Health Care for Older Women:

The issue of health care for older women as it relates to their financial resources and health care reimbursement is the focus of this paper. Federal regulations that affect older women and also the role of the medical establishment are examined. Suggestions are given for policy changes on the federal and local levels and for a redirection of the women's health movement. It is suggested that women tend to be seen as burdens to the health care system and face both age and sex discrimination from many health care providers. This is the disease that needs to be cured.     

Miscarriage in the Workplace: an Authoethnography

This paper is an extension of the literature on pregnancy and work, and it introduces miscarriage as an important topic of study in management. Miscarriage starts with a pregnancy, so a woman who has miscarried deals with many of the same workplace issues as women who carry to term. The experience of miscarriage, however, often leads to physical and emotional trauma and/or grief that many women hide from their co‐workers. In this paper we also explore how secrecy is an integral part of the miscarriage experience. The combination of secrecy and grief that is layered on top of a difficult physical experience makes miscarriage a unique experience that, to date, has mostly been ignored in management literature and practice. It is well documented that contemporary corporate structures have little room for addressing procreation, health and grief, it is perhaps unsurprising then that despite miscarriage being seen as a relatively common event it remains silenced.     

Medical complications of female genital mutilation.

More than 130 million women are subjected to genital mutilation. Despite increasing efforts to reduce the practice, there are many obstacles to eliminating this 2,000-year-old practice, which is based on strong cultural traditions. As college health clinicians provide care to more international students from countries where female genital mutilation is performed, increased awareness and knowledge of the procedure will enable clinicians to understand and manage its complications. We report a case of obstructive uropathy resulting in hydronephrosis secondary to female genital mutilation and review the medical literature regarding this and other complications of genital mutilation "surgery."     

Medical Complications of Female Genital Mutilation

Abstract

More than 130 million women are subjected to genital mutilation. Despite increasing efforts to reduce the practice, there are many obstacles to eliminating this 2,000-year-old practice, which is based on strong cultural traditions. As college health clinicians provide care to more international students from countries where female genital mutilation is performed, increased awareness and knowledge of the procedure will enable clinicians to understand and manage its complications. We report a case of obstructive uropathy resulting in hydronephrosis secondary to female genital mutilation and review the medical literature regarding this and other complications of genital mutilation “surgery.”     

"Women and disability don't mix]" Double discrimination and disabled women's rights

Oxfam's experience with groups of disabled people has revealed that gender affects how disabled people are treated in various cultures. This experience runs counter to the often voiced (even by a consultant hired by Oxfam) assumption that gender analysis serves only to confuse any analysis undertaken of disability-based circumstances. This assumption is echoed in the disability movement itself where activists fear fragmentation through the introduction of gender analysis. Thus, gender is not yet understood as a factor which affects every aspect of life including race, class, ethnicity, caste, and disability. Because 75% of the 250 million disabled women in the world live in developing countries, development programs must consider the specific needs and rights of disabled women who suffer from double discrimination and are more likely than disabled men to live impoverished and isolated lives which lead to depression and despair. In many societies, disabled women, but not disabled men, lose their rights to marriage, family life, education, and health care. Mothers of disabled children are stigmatized, and fathers tend to "blame" defective genes on the mothers and to ignore their disabled offspring. These factors combine to make it difficult to improve the status and livelihoods of disabled women through development work. Disabled women activists have also voiced complaints about their lack of access to the preparatory meetings for the Fourth UN Women's Conference, but disabled women intend to use the Conference to lobby for their rights and to call for scrutiny of health policies which discriminate against the disabled.     

Who cares? A lack of self‐care for women in the non‐profit/non‐governmental sector

In this article I examine the lack of self‐care regimes for women working in the non‐profit/non‐governmental sector. While I draw on ethnographic research conducted in the Malaysian context of women's organizations, the issue of self‐care for activists and feminist activists is a global one that crosses borders and boundaries. I explore the gendered nature of care and care professions to demonstrate how women are predominantly affected in these working environments. To date, there has been little scholarship on self‐care and care in non‐profit/non‐governmental working environments. Using interviews with women working in the sector, I argue that women's emotional, mental and physical health comes at a cost in these hectic workplaces. This article contributes to the literature on gender, work and care in women's organizations by taking seriously women's concerns working in these spaces, where they experience self‐neglect and institutional barriers in care regimes.     

