Complaints,Sensitivities and Responsibility: An Ethnographic Investigation into the Debates Concerning the Care of Bangladeshi Mothers in the East End

The subject of this paper is a maternity services awareness day organised by a community centre in the East End of London. In what I interpret as the fractured political landscape of Tower Hamlets (in East London), this event formed a rare focus for the diverse groups of people I worked with in my fieldwork and provides a focal point through which to reflect upon issues of diaspora, culture and health care. This paper attempts to analyse the public voices of a diasporic community which were challenging mainstream health provision. In this paper, I suggest that the voicing of complaint both reified and contested the needs of Bangladeshi mothers specifically, yet did not alter the services provided. The ways in which “culture” is used or discarded as a critical platform on which to base claims about health care are discussed.     

Making Direct Payments a Choice: a report on the research findings

We describe research done in the London Borough of Tower Hamlets under the supervision of the local Coalition of Disabled People. It involved three different client groups-people with learning difficulties, mental health service users and those with physical disabilities. Few of these service users, their carers and staff had any experience or knowledge of people with disabilities receiving cash to purchase their own support. The study focused on several issues: how to provide effective information; what sorts of support could direct payments purchase; how could it be accessed; how could users handle the money; how could it all be evaluated? Most carers, staff and users considered this radical idea favourably, but were suspicious of their own local authority and would want independent systems of supervision and monitoring, accountable to other users, rather than professionals.     

Issues of Access and Choice in the Mixed Economy of Daycare for Under Fives in Tower Hamlets Docklands

SUMMARY. The ‘market’ is now being promoted as the most appropriate mechanism for meeting parents' needs for daycare. This article reports research undertaken in the London Borough of Tower Hamlets early in 1992 to assess the consequences for access to child daycare of changes in policy which have led to increased emphasis upon market-based solutions and a ‘mixed economy’ of daycare. Socio-economic change, with a widening range of employment and income levels, and increasing numbers of young children characterise the area. There has been a reduction in daycare options for the majority of households with under fives. Affordability is now one of the major factors determining access to daycare. Many other problems in the operation of the market in Tower Hamlets are described. Questions are raised about the viability of a mixed economy of daycare, in the light of the financial problems being experienced by day nurseries operating in the area, and the extent to which private companies can be relied on to provide childcare assistance for their staff. National policy makers must ensure that the daycare needs of low income households are met through the mixed economy of daycare.     

Conformity and change: community effects on female genital cutting in Kenya

In this article, I analyze women's decisions to have their daughters circumcised based on data from 7,873 women in Kenya collected in the 1998 Kenya Demographic and Health Survey. I use multilevel models to assess the degree to which women s decisions are correlated with the decisions of other women in their community, in addition to studying the effects of socioeconomic characteristics measured at both the individual and community levels. I find some support for modernization theories, which argue that economic development leads to gradual erosion of the practice of female circumcision. However, more community-level variation is explained by the convention hypothesis, which proposes that the prevalence of female circumcision will decline rapidly once parents see that a critical mass of other parents have stopped circumcising their daughters. I also find substantial variation among different ethnic groups in the pace and onset of the decline of female genital cutting.     

The sexual experience and marital adjustment of genitally circumcised and infibulated females in the Sudan

In a study conducted over a 5‐year period, the author interviewed over 300 Sudanese women and 100 Sudanese men on the sexual experience of circumcised and infibulated women. Sudanese circumcision involves excision of the clitoris, the labia minora and the inner layers of the labia majora, and fusion or infibulation of the bilateral wound. The findings of this study indicate that sexual desire, pleasure, and orgasm are experienced by the majority of women who have been subjected to this extreme sexual mutilation, in spite of their also being culturally bound to hide these experiences. These findings also seriously question the importance of the clitoris as an organ that must be stimulated in order to produce female orgasm, as is often maintained in Western sexological literature.     

Japanese Women's Views on Penile Hygiene and Male Circumcision

ABSTRACT. Current campaigns to promote male circumcision to reduce the risk for HIV infection among heterosexual men do not seem to apply to Japan because the majority of men are uncircumcised and HIV/AIDS rates remain comparatively lower among industrialized countries. No official statistics on male circumcision exist; the surgery has never been mandatory for infants and it is rare among adults, who are largely circumcised at beauty salons. The procedure is largely commercialized as a cosmetic surgery to boost maleness and to “satisfy” the sexual desires of Japanese women. In this light, this article discusses the outcomes of semistructured interviews with 13 single Japanese women to explore their views on circumcision, penile hygiene, and sexuality. The analysis indicates a reluctance to talk about male circumcision among the participants due to ignorance, language availability, and gender matters. Intriguingly, the participants suggested that expressions related to the foreskin implied derogatory comments toward male's sexual performance and genital sizes.     

