Ethnographic perspectives on the enumeration of aboriginal people in remote Australia

This paper compares population counts and age distributions from the last two Australian Bureau of Statistics (ABS) enumerations of the Aboriginal population of Aurukun, Cape York Peninsula, with the results of detailed ethnographic surveys of the same population at similar points in time. This reveals substantially lower numbers for the ABS counts, particularly of young adults and children. Reasons for this discrepancy are sought in the ethnographic realities of remote indigenous communities and an alternative methodology for Aboriginal enumeration in remote regions is suggested.     

Maternity health care: The experiences of Sub-Saharan African women in Sub-Saharan Africa and Australia

Background

Increasing global migration is resulting in a culturally diverse population in the receiving countries. In Australia, it is estimated that at least four thousand Sub-Saharan African women give birth each year. To respond appropriately to the needs of these women, it is important to understand their experiences of maternity care.

Uncontained subjects: Population and household in remote aboriginal Australia

The particular abstractions represented by the terms population and house-hold are central categories in modern demographic analysis. They form the organizing principles of national censuses in Western liberal democracies such as Australia, and profoundly influence both the collection methodology and the content of the collection instrument. This paper argues that these categories are founded on a particular metaphor, the ‘bounded container’, that broadly reflects the population and household structures of sedentary societies such as mainstream Australia. Bounded discrete categories are conducive to the collection of reliable census data in such societies, since unbounded behaviours can be controlled for by statistical means. However, remote Abprogoma; populations behave in radically unbounded ways. This paper proposes that the dominant metaphor underlying Yolngu (and much remote Aboriginal) sociality is, instead, the nodal network. It then explores the consequences of attempting to capture nodal network societies in terms of models based on the bounded container.     

Census enumeration in remote Australia: Issues for aboriginal data analysis

Given the crucial role played by census data in informing economic and social policies directed at the Aboriginal population in remote areas, some assessment of the quality of remote area data is required as these are derived from enumeration procedures which differ fundamentally from the standard approach employed in the census. This paper discusses the remote area census enumeration strategy employed by the Australian Bureau of Statistics (ABS), with a particular focus on the Northern Territory, and highlights possible implications for the interpretation of census counts and census characteristics.     

Evaluating public policy responses to the economic burden of population ageing with application to Australia

This paper reviews the issues in evaluating public policy interventions that are designed to address the economic burden of population ageing. It then briefly reviews the main public policy options with application to Australia. The economic burden of ageing is defined as the burden on national economic well-being over time and the extent to which this burden is shared between the public and private sectors. A key policy issue is the extent to which the economic burden of ageing should be spread out over present and future generations. This depends on how we value the economic well-being of future generations relative to our own, future projections of economic growth, and the rate at which our subjective sense of well-being improves with our living standards. The paper discusses policies to boost the labour force participation rates of older workers, measures to boost fertility and immigration policy. Also discussed are several policies to shift the burden of ageing from the public to private sectors: the establishment of government financial funds such as the Future Fund, superannuation policy, and health and aged care policy.     

Maternity Care Plans: A retrospective review of a process aiming to support women who decline standard care

BackgroundAll competent adults have the right to refuse medical treatment. When pregnant women do so, ethical and medico-legal concerns arise and women may face difficulties accessing care. Policies guiding the provision of maternity care in these circumstances are rare and unstudied. One tertiary hospital in Australia has a process for clinicians to plan non-standard maternity care via a Maternity Care Plan (MCP).AimTo review processes and outcomes associated with MCPs from the first three and a half years of the policy's implementation.MethodsRetrospective cohort study comprising chart audit, review of demographic data and clinical outcomes, and content analysis of MCPs.FindingsMCPs (n = 52) were most commonly created when women declined recommended caesareans, preferring vaginal birth after two caesareans (VBAC2, n = 23; 44.2%) or vaginal breech birth (n = 7, 13.5%) or when women declined continuous intrapartum monitoring for vaginal birth after one caesarean (n = 8, 15.4%). Intrapartum care deviated from MCPs in 50% of cases, due to new or worsening clinical indications or changed maternal preferences. Clinical outcomes were reassuring. Most VBAC2 or VBAC>2 (69%) and vaginal breech births (96.3%) were attempted without MCPs, but women with MCPs appeared more likely to birth vaginally (VBAC2 success rate 66.7% with MCP, 17.5% without; vaginal breech birth success rate, 50% with MCP, 32.5% without).ConclusionsMCPs enabled clinicians to provide care outside of hospital policies but were utilised for a narrow range of situations, with significant variation in their application. Further research is needed to understand the experiences of women and clinicians.     

A historical account of the governance of midwifery education in Australia and the evolution of the Continuity of Care Experience

Background

Midwifery programs leading to registration as a midwife in Australia have undergone significant change over the last 20 years. During this time accreditation and governance around midwifery education has been reviewed and refined, moving from state to national jurisdiction. A major change has been the mandated inclusion of Continuity of Care Experiences as a clinical practice-based learning component.