Translating Spirituality: Universalism and Particularism in the Diffusion of Spiritual Care from the United States to Israel

Research on the transnational diffusion of ideas and practices shows how cultural objects go through translation, adaptation, and vernacularization when implemented in new localities. Less attention is given to the translators themselves and their heterogeneous and often conflicting visions. Drawing on the notion of transnational social fields (TSF s), this article investigates how cultural objects get vernacularized differently in different parts of the TSF , demonstrating how processes of translation reflect larger social and political struggles over questions of identity. As a case study, we focus on the attempt of actors from Israel and the United States to institutionalize spiritual care in Israeli health‐care organizations. The analysis reveals how spiritual care functioned as a porous cultural object, open to a wide range of interpretations and debates. While actors in New York saw in spiritual care the opportunity to bridge to Israeli Jews and create a global Jewish identity, Israeli actors split between using spiritual care as a vehicle for creating a local Israeli Jewish identity and seeing in spiritual care the opportunity to establish universal identities, broader than the Jewish one. The disagreement and conflicts between the groups influenced the translation process, turning it into a contentious struggle that involved different positions on the continuum between particularism and universalism.     

The sociolinguistics of exogamy: Dialect acquisition in a Zhuang village

Adult dialect acquisition is typically studied in relatively idiosyncratic situations where adults happen to move to another community. But how does dialect acquisition play out in indigenous minority societies that have systemic adult migration due to exogamy? Do the in‐married spouses acquire the local variety? Why or why not? How much do they acquire? We investigated an indigenous Zhuang community in southern China. Sociophonetic analyses of in‐married women and local villagers show that the in‐married women acquired the local variety in most respects but not in aspirated consonants. To the limits of their phonological ability as adult learners, the wives followed the local sociolinguistic norm: they acquired the husbands’ variety. By contrast, in societies experiencing greater external cross‐cultural contact, exogamous women sometimes use their liminal status to challenge such gendered sociolinguistic expectations. Comparing the present study with outcomes in different societies, we lay the foundation for a typology of the sociolinguistics of exogamy. In this way, we help expand the study of language and gender toward new horizons and under‐represented social settings.     

Staying with People Who Slap Us Around: Gender,Juggling Responsibilities and Violence in Paid (and Unpaid) Care Work

Little is actually known about women's occupational health, let alone how men and women may experience similar jobs and health risks differently. Drawing on data from a larger study of social service workers, this article examines four areas where gender is pivotal to the new ways of organizing caring labour, including the expansion of unpaid work and the use of personal resources to subsidize agency resources; gender‐neutral violence; gender‐specific violence and the juggling of home and work responsibilities. Collective assumptions and expectations about how men and women should perform care work result in men's partial insulation from the more intense forms of exploitation, stress and violence. This article looks at health risks, not merely as compensable occupational health concerns, but as avoidable products of forms of work organization that draw on notions of the endlessly stretchable capacity of women to provide care work in any context, including a context of violence. Indeed, the logic of women's elastic caring appear crucial to the survival of some agencies and the gender order in these workplaces.     

Women's rights,the family,and organisational culture: a Lesotho case study

Traditional cultural norms have had significant implications for the work and internal structure of Lesotho Save the Children (LSC). From 1964-90, the organization's work focused entirely on the needs of neglected and abandoned boys, for whom it provided residential care. After consultation with the Department of Social Welfare, it was decided to make the residential center a haven for girls as well as boys in need of protection. Many girls in Lesotho experience physical and sexual abuse within their families; moreover, daughters in poor families are often placed in households of wealthier extended family as domestics, where further abuse occurs. Cultural discomfort acknowledging and discussing sexuality extended to Children's Village staff responsible for the care of child rape victims. Coercive sex is often a prelude to marriage in Lesotho, where many women are kidnapped and raped by their prospective bridegrooms. In-service training has enabled staff to overcome their reticence regarding sexual issues and view rape as a criminal act. Although LSC is unable to challenge the oppression of women and children implicit in the traditional family, it continues to encourage girls and women to protest sexual violence, the abuse of their daughters, and the unequal distribution of labor within the family. All children in the LSC residence perform both male- and female-defined duties and attempts are being made to reduce the division of labor among staff in which females are caretakers and males are authority figures.     

