The effects of status on women’s autonomy in Bolivia,Peru,and Nicaragua

A recent ideological revolution promoting women’s status has raised questions concerning determinants of autonomy and their implications for policy formation. This study seeks to identify objective indicators determinant of autonomy, and then examine their relationship in light of women’s subjective experiences of autonomy. Potential determinants include education, literacy, household size, age at marriage, employment, and socioeconomic status. Analyses are based on these data sets: the 2000 Bolivia Family Interaction and Children’s Well-Being (FICW) Survey, the 2000 Peru Demographic Health Survey and the 1997/1998 Nicaraguan Demographic and Health Survey. Our findings indicate that autonomy is multidimensional. Utilizing Structural equation modeling, we identify two major domains autonomy: decision-making autonomy and personal autonomy in Bolivia, and family autonomy and public autonomy in Nicaragua and Peru. This study shows that each of our specified determinants has some influence on autonomy, with education and socioeconomic status being the most important. We conclude that policies designed to change educational, economic, and familial characteristics of women will only have a modest impact on women’s overall sense of autonomy.     

Midwifery Job Autonomy in New Zealand: I do it all the time

IntroductionThis research aimed to identify what supports and what hinders job autonomy for midwives in New Zealand.MethodsRegistered midwives participated in an open-ended, online survey in 2019. Anonymised participants were asked to describe an incident when they felt they were using their professional judgement and/or initiative to make decisions and the resultant actions. The data was analysed thematically.FindingsThe participants identified that autonomy is embedded within midwifery practice in New Zealand. Self-employed midwives who provide continuity of care as Lead Maternity Carers, identified they practice autonomously ‘all the time’. The relationship with women and their family, and informed decision making, motivated the midwife to advocate for the woman – regardless of the midwife’s work setting. Midwifery expertise, skills, and knowledge were intrinsic to autonomy. Collegial relationships could support or hinder the midwives’ autonomy while a negative hospital work culture could hinder job autonomy.DiscussionMidwives identified that autonomous practice is embedded in their day to day work. It strengthens and is strengthened by their relationships with the woman/whanau and when their body of knowledge is acknowledged by their colleagues. Job autonomy was described when midwifery decisions were challenged by health professionals in hospital settings and these challenges could be viewed as obstructing job autonomy.ConclusionThe high job autonomy that New Zealand midwives enjoy is supported by their expertise, the women and colleagues that understand and respect their scope of practice. When their autonomy is hindered by institutional culture and professional differences provision of woman-centred care can suffer.     

Maternal Household Decision-Making Autonomy and Adolescent Education in Honduras

Maternal decision-making autonomy has been linked to positive outcomes for children’s health and well-being early in life in low- and middle-income countries throughout the world. However, there is a dearth of research examining if and how maternal autonomy continues to influence children’s outcomes into adolescence and whether it impacts other domains of children’s lives beyond health, such as their education. The goal of this study was to determine whether high maternal decision-making was associated with school enrollment for secondary school-aged youth in Honduras. Further, we aimed to assess whether the relationships between maternal autonomy and school enrollment varied by adolescents’ environmental contexts and individual characteristics such as gender. Our analytical sample included 6579 adolescents ages 12–16 living with their mothers from the Honduran Demographic and Health Survey (DHS) 2011–2012. We used stepwise logistic regression models to investigate the association between maternal household decision-making autonomy and adolescents’ school enrollment. Our findings suggest that adolescents, especially girls, benefit from their mothers’ high decision-making autonomy. Findings suggest that maternal decision-making autonomy promotes adolescents’ school enrollment above and beyond other maternal, household, and regional influences.     

Barriers to foundation funding of gay organizations: evidence from Massachusetts

Gay, lesbian, and bisexual service organizations in the United States receive a small share of the philanthropic grants awarded by foundations and other institutional donors. A survey of Massachusetts gay organizations provides explanations for this phenomenon and suggests that a variety of barriers impedes foundation giving. The findings are consistent with those of two national surveys of lesbian organizations and a survey of gay service needs in California. The most commonly cited barriers include: a difficulty in finding foundations sympathetic to gay service programs; a lack of paid grant writers; the perceived need for 501 (c)(3) nonprofit status in order to qualify for most grants; foundations' predilection for funding established service organizations, and their reluctance to fund political advocacy, a lack of familiarity with gay service needs; and homophobia. Although the AIDS crisis helped educate foundations about the gay community, consider-able barriers remain.     