Paralympics 2012 legacy: accessible housing and disability equality or inequality?

The golden summer of sport is now over, but what is the legacy of London 2012 for disabled people? Nadia Ahmed, a disabled student, discusses the difficulties she has faced in finding accessible accommodation in London. She argues that while the Games are over, the United Kingdom still has lots of hurdles to leap when it comes to disability. The article focuses on her own personal experience of not being able to get wheelchair-accessible accommodation in Tower Hamlets, a London borough that is a close neighbour of Stratford where the Olympic and Paralympic games were held. The article raises questions about disability equality following the Paralympics.     

Investigating British General Practitioners' Knowledge and Experience of Elder Abuse: Report of a Research Study in an Inner London Borough

ABSTRACT

Despite the involvement of the medical profession in drawing attention to elder abuse, no research has been conducted in Britain about their experience with the problem. This article is based on a study undertaken in 1996 in the inner London borough of Tower Hamlets. All general medical practitioners (GPs) working in the community were asked about their knowledge and experience of elder abuse; 73 GPs responded, a 68% response rate. One particular aspect of the study is described, both for its methodological interest and for its findings. It involved asking respondents about twenty situations of suspected elder abuse; 84% (61 GPs) had an older patient in at least one of these situations.     

“You see,one day they cut”: The evolution,expression, and consequences of resistance for women who oppose female genital cutting

ABSTRACT

It is estimated that more than 200 million women alive today have undergone female genital cutting (FGC). While emerging evidence shows that attitudes toward FGC may evolve for immigrants as they acculturate to the host country, scant empirical research explores how women come to oppose the practice. This qualitative study used grounded theory methods to explore the trajectory of resistance to FGC for seven women circumcised in childhood who sought asylum in the United States as adults to protect their daughters from the practice. Participants originated from Burkina Faso, Guinea, The Gambia, and Chad. Analysis revealed nine themes tracing the evolution of resistance to FGC and other gender role norms for participants: coercion, threat, and retribution narratives; traumatic memories of circumcision; growing awareness of the personal implications of circumcision; emergence of critical thinking; trangressive thoughts and acts; navigating the consequences of resistance; everyday reinforcement; negotiating resistance dilemmas; and making meaning of resistance. In contrast to previous studies linking opposition to FGC to post-settlement acculturation or pre-migration exposure to organized international human rights campaigns, findings of this study indicate that traumatic memories of the circumcision rite, combined with the capacity to reflect on “taken for granted” cultural practices and to employ critical thinking skills, may lead to resistance to FGC for some women. Furthermore, findings highlight that FGC, and opposition to it, has lasting consequences for women from societies where the practice is embraced, and these consequences persist after migration. Practice and policy recommendations are drawn from the analysis.     

“I Feel Like More of a Man”: A Mixed Methods Study of Masculinity,Sexual Performance,and Circumcision for HIV Prevention

Ethnographic studies from numerous societies have documented the central role of male circumcision in conferring masculinity and preparing boys for adult male sexuality. Despite this link between masculinity, sexuality, and circumcision, there has been little research on these dynamics among men who have been circumcised for HIV prevention. We employed a mixed methods approach with data collected from recently circumcised men in the Dominican Republic (DR) to explore this link. We analyzed survey data collected six to 12 months post-circumcision (N = 293) as well as in-depth interviews conducted with a subsample of those men (n = 30). We found that 42% of men felt more masculine post-circumcision. In multivariate analysis, feeling more masculine was associated with greater concern about being perceived as masculine (OR = 1.70, 95% CI: 1.25–2.32), feeling more potent erections post-circumcision (OR = 2.25, 95% CI: 1.26–4.03), and reporting increased ability to satisfy their partners post-circumcision (OR = 2.30, 95% CI: 1.11–4.77). In qualitative interviews, these factors were all related to masculine norms of sexually satisfying one’s partner, and men’s experiences of circumcision were shaped by social norms of masculinity. This study highlights that circumcision is not simply a biomedical intervention and that circumcision programs need to incorporate considerations of masculine norms and male sexuality into their programming.     

