiences reveals the critical importance of the sociocultural context of childbirth in understanding postpartum depression. We suggest that an examination of women's narratives about their experiences of postpartum depression can broaden the understanding of the kinds of perinatal supports women need beyond health care provision and yet can also usefully inform the practice of health care professionals.     

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.     

我国农村不同地区孕产妇保健情况分析

目的:了解农村地区孕产妇保健现状,分析其影响因素,从而寻找适当的改进措施。方法:利用现有资料对一类、二类、四类农村,以及城乡之间进行比较分析。结果:孕产妇卫生保健利用率二、四类农村要低于一类农村,特别是四类农村孕产妇住院分娩率较低;孕产妇死亡率边远地区显著高于沿海和内地;四类农村产妇分娩地点主要在家里(73·9%),且接生人员主要是家人(58%);在家分娩的主要原因是经济困难、认为住院分娩没必要、来不及等。结论:加大国家对西部妇幼卫生工作的投入;提高农村卫生机构的服务能力和人力资源素质;加强妇女保健的健康教育工作,进一步提高住院分娩率,将有助于改善西部贫困地区的妇女保健状况。     

Family health advocacy: an empowerment model for pregnant and parenting African American women in rural communities

The model of family health advocacy built firmly upon principles of empowerment theory seeks to help individuals, families, and communities to improve their circumstances by incorporating multiple levels of intervention. The goal of family health advocacy is to improve the well-being of pregnant women and mothers of children younger than 2 years by providing social support and health education about risk factors related to infant mortality and prematurity. This program primarily targets rural African American women, a group at high risk. Advocacy and referral for needed medical and social services are provided. This article presents a comprehensive model of health advocacy, including social marketing strategies, recruitment efforts, and curriculum development.     

Embodied responsibilities: pregnancy in the eyes of Japanese ob-gyns

This article explores the correlation between the social, cultural and political setting in which Japanese women gestate their babies and the kind of maternal responsibilities they are expected to exercise. By focusing on prenatal care, I look at ways in which Japanese gynaecologists formulate ideas about women's accountability for pregnancy outcomes and show how these ideas shape the practical strategies through which pregnancy is managed in medical institutions. While interrogating the perspectives these professionals bring into play, I am interested in the relationships between biomedicine, culture and the embodiment of women's roles. My findings reveal a broad range of physiological phenomena for which women are held accountable and a host of instructions they are expected to follow once they engage in prenatal care. Medical narratives render the pregnant body as the physical and mental environment that creates the foetus and highlights women's behaviour and health (rather than genes and chromosomes) as the major factors of foetal health. I show how the embodied mode of maternal responsibilities expected of women is mutually constituted by four interconnected realms of discourse and practice: the medical realm, cultural conceptions of self, national reproductive politics and the gendered division of labour.     

Utilization of health services among rural women in Gujarat, India

This study examined the effects of four sets of factors on use of curative health services among rural women living in Gujarat, India. The sets of factors analyzed were as follows: (1) the demographic characteristics of the women; (2) the characteristics of the household in which they lived; (3) the characteristics of the environment in which they lived; and (4) the price and convenience of care. The study focused on rural married women aged 17–45 who had at least one child. Nested multiple logistic regressions were computed on cross-sectional data to assess the simultaneous influences of the independent variables on (1) reports of episodes of illness (2) use of curative services among rural women who reported an illness and (3) use of a specific service. Four types of service were examined as outcomes of interest, namely, private doctors, Aga Khan Health Services centres, government health centres, and traditional healers. Other things being equal, women's education, income, family structure and kinship affiliation were significant predictors of use of service. Women seemed to be more sensitive to travel time to the health service and its associated costs (purdah restrictions, transportation and time costs) than to the direct costs of service. Factors such as women's occupation and sanitation facilities, while associated with use of service in the expected direction, were not significant predictors of use of service. Implications for health planning are offered, including initiatives to implement health promotion and disease prevention programs in addition to increasing access to the existing health services. Avenues for future studies are suggested, particularly in regard to decision-making processes affecting the health-seeking behavior of rural women. It is recommended that such policies and studies should consider the cultural environment in addition to the existing pluralistic health system.     