How a perineal care bundle impacts midwifery practice in Australian maternity hospitals: A critical,reflexive thematic analysis

BackgroundA care bundle to reduce severe perineal trauma (the bundle) was introduced in 28 Australian maternity hospitals in 2018. The bundle includes five components of which only one – warm perineal compresses – has highest level evidence. There is scant published research about the impact of implementation of perineal bundles.QuestionHow does a perineal care bundle impact midwifery practice in Australian maternity hospitals?MethodsPurposively sampled midwives who worked in hospitals where the bundle had been implemented. Interested midwives were recruited to participate in one-to-one, semi-structured interviews. The researchers conducted critical, reflexive thematic analysis informed by Foucauldian concepts of power.FindingsWe interviewed 12 midwives from five hospitals in one state of Australia. Participants varied by age, clinical role, experience, and education. Three themes were generated: 1) bundle design and implementation 2) changing midwifery practice: obedience, subversion, and compliance; and 3) obstetric dominance and midwifery submission.DiscussionThe bundle exemplifies tensions between obstetric and midwifery constructs of safety in normal birth. Participants’ responses appear consistent with oppressed group behaviour previously reported in nurses and midwives. Women expect midwives to facilitate maternal autonomy yet decision-making in maternity care is commonly geared towards obtaining consent. In our study midwives encouraged women to consent or decline depending on their personal preferences.ConclusionThe introduction of the perineal bundle acts as an exemplar of obstetric dominance in Australian maternity care. We recommend midwives advocate autonomy – women’s and their own – by using clinical judgement, evidence, and woman-centred care.     

Adam Smith on population

Adam Smith dealt with questions of population mainly in his Wealth of Nations. His discussion falls roughly under five heads and reflects in considerable measure his image of the English economy. (1) A country's population capacity, given the average level of consumption, was conditioned by the stock of land, the skill with which it was cultivated, and the degree to which division of labour could be increased and thereby augment output for domestic use and sale in external markets. (2) Growth of population was essentially in response to growth of the demand for labour and served to increase division of labour. (3) The social mechanisms underlying elevation of the scale of living are touched upon, and in an optimistic spirit. (4) The distribution of a country's population responded to its progress in opulence, with the rate of this progress conditioned by the degree to which inappropriate (e.g. mercantilist) policies were avoided. (5) Smith dealt briefly with such matters as colonies, education, size of economy, environmental influences, and public policy, all of which he recognized as significant for the quantity and quality of a country's numbers.     

Survey of Australian maternity hospitals to inform development and implementation of a stillbirth prevention ‘bundle of care’

Background‘Bundles of care’ are being implemented to improve key practice gaps in perinatal care. As part of our development of a stillbirth prevention bundle, we consulted with Australian maternity care providers.ObjectiveTo gain the insights of Australian maternity care providers to inform the development and implementation of a bundle of care for stillbirth prevention.MethodsA 2018 on-line survey of hospitals providing maternity services included 55 questions incorporating multiple choice, Likert items and open text. A senior clinician at each site completed the survey. The survey asked questions about practices related to fetal growth restriction, decreased fetal movements, smoking cessation, intrapartum fetal monitoring, maternal sleep position and perinatal mortality audit. The objectives were to assess which elements of care were most valued; best practice frequency; and, barriers and enablers to implementation.Results227 hospitals were invited with 83 (37%) responding. All proposed elements were perceived as important. Hospitals were least likely to follow best practice recommendations “all the time” for smoking cessation support (<50%), risk assessment for fetal growth restriction (<40%) and advice on sleep position (<20%). Time constraints, absence of clear guidelines and lack of continuity of carer were recognised as barriers to implementation across care practices.ConclusionsAreas for practice improvement were evident. All elements of care were valued, with increasing awareness of safe sleeping position perceived as less important. There is strong support from maternity care providers across Australia for a bundle of care to reduce stillbirth.     

