The mother market

Giving a woman good prenatal and maternity care can capture the health-care spending of her entire family for life. The next decade will bring several challenges to those who market maternity products and services, including fewer new moms, fewer babies in many markets, more minority mothers, and the end of childbearing for the baby-boom generation. The biggest challenge will be to provide a wide range of high-quality childbirth options in the cost-conscious world of managed health care.     

The midwife in Taiwan: an alternative model for maternity care

While more than 99% of all American babies are delivered by obstetricians, the majority of Taiwanese babies are delivered by midwives. The history of traditional and professional midwives in Taiwan is reviewed. Taiwanese midwives operate their businesses according to the principles of client-centered health service. They also serve many social and religious, as well as health, needs of their clients. This system contrasts with that in operation in the U.S. where pregnant women utilize physician-centered, not client-centered, maternity care. The role of the Taiwanese midwife in the management of childbirth is described. Postpartum care provided by the midwife includes nutrition information and initial care of the infant once the mother returns home. The role of the midwife in relation to abortion, adoption and other obstetric and gynecologic services is explained. The American system of childbirth might be made more flexible and acceptable if the client-centered features of the Taiwanese system could be incorporated into the modern American health care system.     

The Deflective Power of Reproductive Technologies:

Advances in reproductive technologies are altering women's experience of maternity and childbirth. They increase medical intervention while decreasing women's options and control over maternity. Although presented as increasing individual choices for women, their potential is to restrict choices for women as a group. The Baby M case illustrates that women's experience of maternity is belittled even in the least technologically dependent arrangement of surrogacy. These technologies deflect pressures for social reforms by promising technological fixes for reproductive difficulties. Often these problems have social causes. Women delay motherhood and increase reproductive risks, for example. to conform to male career timetables. Reforming employment policies is blunted, though, by the technological turn. These technologies should not be allowed to deflect the women's movement from pressuring for social change.     

Mothers in the workforce

This evaluation of maternity leave was completed by the Australian Institute of Family Studies. The use of maternity leave was investigated in 3 separate surveys. In 1, all women throughout Australia who had borne a child during 1 week in May 1984 (2000 women) were surveyed 18 months after the birth. The 2nd and 3rd surveys examined the experience of maternity leave in 1252 private sector businesses of varying sizes and a smaller number of public sector organizations. The study found that 46% of women are in the workforce during pregnancy. However, looking only at women in employment before the 1st birth, 3/4 of them are in the workforce. 44% of women took maternity leave, 33% were eligible but did not take leave, and the remaining 24% were ineligible for maternity leave either because they were casual workers or because they had not been in continuous employment with their employer for the required minimum period of 12 months. Of all maternity leave taken, 78% is taken by public sector employees and only 21% by women employed in the private sector. 1/2 of the women eligible for maternity leave in the private sector who did not take up the option had no information about maternity leave provisions. The main determinants of taking maternity leave, apart from having information about it, are working in the public sector, having a strong attachment to the workforce, having values which see work and child rearing as complementary, being a member of a trade union, having a high education and high status occupation, and being employed in a large establishment. Other survey findings follow. 1) 55% of women who were in employment before their 1st child returned to the workforce within 18 months of the birth. 2) 45% of women returned to work used informal child care provided by family or friends (usually unpaid). 32% used formal care only. 23% used a combination of formal and informal child care. 3) Women are spending an average of between 20% and 25% of their income on child care. 4) Financial reasons are the main reasons given by women for their return to the workforce. 5) Cost and availability of child care is an important issue in determining women's workforce participation after the birth of a child. 6) 60% of women do not return to the workforce after childbirth; 90% of these women intend to do so in the future. 7) For the majority of women who give birth, motherhood emerges as their most important role in life. Almost 1/2 the women agree that a woman should give up her job if it inconveniences her husband and children. 8) 2/3 of working women can establish just as warm and secure a relationship as non-working mothers, compared with 4 out of 10 non-working mothers.     

Parenthood,risk attitudes and risky behavior

This study analyzes how risk attitudes change when individuals experience the major life event of becoming a parent by using longitudinal data for a large and representative sample of individuals from Germany. The analysis uses a survey-based measure of risk aversion. The estimation is based on an individual fixed effects model similar to an event study. On average, men and women experience a considerable increase in risk aversion around the time of first childbirth. This increase already starts as early as two years before they become parents, it is largest shortly after childbirth and it disappears when the child becomes older. When analyzing risky choices, the results indicate that risky labor market behavior remains unaffected by parenthood.     

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.     

Continuity of Midwifery Care in England: A New Professional Project?

Over the last decade, an increasing amount of research has examined the relationship between gender and professionalization using female professional projects to illustrate how the generic notion of a profession has been a gendered one. This paper develops Witz's (1990) theory of professional strategies in female-dominated occupations particularly regarding midwives in Britain in the twentieth century and suggests that an important dimension that also needs to be critically examined in midwifery history is the interaction of gender and social class within midwifery. Furthermore it documents the traditional emphasis in midwifery on the single woman's career path. This historical analysis has resonance today as midwifery in Britain is undergoing a renaissance. The role of the midwife and the current organization of the maternity services are being reviewed with the intention of providing increased choice and control over the reproductive process for women and increased continuity of care with a midwife. These changes are viewed as midwives' new professional project and the implications for midwives and women discussed. The aim of this paper is to explore the explanatory power of these approaches to current developments in maternity care and by drawing historical parallels, consider the impact that this professionalizing strategy may have for those who are excluded from this process of ‘dual closure’. Furthermore, this paper asks whether this new way of working empowers midwives, women, both or neither?     

