Socially disadvantaged women's views of barriers to feeling safe to engage in decision-making in maternity care

BackgroundAlthough midwifery literature suggests that woman-centred care can improve the birthing experiences of women and birth outcomes for women and babies, recent research has identified challenges in supporting socially disadvantaged women to engage in decision-making regarding care options in order to attain a sense of control within their maternity care encounters.ObjectiveThe objective of this paper is to provide an understanding of the issues that affect the socially disadvantaged woman's ability to actively engage in decision-making processes relevant to her care.Research designThe qualitative approach known as Interpretative Phenomenological Analysis was used to gain an understanding of maternity care encounters as experienced by each of the following cohorts: socially disadvantaged women, registered midwives and student midwives. This paper focuses specifically on data from participating socially disadvantaged women that relate to the elements of woman-centred care-choice and control and their understandings of capacity to engage in their maternity care encounters.FindingsSocially disadvantaged women participants did not feel safe to engage in discussions regarding choice or to seek control within their maternity care encounters. Situations such as inadequate contextualised information, perceived risks in not conforming to routine procedures, and the actions and reactions of midwives when these women did seek choice or control resulted in a silent compliance. This response was interpreted as a consequence of women's decisions to accept responsibility for their baby's wellbeing by delegating health care decision-making to the health care professional.ConclusionThis research found that socially disadvantaged women want to engage in their care. However without adequate information and facilitation of choice by midwives, they believe they are outsiders to the maternity care culture and decision-making processes. Consequently, they delegate responsibility for maternity care choices to those who do belong; midwives. These findings suggest that midwives need to better communicate a valuing of the woman's participation in decision-making processes and to work with women so they do have a sense of belonging within the maternity care environment. Midwives need to ensure that socially disadvantaged women do feel safe about having a voice regarding their choices and find ways to give them a sense of control within their maternity care encounters.     

Challenges to reproductive health in Australia

Reproductive health in Australia is assessed using the parameters outlined in the UN 1994 Cairo conference; some limitations of that approach are noted and further aspects of reproductive health identified and discussed. While many of the basic goals of reproductive health, for example low maternal mortality and widespread contraceptive use, have been largely achieved in Australia, the gains have not been uniform and certain groups such as indigenous Australians, those in rural and remote areas, young people and men remain disadvantaged. The remaining challenges cannot be met within the health system alone but require broader systemic interventions.     

Adherence to three different strategies to prevent early onset GBS infection in newborns

ProblemDespite the introduction of preventive guidelines, no decrease in the incidence of early onset infection was observed.BackgroundEarly onset group B streptococcal (EOGBS) infection is an important cause of neonatal morbidity and mortality.AimOur study was conducted to determine adherence to three guideline-based group B streptococcus (GBS) preventive strategies.MethodsA prospective experimental study clustered by obstetric collaboration region was performed between March 2013 and August 2014 among midwives, obstetricians and paediatricians in the Netherlands. At baseline, the three regions operated according to the Dutch preventive strategy (founded on the risk-based strategy) in order to prevent EOGBS infection, whereas in the study period they followed either the risk-based, the combination or the Dutch strategy. Adherence was measured prospectively per pregnant woman, using predefined core elements of each preventive strategy: identification of risk factors, maternal GBS screening, application of intrapartum antibiotic prophylaxis and observation of the child. Data about adherence to the core elements were collected from medical records, maternal questionnaires and laboratory test results.FindingsIn the three regions, a total of 121 care providers and 1562 women participated.We found an overall adherence of 90% to the risk-based strategy, 57% to the combination strategy and 89% to the Dutch strategy. Adherence to a strategy in case women had EOGBS risk factors was below 20% in all strategies.DiscussionThe majority of women with EOGBS risk factors did not receive the care prescribed by any of three preventive strategies and were not treated optimally.ConclusionThe risk-based and the Dutch strategy are the recommended strategies for implementation.     

Estimation of damage to human health due to forest burning in the Amazon

Forest burning stands as a highly used practice in the Brazilian Amazon Forest. Burning trees is the cheapest way to expand agricultural frontiers in the Amazon region. Nevertheless, the smoke generated in this process can produce undesirable negative effects, in particular health-induced problems by the polluted air. This study aims to investigate whether these effects on the health of the region’s population are statistically significant, using as variables mortality and morbidity rates associated with respiratory diseases. The estimated morbidity model was used to estimate the health damage to those people who became ill only by the fire.

Relating Changes in Life Expectancy to Changes in Mortality

I address the problem of what can be said of changes in mortality rates, if one knows how life expectancies change. I note a general formula relating life expectancies in different ages to mortality and prove that if mortality changes over time following a proportional-hazard model, then there is a one-to-one correspondence between life expectancy at birth and mortality rates. Extensions and an application of these results to the analysis of mortality change are presented.     

