Overcoming the ‘tyranny of the urgent’: integrating gender into disease outbreak preparedness and response

ABSTRACT

This article contributes to discussions on the gender dimensions of disease outbreaks, and preparedness policies and responses, by providing a multi-level analysis of gender-related gaps, particularly illustrating how the failure to challenge gender assumptions and incorporate gender as a priority at the global level has national and local impacts. The implications of neglecting gender dynamics, as well as the potential of equity-based approaches to disease outbreak responses, is illustrated through a case study of the Social Enterprise Network for Development (SEND) Sierra Leone, a non-government organisation (NGO) based in Kailahun, during the Ebola outbreak.     

Hypothesis Testing of CNA Perceptions of Organizational Culture in Long Term Care

This commentary for the special issue on research that went wrong describes a study that explored factors that contribute to variability within Certified Nursing Assistants (CNAs) on organizational safety culture. We know from previous research that CNAs provide most direct care in nursing homes and that direct care workers often experience agency culture differently from agency management (Wolf et al., 2014). We were looking for factors that nursing homes could alter to improve the culture for CNAs, and thus, residents. We conducted a secondary analysis of data collected via a multi-component paper survey of CNAs employed in long term care. We used results from the Nursing Home Survey on Patient Safety Culture and primary shift, type of unit, and years as a CNA to identify modifiable characteristics that would explain variability in the perceptions of patient safety culture. The final sample included n = 106 from three nursing homes. Dimension scores were compared using bivariate tests appropriate to the scale and ordinal logistic regression. Despite support in the literature for the hypothesis, we found few significant differences on the total scale within groups. Differences in perceptions have implications for quality of care and the experiences of residents within nursing homes.     

The turn to optional familialism through the market: Long‐term care,cash‐for‐care,and caregiving policies in Europe

Cash‐for‐care (CfC) schemes are monetary transfers to people in need of care who can use them to organize their own care arrangements. Mostly introduced in the 1990s, these schemes combine different policy objectives, as they can aim at (implicitly or explicitly) supporting informal caregivers as well as increasing user choice in long‐term care or even foster the formalization of care relations and the creation of care markets. This article explores from a comparative perspective, how CfC schemes, within broader long‐term care policies, envision, frame, and aim to condition informal care, if different models of relationships between CfC and informal care exist and how these have persisted or changed over time and into which directions. Building on the scholarly debate on familialization vs. defamilialization policies, the paper proposes an analytical framework to investigate the trajectories of seven European countries over a period of 20 years. The results show that, far from being simply instruments of supported familialism, CfC schemes have contributed to a turn towards “optional familialism through the market,” according to which families are encouraged to provide family care and are (directly or indirectly) given alternatives through the provision of market care.     

Stillbirth in Australia 1: The road to now: Two decades of stillbirth research and advocacy in Australia

Stillbirth is a major public health problem with an enormous mortality burden and psychosocial impact on parents, families and the wider community both globally and in Australia. In 2015, Australia’s late gestation stillbirth rate was over 30% higher than that of the best-performing countries globally, highlighting the urgent need for action. We present an overview of the foundations which led to the establishment of Australia’s NHMRC Centre of Research Excellence in Stillbirth (Stillbirth CRE) in 2017 and highlight key activities in the following areas: Opportunities to expand and improve collaborations between research teams; Supporting the conduct and development of innovative, high quality, collaborative research that incorporates a strong parent voice; Promoting effective translation of research into health policy and/or practice; and the Regional and global work of the Stillbirth CRE. We highlight the first-ever Senate Inquiry into Stillbirth in Australia in 2018. These events ultimately led to the development of a National Stillbirth Action and Implementation Plan for Australia with the aims of reducing stillbirth rates by 20% over the next five years, reducing the disparity in stillbirth rates between advantaged and disadvantaged communities, and improving care for all families who experience this loss.     

Hesitant Madams in a Global City: Japanese Expat Wives and their Global Householding in Hong Kong

Care work, once a sanctioned labor of love, is increasingly commodified in transnational contexts. The picture of migrant women shouldering the housework and child care of local professonal women may seem like a mutually beneficial arrangement—matching the “needs” of the haves and have-nots—, but the global care chain ultimately works to maintain the traditional gendered division of labor as well as global inequality. To this trend of globalization of care work, Japan has been an exception; however, how much longer it will be so is now in a question, as the government paves the way for importing domestic labor from abroad. This article focuses on Japanese expat wives in Hong Kong in order to locate Japanese women vis-à-vis the global care chain. The narrative analysis on how they decide whether to hire a domestic worker in their home away from home highlights the sociopolitical nature of their supposedly private choices. Some drew on cultural ideal of wifehood and motherhood to rationalize their choice while others referred to racialized or even overtly racist and classist images of foreign domestic workers. A few women spoke against the system itself, showing awareness of its inherent social injustice. All such narratives are never purely personal; their decisions and the rationalization behind them sustain the prevailing discourses of gender, race, ethnicity, culture, and class, which, in turn, envelop their attempts at global householding.     