Recruiting Arab Fathers in a Center for Children at Risk in Israel

Arab society in Israel is positioned between the traditional, collective values of Arab culture and the more prevalent Western individualistic values of the Israeli society at large. This poses a challenge for the welfare services in Israel, especially in the case of Arab clients, who tend to receive and interpret the social workers' messages as contradictory to their cultural norms. Therefore, recruiting Arab fathers for treatment is a particularly difficult task. The article focuses on creating a culturally sensitive process for recruiting Arab fathers for treatment in a center dealing with Arab families at risk in Israel.     

Rediscovering the value of urban rivers

Rivers commonly serve as defining, founding features of human settlements, yet urbanisation has degraded them, often to the extent that they no longer provide the services to society from which the settlements developed. Urban river restoration has expanded in recent years and part of this can be attributed to the increased recognition of the interconnected benefits that restored ecosystems can provide to society. This paper reviews the impact of urbanisation on rivers and the ecosystem services that they provide, and explores the ecosystem approach to restoration. Techniques and tools for the practical application of the ecosystem services approach in conservation are considered, with reference to case studies. There is a need to internalise ecosystem service insights into pragmatic, transparent and readily-used and understood planning tools, based on the capacities of a range of ecosystem services in river corridors. This is necessary if we are to avoid the continued erosion of critical resources such as rivers, rediscovering their multiple values to society, and to accelerate the translation of these sustainability concepts into applied tools.     

The Perspectives of Young Men and Their Teenage Partners on Maternity and Health Services During Pregnancy and Early Parenthood

This study discusses young couples’ interactions with maternity and health services paying particular attention to men’s perspectives. Findings are based on research conducted in Scotland with men (aged 16–25) and their teenage partners (aged 16–19). Most young men were very involved in their child’s life and provided support and care to their partner during pregnancy and in early parenthood. Men often felt excluded or judged when accessing services, although positive experiences were reported too. The study discusses ways in which maternity and health services can be better attuned to meet the needs of young couples and be inclusive of men.     

Paradoxes, locations and the need for social coherence: a qualitative study of living with a learning difficulty

Policy rhetoric over recent decades has promoted social inclusion of the more vulnerable sectors of society, such as people with learning difficulties. This study aimed to describe the experiences of people who live with learning difficulties in order to inform local service development. Thirty-five people with a learning difficulty and/or a family member were interviewed. A model of social coherence was developed that moves beyond the self-limiting debates about social inclusion and exclusion. It is underpinned by a sense of location for the person with a disability in relation to services and carers, family and community, dependency and risk, temporality and space, events, control and society. Key recommendations are for services to know the individual and his/her family; to be responsive to individual needs; to enhance the capacity of families and communities to support people with difficulty in learning; and to help these people to feel more valued.     

Outreach social work: from managing access to practices of accessibility

A recurring feature of outreach work is that outreach tries to reach people who are left without care and not effectively reached by existing services. In this article, we discuss the importance of outreach practices in the context of changes in society. We suggest that the pressure on the managing of access to social services is increasing along with the demand to avoid an unnecessary inflow, and make a distinction between a residual and structural approach to social work and social service delivery. In a residual approach, outreach social work can be seen as a strategy to manage access or as a strategy to link clients with appropriate services. In this sense, they ensure that people meet predefined criteria of social services. From a structural approach, however, the focus lies on how practices possibly contribute to the realization of human dignity in social interactions and might lead to a socio-political analysis of those situations in which social work intervenes. On a conceptual level, outreach practices thus appear as practices of accessibility. From this perspective, existing problem constructions and dynamics of inclusion and exclusion in social services but also more broadly in society might be questioned and ultimately changed.     

Long-term care policy and financing as a public or private matter in the United States

Effective approaches to assure adequate resources, infrastructure, and broad societal support to address chronic care needs are volatile and potentially unpopular issues that can result in many losers (those getting far less than they want) and few winners (those who gain access to scarce societal resources for care). In the United States, debates on long-term care involve a complex set of issues and services that link health, social services (welfare), and economic policies that often pit public and private sector interests and values against one another. Yet long-term care policies fill a necessary function in society to clarify roles, expectations, and functions of public, non-profit, for profit, individual, and family sectors of a society. By assessing and developing policy proposals that include all long-term care system dimensions, a society can arrive at systematic, fair, and rational decisions. Limiting decisions to system financing aspects alone is likely to result in unforeseen or unintended effects in a long-term care system that stopgap "fixes" cannot resolve. Three underlying policy challenges are presented: the need for policymakers to consider whether the public sector is the first or last source of payment for long-term care; whether government is seen primarily as a risk or cost manager; and the extent to which choice is afforded to elders and family caregivers with regard to the types, settings, and amount of long-term care desired to complement family care.     