Adam Smith on population

Abstract Adam Smith dealt with questions of population mainly in his Wealth of Nations. His discussion falls roughly under five heads and reflects in considerable measure his image of the English economy. (1) A country's population capacity, given the average level of consumption, was conditioned by the stock of land, the skill with which it was cultivated, and the degree to which division of labour could be increased and thereby augment output for domestic use and sale in external markets. (2) Growth of population was essentially in response to growth of the demand for labour and served to increase division of labour. (3) The social mechanisms underlying elevation of the scale of living are touched upon, and in an optimistic spirit. (4) The distribution of a country's population responded to its progress in opulence, with the rate of this progress conditioned by the degree to which inappropriate (e.g. mercantilist) policies were avoided. (5) Smith dealt briefly with such matters as colonies, education, size of economy, environmental influences, and public policy, all of which he recognized as significant for the quantity and quality of a country's numbers.     

Women's autonomy,women's status and fertility-related behavior in Zimbabwe

Women's household decision-making autonomy is a potentially important but less studied indicator of women's ability to control their fertility. Using a DHS sample of 3,701 married black African women from Zimbabwe, I look at women who have no say in major purchases, whether they should work outside the home,and the number of children. When men dominated all household decisions, women were less likely to approve of contraceptive use, discuss their desired number of children with their spouse, report ever use of a modern method of contraception, and to intend to use contraception in the future. However, women's decision-making autonomy was not associated with current modern contraceptive use. Women who had no decision-making autonomy had 0.26 more children than women who had some autonomy. These autonomy measures provide additional independent explanatory power of fertility-related behavior net of traditional measures of women's status such as education and labor force participation.     

The Influence of the Built Environment and Other Factors on the Physical Activity of Older Women from Different Ethnic Communities

ABSTRACT

Inactivity has been identified as a major contributor to the burden of disease in older women. Study aims were: (a) to assess the personal, social, and environmental facilitators and impediments to physical activity in older women from ethnic communities; and (b) to determine the factors associated with physical activity participation. Older women (aged 60–84 years) were recruited from the local Italian (n = 20), Vietnamese (n = 26) and Anglo-Celtic (n = 26) communities. A survey questionnaire was administered in the participants' preferred language. The most common barriers were: “I am not in good health,” “I am self-conscious about my looks,” “I am too tired,” “I don't have time,” and “The weather is bad.” When comparing the ethnic groups, the Vietnamese women reported fewer barriers than the Italian women (2.6 vs. 5.9). While the Vietnamese women were much more likely to report being “self-conscious about my looks,” the Italian women more commonly reported poor health, being too tired, and not liking exercise as barriers. Overall, those living alone were more likely to be active and those who reported fear of injury, less active. Recognizing ethnospecific differences in the prevalence of barriers may be important when devising strategies to increase activity levels of older women.     

Women's Transitions in Retirement:

To facilitate insight into the choices and options each woman has for her retirement. the retirement olanner should guide each woman through a self ass~ssmenptr ocess. 'he first step invilves an examination of how she has cooed and made decisions during the other of life's transitions. This is 'followed by an assessment 07 the meaning work has for each individual: its social aspects, the slructure, and the issues of identity, prestige, and power. Continuing the process, the retirement planner helps women evaluate the changing relationships with friends and family. The married woman will assess her marriage in the framework of her need for privacy, independence and autonomy. Sample questions from self assessment scales are included.     

A test of the stranger-interviewer norm in the Dominican Republic

We offer the first empirical test of the ‘stranger-interviewer norm’, according to which interviewers in social, demographic, and health surveys should be strangers—not personally familiar with respondents. We use data from an experimental survey in the Dominican Republic that featured three types of interviewer: from out of town (outsiders); local but unknown to the respondent (local-strangers); and local with a previous relationship to the respondent (insiders). We were able to validate answers to up to 18 questions per respondent, mainly by checking official documents in their possession. Contrary to expectations derived from the stranger-interviewer norm, respondents were more reluctant to show the documents needed for validation when the interviewer was an outsider. Furthermore, and again at odds with the stranger-interviewer norm, we found no difference in accuracy by type of interviewer. Our results have important implications for the selection of survey interviewers in less developed and non-Western settings.     

Women’s views about the timing of birth

Background

Estimated date of birth (EDB) is used to guide the care provided to women during pregnancy and birth, although its imprecision is recognised. Alternatives to the EDB have been suggested for use with women however their attitudes to timing of birth information have not been examined.