Making Sense of After‐School Care Dilemmas in Mothers' Stories of After‐School Care in Finland and Sweden

The study focuses on dilemmas in storied experiences of everyday after‐school care arrangements among Swedish and Finnish mothers. Finland and Sweden, which share a history of strong labour market attachment among women, arrange institutional after‐school care in similar ways. The data consist of interviews with three Swedish and six Finnish mothers. A positioning analysis of four stories shows how decisions related to children's after‐school hours were allocated among different actors. Two reoccurring dilemmas, Competent‐dependent child stories and Unburdened‐deficient mother stories, emerged from the data analysis as related to prevailing moral discourses on childhood and motherhood.     

Maternity waiting homes in times of crisis: Can current models meet women’s needs?

BackgroundMaternity waiting homes (MWHs) located close to birthing facilities are a conditional recommendation by the World Health Organisation, based on very low-quality evidence that they contribute to improvements in maternal or perinatal health outcomes. In addition, several studies suggest that more vulnerable women are less likely to use them. Yet significant investments continue to be made in building and running MWHs within conflict-affected and under-resourced health systems.AimsWe critically examine the literature to shed light on the challenges and opportunities provided by MWHs during health emergencies and in conflict situations.Findings and discussionMWHs are difficult to utilise during crises because they require women to be away from home, are often designed as dormitories, can lack security and be over-crowded. Some MWHs have been adapted during situations of political conflict to incorporate birthing and broader reproductive health care, thereby improving the availability of care away from over-burdened health facilities. How MWHs are adapted during times of crisis may provide insights into what systems of care are more appropriate in meeting women’s needs more broadly.ConclusionThe current global pandemic is an important time to reflect on whether MWHs are meeting the needs of a diverse range of women, in times of stability and during emergencies, and engage in genuine dialogue with women about the kinds of maternity care they want. We need to co-create those systems now so that they are more resilient during the inevitable crises we will face in the future.     

Community care for adults with severe mental disorders in rural China: A case study

In China, family care is the dominant form of care for people with mental disorders. Since 2004, the government has been developing a community‐care model that places more responsibility on community organisations and the local governments at the provincial, municipal and county levels for the provision of formal care. As a large number of people with severe mental disorders live in rural China, this case study was conducted in a rural county in order to examine the development of community care. It was found that, although family care remains dominant, families’ need for formal care is increasing. Community services have improved, but their development is constrained by several contextual and micro factors. In this study, it is argued that the community‐care model introduces a process of reconfiguration of the relative responsibility for care among the family, social organisations and the government, but progress depends on further administrative and fiscal reforms.     

Health-care Work in Globalization: News Reports on Care Worker Migration to Japan

Health-care worker migration has emerged as a social issue in Japan, contrary to it has in Indonesia. This article shows how national contexts affected by globalization have shaped social understandings and policies towards health-care worker migration in the two societies over time. Analyses of news coverage in the Japanese and Indonesian national media reveal a gap of social responses toward this change. The Japanese are more likely to respond negatively to health-care worker migration; yet they intend to face cross-cultural challenges, although slowly, making revisions to related policies. In contrast, in Indonesia, from where health-care workers migrate to Japan and many other countries, this tends to be understood positively, overall, as providing economic benefits and permitting Indonesian professionals to contribute to the worker shortage in Japan. I interpret these results based on the literature on health-care worker migration, emerging global norms and local changes, and comparative research on employment and care work. This study contributes to the sociological understanding of worker migration and health-care issues.     

Psychometric properties of the Transitions from Foster Care Key Leader Survey

This study summarizes the development and piloting of the Transitions from Foster Care Key Leader Survey (TFC-KLS), an instrument designed to measure change in systems serving young people transitioning from foster care to adulthood. The Jim Casey Youth Opportunity Initiative’s logic model was used as a basis for instrument development. The instrument was piloted with 119 key leaders in six communities. Seven of eight latent scales performed well in psychometric testing. The relationships among the 24 measures of system change were explored. A CFA testing overall model fit was satisfactory following slight modifications. Finally, a test of inter-rater reliability between two raters did not find reliable reporting of service availability in a supplemental portion of the survey. The findings were generally positive and supported the validity and utility of the instrument for measuring system change, following some adaptations. Implications for the field are discussed.