Multi-level rural community engagement in health

Community participation in health is consistent with notions of democracy. A systems perspective of engagement can see consumers engaged to legitimise government agendas. Often community participation is via consultation instead of partnership or delegation. A community development approach to engagement can empower communities to take responsibility for their own health care. Understanding rural place facilitates alignment between health programs and community, assists in incorporating community resources into health care and provides information about health needs. Rural communities, health services and other community organisations need skills in working together to develop effective partnerships that transfer some power from health systems. Rural engagement with national/state agendas is a challenge. Community engagement takes time and resources, but can be expected to lead to better health outcomes for rural residents.     

Unraveling the mysteries of timing: women's perceptions about time to treatment for cardiac symptoms

Women in the USA are at disproportionate risk of dying from a myocardial infarction (MI), of suffering disabilities following an MI, and of reinfarcting and dying within a year of their initial MI. Various explanations, including women's older age at clinical manifestation of coronary heart disease (CHD) and higher likelihood of co-morbidities, have been offered for women's heightened risk of poor outcomes. Less frequently, research has focused on examining women's prolonged time elapse between symptom onset and biomedical treatment, a phenomenon that renders women less likely to undergo lifesaving reperfusion strategies. [1] To explore factors and circumstances that may shape CHD time to treatment, 40 middle age and older women living in Kentucky, USA, half with diagnosed CHD and half with chronic conditions considered to be risk factors for CHD, participated in a series of in-depth interviews. While much of the existing CHD literature implicates individual responsibility as the determining feature in time to treatment, these women's narratives suggested that treatment decisions inextricably are linked to broader social and structural constraints. Such supra-individual forces that shape the CHD experiences of women include the social construction of "standard" cardiac symptoms based on male norms that ultimately confuse symptom detection, women's negative encounters with health care providers who discount their knowledge, the competing social demands women face when threatened by a serious illness, and structural barriers delimiting women's health care choices.     

Preventive care for women in prison: a qualitative community health assessment of the Papanicolaou test and follow-up treatment at a California state women's prison

Growing evidence indicates that women in prison are particularly vulnerable to many negative health outcomes, including cervical cancer. The Papanicolaou (Pap) test is an effective tool to screen for this disease. To determine what is and is not working with the Pap test and follow-up treatment, we performed qualitative interviews with women prisoners and key informants at a California state women's prison. Our assessment revealed that the process of administering Pap tests at this institution was not meeting the health care needs of the women interviewed.Women reported having negative experiences during the test and with their health care providers. Additionally the prison's culture and infrastructure create obstacles that hinder prisoners from receiving quality care and providers from delivering that care. In response, women prisoners use self-and community advocacy to meet their health care needs and cope with these challenges.     

In search of healing between two worlds: the use of traditional and modern health services by older women in rural Bangladesh

The objective of this study is to gain a deeper understanding of the use of traditional and modern medicine among older adult women living in rural Bangladesh. Factors are identified that guide the women's decisions about who to seek help from when they are ill. The findings provide evidence that, in spite of the availability of modern health care, traditional healers--faith-based and herbalists--are widely utilized. Reasons given for their choice of health care providers fall into two categories: belief in the effectiveness of the intervention and service delivery considerations. These data suggest that use of traditional healers persists among women in rural areas of Bangladesh and that health policy should be developed with an acknowledgment of these health practices.     