透析实施生育保险制度的局势

从社会学视角对实施生育保险制度的必要性进行探讨,分别从宏观(包括人口转变规律、经济体制改革、提高人口素质的需求三个方面)、中观(包括社会支持网络的变迁、保障女性群体地位、保障企业平等竞争三个方面)和微观层面(包括生育观念的转变、生育的风险性、体现女性的生育价值三个方面)进行层层剖析,说明实施和拓宽生育保险制度势在必行。     

生育保险立法问题研究

生育保险是国家通过社会保险立法的强制手段征集生育保险基金,在妇女劳动者因为妊娠、分娩而不能工作、工资收入暂时中断时,可以从国家和社会获得医疗保健服务和物质帮助,以保障参保母子的基本生活和身心健康,确保社会人口再生产和妇女、儿童权益的一项社会保障制度。生育保险促进了男女的实质平等,保障了劳动力的再生产,维护了社会的和谐和稳定。提高生育保险的立法层次,扩大生育保险的覆盖范围,建立合理的基金筹集机制,加强对生育保险基金的管理,规范生育保险待遇标准是完善生育保险立法的当务之急。     

Maternity leave and the employment of new mothers in the United States

We use data from the National Longitudinal Survey of Youth to examine the relationships between maternity leave coverage and U.S. womens post-birth leave taking and employment decisions from 1988 to 1996. We find that women who were employed before birth are working much more quickly post-birth than women who were not. We also find that, among mothers who were employed pre-birth, those in jobs that provided leave coverage are more likely to take a leave of up to 12 weeks, but return more quickly after 12 weeks. Our results suggest that maternity leave coverage is related to leave taking, as well as the length of time that a new mother stays home after a birth.All correspondence to: Jane Waldfogel. Funding for this project was provided by the National Institute of Child Health and Human Development and the William T. Grant Foundation. We are grateful to the editor and two anonymous referees for helpful comments. Responsible editor: Daniel S. Hamermesh.     

The potential impact of comparative effectiveness research on U.S. Health Care expenditures

Comparative effectiveness research (CER) has the potential to slow health care spending growth by focusing resources on health interventions that provide the most value. In this article, we discuss issues surrounding CER and its implementation and apply these methods to a salient clinical example: treatment of prostate cancer. Physicians have several options for treating patients recently diagnosed with localized disease, including removal of the prostate (radical prostatectomy), treatment with radioactive seeds (brachytherapy), radiation therapy (IMRT), or—if none of these are pursued—active surveillance. Using a commercial health insurance claims database and after adjustment for comorbid conditions, we estimate that the additional cost of treatment with radical prostatectomy is $7,300, while other alternatives are more expensive—$19,000 for brachytherapy and $46,900 for IMRT. However, a review of the clinical literature uncovers no evidence that justifies the use of these more expensive approaches. These results imply that if patient management strategies were shifted to those supported by CER-based criteria, an estimated $1.7 to $3.0 billion (2009 present value) could be saved each year.     

Maternity services and the discharge process: A review of practice in Queensland

BackgroundEfforts to increase postnatal support available to women and families are hampered by inadequate referral mechanisms. However, the discharge process in maternity services has received little research attention.AimTo review current discharge practices in Queensland, in order to identify mechanisms to minimise fragmentation in the care of women and families as they transition from hospital-based postnatal care to community-based health and other services.MethodsA survey of discharge practices in Queensland hospitals that offer birthing services (N = 55) and content analysis of discharge summary forms used by those hospitals.FindingsFifty-two Queensland birthing hospitals participated in the study. Discharge summaries were most commonly sent to General Practitioners (83%), less commonly to Child and Family Health Nurses (CFHNs; 52%) and rarely to other care providers. Discharge summaries were usually disseminated within one week of discharge (87%), but did not capture any information about care provided by domiciliary services. Almost one-fifth (19%) of hospitals did not seek women's consent for the disclosure of their discharge summary and only 10% of hospitals had processes for women to check accuracy. Significant gaps in the content of discharge summaries were identified, particularly in psychosocial and cultural information, and post-discharge advice. The format of discharge summaries diminished their readability.ConclusionDischarge summaries (format and content) should be consistent, comprehensive and specific to maternity services. Discharge summaries should be generated and disseminated electronically at the time of discharge from the maternity service. Women should review their discharge summaries and direct and consent to its dissemination.     

Maternity high-dependency care and the Australian midwife: A review of the literature

Background

Maternity high-dependency care has emerged throughout the 21st century in Australian maternity hospitals as a distinct sub-speciality of maternity care. However, what the care involves, how and why it should be provided, and the role of midwives in the provision of such care remains highly variable.