Like mother,like daughter? Female genital cutting in Minia,Egypt

Evidence that 97 percent of ever-married Egyptian women were circumcised in 1995 fueled interest to understand the levels, determinants, and consequences of this practice. Qualitative data suggest that ideologies of femininity, pressure to conform to behaviors characterizing womanhood, and constraints to other opportunities perpetuate women's support for female genital cutting in Minia, Egypt. While the practice remains prevalent in Minia, age-specific probabilities of genital cutting are lower among daughters than mothers and among younger than older daughters. A mother's education is negatively associated with, and her circumcision status positively associated with, her intent and decision to circumcise a daughter. Increasing reliance on doctors to perform the procedure is positively associated with urban residence and father's education, indicating a need to understand local meanings of modernity. Overall, increasing girls' access to higher education may contribute to further declines in female genital cutting in this setting.     

Female circumcision: the view from Sudan. Interview [with Ikhlas Nouh Osman

Female circumcision involves removing either all or part of the clitoris, labia minora, and/or labia majora. The practice is therefore increasingly being described as female genital mutilation. More than 90% of women in Sudan have undergone female genital mutilation. Pharonic circumcision is the most prevalent in Sudan. This form of mutilation involves the full removal of the clitoris and the labia. The two sides of the wound are then sewn together, leaving a small hole through which urine and menstrual blood may pass. Female genital mutilation occurs because women believe that the resultant narrow vaginal entrance will give pleasure to a future husband, due to tradition, uncircumcised women have great difficulty finding a spouse, and from the belief that the practice is mentioned in Islam. Koranic law is widely respected and followed in the Islamic areas of Sudan. Contrary to the belief of women that female circumcision keeps the vagina very clean, considerable health and psychological problems may result following the operation and throughout the woman's life. An activist against female genital mutilation describes her experience undergoing the operation, the trauma of first penile penetration with her husband, giving birth, and how women have their genital orifice restitched after delivery to the size before penetration. Nongovernmental organization efforts in Sudan against female circumcision are described.     

The Caring Wife: The Experience of Caring for a Severely Disabled Husband in the Community

Modern medicine has dramatically increased the chances of survival following major trauma such as a severe head injury or high level injury to the spinal cord. Greater numbers of seriously disabled people are thus returning to live in the community. This article examines the situation of the wife who assumes a caring role following the onset of severe disability in her husband. The study examines community care for people with traumatic disabilities and the social expectations of women's role in the provision of that care. Reference is made to the British situation although similar experiences are shared by women in other developed countries. As health care and social service professionals seek to serve the needs of their physically disabled client it is recommended that they view also the needs of their other client-the carer.     

Challenges Faced by Young Mothers with a Care History and Views of Stakeholders About the Potential for Group Family Nurse Partnership to Support Their Needs

Women with experience of being ‘looked after’ are more likely than their peers to become young mothers. There has been limited research investigating support for their needs. This study, embedded in a randomised trial of Group Family Nurse Partnership (gFNP), involved interviews with young mothers with care experience, Family Nurses delivering group gFNP, and health and social care professionals. This first qualitative study to explore the views of these varied stakeholders found consensus regarding young mothers’ social isolation and lack of trusting relationships but diversity in views about the potential of gFNP to meet their needs.     

A survey of Colorado's migrant farmworkers: access to health care

This report utilizes data collected in a 1986 sample survey of 329 adult (18 to 50 years old) migrant farmworkers in Colorado to determine their health needs, health services utilization, and overall access to care. Health needs include selected indices of medical, dental, nutrition, and reproductive health. About 1/4 of the population had no usual source of health care. Upstream states such as Colorado are responsible as the primary providers of health services for those who either have no source of health care at their home base or experience a variety of barriers in their attempts to access services. Women are most likely to have had a medical visit over the past 12 months and are more likely to have experienced hospitalization. Unfortunately, although their contact with medical professionals is more frequent, the family planning needs of women are not being met. A large disparity exists between ideal family size and number of pregnancies and live births. The findings of this survey document the inferior health status of the migrant farmworker population in Colorado. Hunger, poverty, and environmental hazards increase the risk of illness, while at the same time, barriers to care often prevent migrants from accessing needed health services. Recommendations include 1) promoting and funding family planning and reproductive health services for migrant farmworker women and their partners, 2) incorporating trained family planning promoters in the migrant health delivery system, 3) maintaining successful models of restorative dental care for adults, 4) increasing access to services in nontraditional settings, 5) increasing use of ancillary personnel to provide services, especially dental services, 6) maintaining outreach programs in the available food programs, and 7) encouraging migrant health programs to provide leadership in the development of alternative food sources.     