The relationship between medical education and trans health disparities: a call to research

According to the National Transgender Discrimination Survey, 28% of trans respondents reported postponing medical care due to discrimination, and 28% reported being harassed by providers when they did seek out care. Scholars have proposed that what is taught (or not) in medical schools might play a role in the unequal health care experienced by many trans people. As medical education becomes a site of intervention for reducing transgender health disparities, it presents opportunities for sociologists to study and explain the processes by which medical training creates, reinforces, and potentially challenges stigma‐related health disparities. In this paper, we propose three areas of inquiry that might help explain this situation: the hidden curriculum, patient health movements and consumerism, and medical competency. By employing these concepts, we argue that sociologists can develop more comprehensive explanations for the relationship between medical education and transgender health inequalities and offer solutions to address this disparity.     

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.     

The Influence of an Untoward Public Act on Conceptions of Self1

This study focuses on the process of making sense of the experience of being exposed to. It looks at audience interpretations of the experience of having viewed a stranger's genitals in a public place and the effects on viewer self concepts. The study is based on in-depth interviews with 25 adult women. Findings indicate that women typically incorporate their definitions of the experience into their self-images which, as a result, are impuned and discredited. Women often saw the self as having played a role in the production of the event. Although women generally were critical in their assessment of themselves and their management of the situation they used vocabularies of non-responsibility when recounting the experience thereby reducing the likelihood of criticism by others.     

Diaspora and Health? Traditional Medicine and Culture in a Mexican Migrant Community

As members of the Mexican diaspora acculturate/assimilate to life in the United States they gain skills that help them improve their socioeconomic status and overcome barriers to the mainstream American healthcare system. Thus, we might expect better health among more acculturated Mexicans. However, most of the research conducted during the past 20 years shows that the health of Mexicans living in the United States deteriorates as acculturation increases. This suggests that certain health promoting aspects of Mexican culture are lost as migrants adapt to and adopt American ways of life. This paper is the first step in testing the hypothesis that declining health among acculturated people of Mexican descent is related to a loss of traditional medical knowledge. During an ethnographic study of women’s medical knowledge in an unacculturated Mexican migrant community in Athens, Georgia, I observed many ways low‐income, undocumented migrants maintain good health. Migrant women encourage health‐promoting behaviors and treat sick family members with a variety of home remedies that appear to be effective according to chemical and pharmacological analyses. Additionally, migrant women in Athens learn how to navigate the American medical and social service systems and overcome barriers to professional healthcare services using information provided through social networks. Nevertheless, migrant women often prefer to treat sick family at home and indicated a preference for Mexican folk medicines over professional medical care in most situations. This case study suggests that migration and diaspora need not always lead to disease. The maintenance of a Mexican culture that is distinct from the rest of American society helps ensure that traditional medical knowledge is not lost, while the social networks that link Mexicans to each other and to their homeland help minimize threats to health, which are usually associated with migration. Thus, increased access to professional medical care may not improve the health of migrants if it comes with the loss of traditional medical knowledge.     

Understanding intimate partner violence against women in the rural South

Most U.S. intimate partner violence (IPV) research to date has been limited to women residing in urban areas, with the small body of research focusing on rural populations being primarily qualitative. In this case-control study of Southern rural women, while many factors are consistent with those found in urban settings, unlike findings elsewhere, IPV risk appears to increase with age, and race showed no increased risk. Furthermore, in rural areas where guns are more acceptable than in other parts of the United States, partners of IPV victims are considerably more likely to carry weapons than partners of nonabused women. Given the geographic limitations to police and medical response to severe IPV in a rural setting, an improved understanding of IPV risk among this population can aid health care providers in ascertaining risk before it escalates further.     