Contraceptive behavior among unmarried young women: A theoretical framework for research

Adoption of the most effective methods of contraception requires individual decision-making and negotiation with contraceptive providers. In order to take account of both behavioral elements, a two-dimensional framework for understanding contraceptive adoption and continuation by unmarried young is proposed, incorporating a "social-psychological model" of individual decision-making and an "interpersonal model" of factors affecting provider-client interaction. The social-psychological model is based on an earlier value-expectancy theory of behavior motivation as applied to health-related behaviors. The interpersonal model is derived from conflict-bargaining perspectives on professional-client interaction; it is suggested that expectations for this interaction are based on a limited number of internalized "models": the "professional"; the "bureaucratic"; the "commercial"; and the "parental." Insofar as client and professional "models" disagree, communication may break down and client understanding and/or acceptance of provider advice cannot be assured. The components of the social-psychological and interpersonal models are described in detail, and a combined framework is proposed.     

Dimensions of women’s autonomy and the influence on maternal health care utilization in a north indian city

The dimensions of women's autonomy and their relationship to maternal health care utilization were investigated in a probability sample of 300 women in Varanasi, India. We examined the determinants of women's autonomy in three areas: control over finances, decision-making power, and freedom of movement. After we control for age, education, household structure, and other factors, women with closer ties to natal kin were more likely to have greater autonomy in each of these three areas. Further analyses demonstrated that women with greater freedom of movement obtained higher levels of antenatal care and were more likely to use safe delivery care. The influence of women's autonomy on the use of health care appears to be as important as other known determinants such as education.     

An Integrational Model of Quality of Life in Older Age. Results from the ESRC/MRC HSRC Quality of Life Survey in Britain

This paper is based on the results of anational survey of the quality of life of 999randomly sampled people aged 65 and over,living at home in Britain. The survey wassemi-structured, and a sample of surveyrespondents was followed up and interviewedin-depth in order to explore their perceptionsof quality of life in full. Comparisons aremade here between the results of (i) ahierarchical multiple regression model basedon theoretically derived indicators of survey respondents' ratings of their overall quality of life, with (ii) the samerespondents' own definitions of quality oflife, categorised from their responses toopen ended survey questions, and (iii) theviews of a sub-sample of these survey respondents who were subsequently interviewed in greater depth. Respondents were asked theopen ended questions on quality of life at theoutset of the survey interview in order toprevent any respondent bias from thestructured measures used.The core components, and the central planks,of quality of life, which were consistentlyemphasised by the three approaches, were psychological characteristics and outlook,health and functional status, personal andneighbourhood social capital. The lay modelsalso emphasised the importance of financialcircumstances and independence, which need tobe incorporated into a definition of broader quality of life.     

Japanese women's experiences of pharmacological pain relief in New Zealand

BackgroundIn Japan, most women manage labour pain without pharmacological interventions. However, New Zealand statistics show a high percentage of epidural use amongst Asian women. Entonox (a gas mixture of nitrous oxide and oxygen) and pethidine are also available to women in New Zealand. This article investigates how Japanese women in New Zealand respond to the use of pharmacological pain relief in labour.QuestionsThe study was guided by two research questions: (1) How do Japanese women experience and manage labour pain in New Zealand? (2) How do they feel about the use of pharmacological pain relief?MethodsThirteen Japanese women who had given birth in New Zealand were interviewed individually or in a focus group. The conversations were analysed using thematic analysis.FindingsAlthough in Japan very few women use pain relief, nine women received epidural and/or Entonox out of 11 women who experienced labour pain. The contrast between their Japanese cultural expectations and their birth experiences caused some of the women subsequent personal conflict.ConclusionJapanese women's cultural perspectives and passive attitudes were demonstrated to influence the decision-making process concerning pain relief. It was concluded that understanding Japanese cultural worldviews and approaches to the role of pain in labour would help maternity providers in their provision of appropriate care for Japanese women.     

Men's influence on the onset and progress of fertility decline in Ghana, 1988-98

While lower fertility is commonly associated with women's reproductive autonomy, we demonstrate that the influence of men's education on reproductive decision-making increased during the first decade of rapid fertility decline in Ghana. Husband's education exerts a stronger influence on wife's fertility intentions than does her own education, and the magnitude of the effect of his education increased significantly from 1988 to 1998. Lower fertility in Ghana seems to be associated more with men's declining fertility desires than with women's increasing reproductive autonomy. Nevertheless, there is some indication that women's education may play a relatively greater role in reproductive decision-making as fertility decline progresses still further.