Migrants' perceptions of health promotion messages in rural Tasmania

Asian migrants living in rural Tasmania experience a social and cultural environment dissimilar to larger Australian cities. This study investigated Asian migrants' lived experiences, their intercultural views with a focus on health risk behaviours within the challenge of a new rural environment. Certain health risks were identified and possible social and cultural connections. This exploratory study used a qualitative approach focussing on the personal experience of the Asian migrants living in rural Tasmania, Australia. Interviews were conducted from October to December 2011 with 36 Asian migrants residing in rural Tasmania, recruited through purposive sampling. Sub-populations such as Asian migrants residing in less dense culturally and linguistically diverse communities, including Tasmania, continue to maintain health and health risk beliefs from their culture. Migrant sub-population selectively adapted to their new environment, with longer term migrants acquiring western health conditions. The research provided insights about Asian migrant's views regarding non-communicable health issues in less dense culturally and linguistically diverse communities. In addition to adding to existing knowledge, the study provided some specific insights for better understanding of the relationship between health, risk and society and hopefully for improving primary health care access and delivery of care in rural and other small communities where sparse and less cohesive culturally and linguistically diverse communities exist.     

Medicine, gender, and disability: disabled women's health care encounters

In this article I examine the intersection of gender and disability in the medical arena by considering disabled women's experiences of receiving health care in the United Kingdom. Drawing on the "social model of disability," I focus on the attitudes and practices of doctors. I use two sources of qualitative data: (i) 68 disabled women's narratives gathered in the United Kingdom in 1996-1997; (ii) interviews with 17 disabled women regarding their reproductive experiences in the United Kingdom. I suggest that disabled women health service users are at risk of experiencing oppressive medical practices because two forces of oppression appear to be frequently, and interactively, in play: patriarchy and disablism.     

Mental health advocacy and African and Caribbean men: good practice principles and organizational models for delivery

Background Advocacy has a critical role to play in addressing concerns about access to appropriate mental health care and treatment for African and Caribbean men. Aim To investigate good practice principles and organizational models for mental health advocacy provision for African and Caribbean men. Study design The study consisted of: (i) A systematic literature review. Bibliographic and internet searching was undertaken from 1994 to 2006. The inclusion criteria related to mental health, advocacy provision for African and Caribbean men. (ii) Four focus groups with African and Caribbean men to explore needs for and experiences of mental health advocacy. (iii) An investigation into current advocacy provision through a survey of advocacy provision in England, Wales and Northern Ireland. (iv) Twenty‐two qualitative stakeholder interviews to investigate the operation of mental health advocacy for this client group. The study was undertaken in partnership with two service user‐led organizations and an African Caribbean mental health service. Results Primary research in this area is scant. Mainstream mental health advocacy services are often poor at providing appropriate services. Services developed by the Black Community and voluntary sector are grounded in different conceptualizations of advocacy and sharper understanding of the needs of African and Caribbean men. The lack of sustainable funding for these organizations is a major barrier to the development of high‐quality advocacy for this group, reflecting a lack of understanding about their distinctive role. Conclusions The commissioning and provision of mental health advocacy needs to recognize the distinct experiences of African and Caribbean men and develop capacity in the range of organizations to ensure equitable access.     

Improving reproductive health in rural China through participatory planning

Abstract China's new health reform initiative aims to provide quality accessible health care to all, including remote rural populations, by 2020. Public health insurance coverage for the rural poor has increased, but rural women have fared worse because of lower status and lack of voice in shaping the services they need. Use of prenatal care, safe delivery and reproductive tract infections (RTIs) services is inadequate and service seeking for health problems remains lower for men. We present findings from a study of gender and health equity in rural China from 2002 to 2008 and offer recommendations from over a decade of applied research on reproductive health in rural China. Three studies, conducted in poor counties between 1994 and 2008, identified problems in access and pilot tested interventions and mechanisms to increase women's participation in health planning. They were done in conjunction with a World Bank programme and the global Gender and Health Equity Network (GHEN). Reproductive health service-seeking improved and the study interventions increased local government commitment to providing such services through new health insurance mechanisms. Findings from the studies were summarised into recommendations on gender and health for inclusion in new health reform efforts.