The path to lowest-low fertility in Ukraine

The phenomenon of lowest-low fertility, defined as total fertility below 1.3, is now emerging throughout Europe and is attributed by many to postponement of the initiation of childbearing. Here an investigation of the case of Ukraine, where total fertility--1.1 in 2001--is one of the world's lowest, shows that there is more than one pathway to lowest-low fertility. Although Ukraine has undergone immense political and economic transformations in the past decade, it has maintained a young age at first birth and nearly universal childbearing. Analyses of official national statistics and the Ukrainian Reproductive Health Survey show that fertility declined to very low levels without a transition to a later pattern of childbearing. Findings from focus-group interviews are used to suggest explanations of the early fertility pattern. These include the persistence of traditional norms for childbearing and the roles of men and women, concerns about medical complications and infertility at a later age, and the link between early fertility and early marriage.     

Running to stay in the same place

Although the world's population growth rate will decline to 1.6% by the year 2000, another 2 billion persons will have been added to the world's population by that time. Most of the increase will occur in the world's poorest regions and in countries which also experienced vast growth from 1950-1980. These increases will aggravate the existing problems of rural migration, rapid urbanization, urban poverty, and unemployment and will reduce the impact of development programs. By the year 2000, over 80% of the world's population will live in developing areas. Latin America's proportion of the world's population will increase from 8-10%, Africa's share will increase from 11-13%, and Asia's share, excluding China, will increase from 32-36%. China's share, however, will decline from 28-23%. Within these regions the increases in population will be unevenly distributed. Programs and policies dealing with resource allocation, health, economic development, and job creation will have to be focused on those areas of highest population concentration. If major efforts are not directed toward employment generation, and if employment generation is not tailored to the needs of the labor force in these areas, the resultant increase in poverty will reduce the effectiveness of family planning programs and destroy the gains made in the past to stem population growth.     

Trends in return migration to the south

Demography - The rate of return migration to the South rose by nearly 19 percent between the late 1950’s and the late 1960’s and was an important factor in changing the South’s...     

Institutional impediments to population policy in Australia

Despite being near the top of the OECD league in rate of population growth, Australia does not have any explicit population policy. The potential constituent parts of one, particularly on immigration, family and environment, are firmly enmeshed in separate political domains and responsive to separate clusters of interests. Vague, demographically ill-informed, and mutually inconsistent views of a desired population size or trajectory for Australia co-exist, with no arena for systematic engagement and considered debate among them. Australia is not alone in this respect: instructive parallels can be drawn from Canada and the United States. Indeed, population policy may well be one of the issues that modern liberal democracies find peculiarly difficult to deal with. However, there are also specific historical circumstances that led to this outcome, and that perpetuate it. Revised version of a paper presented at the Seventh National Conference of the Australian Population Association, held in Canberra in September 1994.     

From Damsels in Distress to Sexy Superheroes

Video games are an important form of media that have the potential to impact gender role attitudes. Sexist portrayals of characters may affect gender behaviors and attitudes. As such, it is important to discover how characters, particularly females, are portrayed in video games. The current study examined video game magazines analyzing the portrayal of female video game characters and how this portrayal has changed in the last twenty years. Results indicate a growing trend toward a decreased benevolent sexism portrayal and an increase in a hostile sexism portrayal over time.     

Self-selection in migration and returns to unobservables

We build a model of migration that considers both observable and unobservable individual characteristics and their returns across locations. We focus on the interprovincial migration patterns of Canadian physicians, in part, because physicians are paid on a fee-for-service basis. Because fees are exogenous, we can estimate a mixed conditional-logit model to determine the effects of individual- and destination-specific characteristics (particularly earnings differentials) on physician location decisions. We find, among other things, that individuals with greater earnings potential based on unobservables are more likely to migrate to provinces where the returns to such unobservables are greater.      

Demographic response to environmental pressure in Malawi

The discussion in this paper uses Malawi as a case study to shed some light on the interrelationships between population growth and demographic responses to environmental pressure. It is noted that certain parts of the country that are experiencing extreme environmental stress have began to go through a rapid phase of demographic and social change and transformation. For example, the Southern Region of the country, which has some of the highest densities, is experiencing a fertility transition. There is a spontaneous internal migration pattern from densely populated rural areas to other sparsely populated rural areas. Other non-demographic responses to population pressures are also briefly discussed in this paper.     