Governmental intrusiveness in the family: A continuing dilemma

This discussion examines the ongoing controversy between critics of and advocates for child protective services. Although this controversy is often identified as taking place between lawyers and social workers, it is a problem that must be faced by society as a whole. The needs of society and the needs of individuals relate directly to each other. When these needs conflict with each other, modification in procedures designed to carry them out becomes crucial. Interventions must be designed so as to achieve that which is in the “best interests of the child” as well as in the best interest of society.     

Predicting the timing of maternal employment after birth among a low-income and ethnically diverse sample

Policy pressures in the USA to transition parents from public assistance to work and concerns about the effects of early maternal employment on children highlight the importance of studying predictors of the timing of postpartum maternal employment. Little attention has been given to postpartum employment patterns of low-income ethnic minorities and immigrants, whose working conditions and employment prospects are different from white, middle-class mothers. Using a sample of low-income Mexicans, Dominicans, and African-Americans (N = 310), we studied whether and when mothers start working the first year following childbirth, and what factors promote or delay postpartum employment. Using discrete-time survival analysis, we modeled the odds of working at each month and tested the influence of family context, mothers' work and family values and plans, maternity leave benefit, and instrumental support availability on the timing of employment. By 11 months, half of the mothers had started working. Having maternity leave, plans to work, childcare arrangements, and a strong work orientation increased the odds of working. Household earnings were related to postpartum employment, but this effect varied over time. For African-Americans, instrumental support availability predicted earlier returns to employment, whereas for Mexicans and Dominicans it related to later returns to employment.     

The impact of childbirth on Spanish women’s decisions to leave the labor market

The present paper analyzes the effect of childbirth on Spanish women??s decisions to withdraw from paid work, defined here as the transition from employment to out of the labor force due to the requirements of household production. Decisions regarding fertility and labor market participation are interrelated and depend on individual and household characteristics, as well as external variables such as the availability of childcare services. We postulate that a female??s decision to leave the labor market is taken in a household context, and thus is the outcome which maximizes household welfare after taking into account the employment and earnings characteristics of all household members. We pay special attention to the effect of the male partner??s characteristics upon the female??s decision to withdraw from the labor market. Our empirical results show that in order to better define social and labor market policies on work and family reconciliation, increased attention should be paid to the job characteristics of males given their effect on the optimal assignment of tasks within the household following childbirth.     

SHOULD WE GET MARRIED? THE EFFECT OF PARENTS' MARRIAGE ON OUT‐OF‐WEDLOCK CHILDREN

Using a representative sample of children all born to unwed parents drawn from the Fragile Families and Child Wellbeing Study and a potential outcome approach to account for self-selection into marriage, we investigate whether marriage after childbearing has a causal effect on early child development. Comparing children with similar background characteristics and parental mate-selection patterns who differ only in terms of whether their parents marry after childbirth, we find that marriage after childbirth significantly increases a child's early cognitive performance but there is no evidence that it affects child asthma risk or behavioral outcomes.     

Long-Term Care Policy and Financing as a Public or Private Matter in the United States

Summary

Effective approaches to assure adequate resources, infrastructure, and broad societal support to address chronic care needs are volatile and potentially unpopular issues that can result in many losers (those getting far less than they want) and few winners (those who gain access to scarce societal resources for care). In the United States, debates on long-term care involve a complex set of issues and services that link health, social services (welfare), and economic policies that often pit public and private sector interests and values against one another. Yet long-term care policies fill a necessary function in society to clarify roles, expectations, and functions of public, non-profit, for profit, individual, and family sectors of a society. By assessing and developing policy proposals that include all long-term care system dimensions, a society can arrive at systematic, fair, and rational decisions. Limiting decisions to system financing aspects alone is likely to result in unforeseen or unintended effects in a long-term care system that stopgap “fixes” cannot resolve. Three underlying policy challenges are presented: the need for policymakers to consider whether the public sector is the first or last source of payment for long-term care; whether government is seen primarily as a risk or cost manager; and the extent to which choice is afforded to elders and family caregivers with regard to the types, settings, and amount of long-term care desired to complement family care.     

Medicalization, Natural Childbirth and Birthing Experiences

Although much of the early sociological and feminist analysis of medicalization focused on reproductive issues and childbirth, attention has moved away from this topic over time as new conditions have become subject to the medicalization process. At the same time, one of the major concepts within this analytical framework, the dichotomy of 'natural' versus 'medical', has not been sufficiently problematized. In this article, we call for a renewed examination of the medicalization of childbirth from a critical perspective that neither takes for granted the meaning of this dichotomy, nor presupposes feminist perspectives or those of privileged groups of women. We revisit sociological frameworks and feminist critiques of medicalization, specifically around childbirth, and review scholarship that addresses their limitations. We propose a research agenda that goes beyond the traditional assumptions about 'natural' and 'medical' childbirth and examines more closely how medicalization processes both shape and conflict with women's subjective experiences of childbirth.