Voices of pacific youth: Video research as a tool for youth expression

Between 1994 and 1998, UNICEF administered a project to document on video tape the concerns and experience of young people living in the South Pacific Islands. Video was a valuable dual‐purpose medium for this project: it was useful both as a research tool and as a means to communicate sensitive issues across culturally defined borders between young and old. In this article I review the UNICEF produced videos as primary documents about the changing circumstances of youth who live in the Pacific societies. I also examine the challenges of trying to conduct investigations of this sort in cultural environments where young people are inhibited from expressing their views and feelings, and where adolescent perspectives are categorically devalued.     

Inter‐professional Learning to Prepare Medical and Social Work Students for Practice with Refugees and Asylum Seekers

Social workers and medical practitioners, particularly those in general practice, provide services for individuals who experience social exclusion. Access to medical, health and social care services has been identified as problematic for refugees and asylum seekers, reflecting their marginalised status within society. It is widely accepted that multi‐agency responses and working together are key requirements in improving access to services and promoting social inclusion; however, achieving this across professional and agency boundaries often remains challenging. Joint planning and training have been suggested as being important in improving communication, leading to more flexible and creative services.

This paper describes the genesis and implementation of a series of innovative inter‐professional workshops for medical and social work students, focussing specifically on marginalised groups. Learning and teaching input was developed by, and came from, service users and qualified medical, health and social work practitioners. The paper focuses particularly on the sessions relating to refugees and asylum seekers. The content and structure of the sessions are discussed and students' responses are reported. The implications for future inter‐professional learning and practice in relation to socially excluded groups are highlighted.     

‘She is Too Young for These Chores’ — Is Housework Taking a Back Seat in Urban Chinese Childhood?

The child in contemporary urban China is experiencing an increasingly exclusive focus on academic achievement at the expense of non‐academic activities, particularly housework. In‐depth interviews with caregivers (including grandparents and parents) from 9 three‐generational families (n = 34) and parents from 10 nuclear families (n = 20) were conducted. Results show that although children from both family types were low in housework participation, children in three‐generational families were perceived by their caregivers to be less competent in performing self‐care and family‐care tasks. They were also less frequently assigned regular tasks as compared with children from nuclear families. Unlike caregivers from western societies, where children's participation in housework is seen as either a means of socialisation or a source of domestic labour, Chinese caregivers consider housework as a distraction, at best an addendum to academic work.     

The Cost of Instability: The Effects of Family,Work, and Welfare Change on Low‐Income Women’s Health Insurance Status

The number of uninsured Americans has risen substantially over the last decade. Despite the availability of Medicaid, low‐income women are at particularly elevated risk of having no or inadequate health insurance. How does continuity of work, family, and welfare affect low‐income women’s health insurance status? A multinomial logistic regression analysis of 1,662 low‐income women from the Welfare, Children, and Families: A Three‐City Study provides evidence of the consequences of life changes on access to health insurance from 1999–2005. The results show that compared to those with stable welfare, work, and family attachments, new full‐time employment actually increases low‐income women’s risk of being uninsured as does being underemployed, on welfare, or single for extended periods of time. These findings illustrate how health‐care reform must adequately address the complexity of low‐income women’s lives—including the ways labor market, state, and family factors interact to create barriers to health insurance—in order to improve access to care under the current U.S. health insurance model.     

Untangling Inequalities: Gender,Race, and Socioeconomic Differences in Depression1

In their important paper, Link and Phelan (1995) argue that socioeconomic status is a fundamental cause of variation in well‐being and that the social resources associated with socioeconomic status constitute the fundamental cause of variation in well‐being. In this article, I elaborate on the fundamental cause perspective in three respects: by suggesting an expansion of the definition of resources, by examining how race and gender influence variation in the relationship between resources and mental health, and by developing a model of the relationship between social class, race, and gender that takes account of the potential asymmetry in the influence of resources across race and gender. Using the 2003 National Health Interview Survey and ordinary least squares regression, I find that black and white men are significantly less depressed than black and white women. However, women accrue greater mental health advantage from marriage, home ownership, and education. African‐American men experience less depression as a result of being unmarried and non‐Hispanic white women experience less benefit from full‐time employment, relative to African‐American women and men. Results are discussed in terms of implications for future research on race, class, and gender differences in health.