Nennu and Shunu: gender, body politics, and the beauty economy in China

This essay analyzes recent discourse on two emerging representations of women in China, "tender" women (nennu) and "ripe" women (shunu), in order to examine the relationships among gender, body politics, and consumerism. The discourse of nennu and shunu suggests that older, ripe women become younger and more tender by consuming fashions, cosmetic surgery technologies, and beauty and health care products and services because tender women represent the ideal active consumership that celebrates beauty, sexuality, and individuality. This discourse serves to enhance consumers' desire for beauty and health and to ensure the continued growth of China's beauty economy and consumer capitalism. Highlighting the role of the female body, feminine beauty, and feminine youth in developing consumerism, this discourse downplays the contributions of millions of beauty and health care providers (predominantly laid-off female workers and rural migrant women) and new forms of gender exploitation. Such an overemphasis on gender masks intensified class division. This essay suggests that women and their bodies become new terrains from which post-Mao China can draw its power and enact consumerism. Gender constitutes both an economic multiplier to boost China's consumer capitalism and a biopolitical strategy to regulate and remold women and their bodies into subjects that are identified with the state's political and economic objectives. Since consumerism has been incorporated into China's nation-building project, gender thus becomes a vital resource for both consumer capitalist development and nation building. This essay shows that both gender and the body are useful analytic categories for the study of postsocialism.     

Islam and development: opportunities and constraints for Somali women

This article describes the effects of the rise of Islamic extremism on women's lives in Somalia since the early 1990s. Throughout the conflict and afterwards, Somali women's organizations in different parts of the country have been active in both development work and advocacy for peace. They were challenging both the government and nongovernmental organizations to recognize and promote the role of women in society, and to resist threats to women's rights. It has been documented that religious extremists were challenging women's rights within marriage and family, to their economic and political participation outside the home, and to their freedom of dress and behavior. The paper also highlights the fact that wholesome and unwholesome traditional practices tend to be associated with Islam, and with other rights as defined in Islam. It reconfirmed that the violations against Somali women's rights are culturally rooted, and that such practice continues unchecked. Until Somali women received a better education, particularly in religious education, this situation will continue. The only hope are the women's organizations who seriously attempt to redress the extremists' strategy of marginalizing women on the grounds of religious evidence.     

Shift work--problems and its impact on female nurses in Udaipur, Rajasthan India

Abstract : There is good evidence that shift work has negative effects on workers health, safety and performance. It is quite appropriate that attention is paid to this very important feature of socio-technical systems, which may adversely affect mental and physical health, social life and safety of shift workers. Research into the impact of shift work on professionals has consistently identified a range of negative outcomes in physical, psychological, and social domains (Akerstedt, 1988; Costa, Lievore, Casaletti, Gaffuri, & Folkard, 1989; Kogi, 2005; Paley & Tepas, 1994). Hospitals, the biggest employer in the health care field, employ more night shift workers than any other industry. It can therefore be inferred that in medical domain high percentage of workforce may be affected by problems related to shift work. Thus the present study will provide knowledge base for the problems faced by the female nurses. The present study was undertaken with an objective of getting an insight into the problems faced by female nurses in shift work. . It was found that the female nurses in India worked on roaster pattern of change in shift every seven days. They did not have a say in the change of duties, it could only be done on mutual grounds. Partners of younger group did not much adjust to their shift pattern this created stress among the nurses.The results showed that the female nurses in both the age groups i.e. 30-45 years and 45-60 years faced many problems related to health and well being, fatigue, social and domestic situations. They could not give much time to their children in particular. Travelling in nights was risky for them. Common problem was the insufficient sleep during night shifts. The nurses had to cater to the needs of the family, children in particular along with the adjustments to be made due to shift work. They had to sometimes do the night duties and attend social functions as a part of their duty. Children and husband in some cases did not cooperate this lead to frustration. When asked as to whether they would could shift job if they get regular one more than 50 % said yes this means that there need to be come training and intervention for the shift workers and their family so that the problems faced and their impact on personal health of the female nurses could be reduced.     

Trust and Health Care

Trust is believed to be particularly salient to the provision of health care, and since the establishment of the National Health Service (NHS) in the UK, trust has played an important role in the relationships between its three key actors: the state, healthcare practitioners, and patients and the public. Service users trusted the judgement, knowledge and expertise of health professionals to provide a competent service that met their needs, and they trusted the state to ensure equity in the allocation of public goods and services. These implicit or taken-for-granted trust relationships have, it is claimed, been challenged as a result of the introduction of changes in the organisation and funding for the health service, in the regulation and performance assessment of health professionals, and in public attitudes to health care and scientific medicine. This paper considers the influences of social changes and recent policy and professional initiatives in health care on the structure of trust relations in health care in the UK. It presents a theoretical framework for examining trust relations using the NHS as a case study and concludes with an agenda for future research.