Economic Impact of Rural to Urban Labor Migration in China from 1991 to 2011

This paper quantitatively explores the size of rural labor force transfer and the specified flow nonagricultural industries, and the corresponding contribution of the increase of labor force utilization and productivity to economic growth from 1991 to 2011. The transfer size increased from 86.73 million people in 1990 to more than 250 million people in 2011. In 2011, 53.7% of the transfer labor worked in second industry, the others in third industry. By using growth accounting, this paper decomposes GDP growth into three growth components: working age population, labor force productivity and labor force utilization. Firstly, the paper calculated the real average annual growth rate of these three factor from 1991 to 2011 and their contributions to GDP growth. Then we calculated the changes of three factors and GDP'growth rates under the scenario without rural labor transfer, and finally got the contribution of rural labor transfer to GDP growth by comparing the difference between real and assumption scenario. The resuit shows that from 1991 to 2011, the real average annual growth rate of three factors were 1.3%, 9.3% and-0.3%, and their contribution the GDP growth was 12.2%, 90.2% and-2.4%separately. Under the scenario without rural labor transfer, the average annual growth rates of labor force productivity and labor force utilization would reduce to 8.9% and-1.4%, while the GDP average annual growth rate would reduce from 10.3% to 8.8%. The profound analysis in details shows that the transfer promoted labor force utilization by 30.7%and productivity by 23.9% annually on average, therefore promoting GDP by 63.7%, and GDP growth rate by 1.6% annually on average. On the one hand, through the utilizing of the ‘surplus rural labor force', the transfer promoted the labor force utilization, then made the potential population dividend brought by the increase of working age population size practical; on the other hand, through promoting of labor force industry structure, the transfer promoted the total productivity. The transfer has been and will be an important driving force of economic growth in China.     

论人力资本对中国农村经济增长的作用

文章从基本经济理论出发,首先使用微观调查数据,计算各种层次教育的回报率,在此基础上测量农村人力资本的存量。然后使用1989～1995年29个省的宏观数据,将人力资本引入到生产函数中,研究人力资本对农村地区产出的作用。计量经济学回归结果表明,人力资本的投入对中国农村经济增长具有重要的促进作用,这种作用在经济较发达的沿海地区特别明显。     

Morale in Relation to Caring and Social Exclusion in Society

Morale, as a future-oriented indicator of well-being, is susceptible to caring and social exclusion in society, with respect to social integration theory. The influences of caring and social exclusion perceived in society merit the concern of the present study. In addition, the study explores personal background characteristics as conditions for moderating the influences. A telephone survey of 1,526 adults in Hong Kong in China provided data for the study. Results demonstrated the main effects of caring and social exclusion perceived in society on morale and conditions that moderated the effects. The strongest condition is age, such that social exclusion was particularly demoralizing to the older person. In contrast, the person’s wealth did not have a main effect on morale. Results therefore favor the idealist explanation rather than materialist explanation for morale.     

Problems in using birth-history analysis to estimate trends in fertility

Summary The problem investigated is the adequacy of birth-history analysis as a method for estimating fertility change. The analysis demonstrates that inaccurate reporting of the dates of birth of live-born children can, under reasonable assumptions, significantly distort cohort fertility schedules in such a way that estimates of change in fertility will be biased in the direction of exaggerating declines in fertility. This kind of bias is shown to exist in fertility estimates obtained from survey data in El Salvador and Bangladesh. An important implication is that birth history questionnaires should begin with the most recent, rather than the earliest, event in a respondent's experience.     

Changes in union status during the transition to parenthood in eleven European countries, 1970s to early 2000s

Couples who have children are increasingly likely to have lived together without being married at some point in their relationship. Some couples begin their unions with cohabitation and marry before first conception, some marry during pregnancy or directly after the first birth, while others remain unmarried 3 years after the first birth. Using union and fertility histories since the 1970s for eleven countries, we examine whether women who have children in unions marry, and if so, at what stage in family formation. We also examine whether women who conceive when cohabiting are more likely to marry or separate. We find that patterns of union formation and childbearing develop along different trajectories across countries. In all countries, however, less than 40 per cent of women remained in cohabitation up to 3 years after the first birth, suggesting that marriage remains the predominant institution for raising children.     

Approaches to the Fertility Transition in Victorian England

The secular decline of marital fertility which took place in late nineteenth and early twentieth-century England and Wales is considered by using a number of approaches. Among the theoretical approaches considered are those of transition models, and social diffusion. The former overemphasises the role of industrialization and urbanization; the latter is inappropriate when dealing with the development of a small-family ideal in Victorian society. Explanations of fertility decline using ecological and time-series analysis are considered. The registration districts of England and Wales provide the framework for analyses of spatial variations in marital fertility and its correlates in 1861, 1891 and 1911. A time-series analysis attempts to establish the sequential nature of social, economic and demographic changes during the sixty years preceding the First World War. The following points are emphasised in conclusion. The Victorian fertility transition was not directly related to the development of an urban-industrial society, the social diffusion of family ideals or the use of appliance methods of contraception. But its immediate cause was probably linked to the substantial increase in family planning literature available from the 1870s, and the challenge that this posed to the tradition of unlimited marital fertility. This critical change in social attitudes to family planning was facilitated both by developments in mass education and, ultimately by the decline of infant mortality.     

Interventions to Reduce Sexual Minority Stigma in Sororities

This study examined the effects that two different types of interventions have on reducing sexual minority stigma in sororities. Affect, behaviors, and cognitions toward gay men and lesbians were measured using the Affective Reactions to Homosexuality Scale, Homophobic Behavior of Students Scale, and Attitudes Toward Lesbians and Gays Scale. A total of 82 participants from two sororities participated in two different types of interventions, that is, panel discussion and video and discussion. Repeated measures analyses revealed significant reductions in the measures of sexual minority stigma and that neither intervention was more effective than the other. Implications of the findings and directions for future research are discussed.