Maternal Health Policies in Countries in Transition: Poland and Kyrgyzstan, 1990–2006

ABSTRACT

Starting with the initiation of democratic and market economic transitions, unsupportive policies concerning women's reproductive health were implemented in Kyrgyzstan and Poland in the period 1990–2006. These policies were expressed by (1) political decisions limiting available funding to support medical practices protecting women's reproductive health, (2) diminishing or restricted dissemination of knowledge about family planning, and (3) the implementation of new contraception and abortion policies. Could these changes be perceived as combat between democratic liberalism, cosmopolitanism, and tolerance versus traditionalism, insularism, and fundamentalism? We use analyses of policies concerning women's reproductive and maternal health to manifest rivalry between economic crisis and the push toward modernity and between traditionalism and liberalism. We demonstrate that the return to traditional gender roles and gender policies, and their practical application expressed in maternal health policies, illustrates cultural backlash toward diffusing Western liberalism in countries in political and economic transition.     

Safe Motherhood in the Context of Nepal

ABSTRACT

Nepal ranks low on the Human Development Index and has a high maternal mortality rate. Various factors contribute to the high rate of maternal mortality and include a shortage of health care professionals, limited access to basic maternal health care, poverty, illiteracy, women's low social status, a poorly developed transportation system, a limited communication system, political conflict, and a diverse population. Interviews with pregnant women, observational data, and national statistics provide the basis for suggestions provided by the author. These include upgrading and opening new maternal care facilities, integrating midwives into local health services, providing education on women's health needs during pregnancy, and improving public awareness of the availability of maternal care services.     

Body or soul: representing lesbians in post-soviet Russian culture

This article examines representations of lesbians in contemporary Russian literature and film as expressions of a host of post-Soviet anxieties over the social, political, and economic turmoil following the fall of communism. In particular, the author examines three recurrent motifs: the lesbian as narcissist; the lesbian as prostitute; and the lesbian as predator. While many authors and filmmakers present these qualities as a threat to the (patriarchal) social order, others celebrate those very attributes as a liberating alternative to the narrow roles traditionally available to Russian women, which stress their qualities of maternal love and self-sacrifice.     

Methadone and Menopause: Midlife Women in Drug Treatment

ABSTRACT

As a rising number of midlife women receive methadone treatment, issues related to the menopausal transition take on increased importance. The similarity between many of the symptoms associated with opiate withdrawal, methadone and menopause (hot and cold flashes, sweats, fatigue, decreased libido, menstrual irregularity and insomnia), make it plausible these women and clinical staff attribute menopausal symptoms to other conditions of greater familiarity. The paucity of research, multiplicity of health problems and typically poor access to health care, further complicate the picture and underscore the importance of better integration of health care and social work intervention.     

Creation and evaluation of a maternal mental health course

Perinatal Mood and Anxiety Disorders (PMADs) engender significant and increasing personal, social, developmental, and economic burdens to women, children, families, and global public health. In the US, a Master of Social Work (MSW) elective course, Introduction to Maternal Mental Health, was created to prepare future social workers to better understand, detect, intervene, and advocate with women struggling with perinatal mental health concerns. A pilot study used pre–post-surveys (N = 10) and a focus group to examine students’ knowledge acquisition, course satisfaction, and perceived self-efficacy. A Wilcoxon signed-rank test showed a statistically significant difference between pre- and post-survey course content knowledge scores. Positive focus group feedback and survey outcomes suggest that students benefitted from the course in terms of increased learning and professional efficacy in maternal mental health; however, the study should be replicated using a larger sample and comparison group. The course outline provided may be used to develop a similar course or to infuse maternal mental health content into existing courses. The paper concludes with implications and recommendations for social work educators.     

Living on a knife edge: the responses of people with physical health conditions to changes in disability benefits

Abstract

This article documents the experiences of people with a physical health condition or disability who have experienced a loss of or change in disability benefits under the welfare reform programme in the United Kingdom. A theoretical model was constructed using in-depth interviews and grounded theory methods. The findings show that participants experienced the benefits system as dehumanising, and felt that they lived in a judgemental and invalidating society, where they were perceived as ‘scroungers’ and faced discrimination from others. These experiences negatively affected their mental and physical health and well-being. They also negatively affected participants’ identity, leading to experiences of shame, hopelessness and social isolation. However, many participants attempted to resist these negative impacts (e.g. through seeking support or taking political action). The findings demonstrate the significant impact of benefit changes on well-being and identity, thus highlighting important implications for claimants, and staff in healthcare, the benefits system and government.     

Effects of Global Democracy on Women's Reproductive Health: 1970–2005, Cross-World Analysis

ABSTRACT

Despite many trends that have been commonly assumed to enrich societal well-being, this article posits that in addition to benefits there are also costs associated with democratization. This article comparatively analyzes the effects of democratic transition on women's health in democratizing well-developed as compared with developing countries across the world. Considering the junction of positive and negative outcomes of democratization, the author argues that to women the costs of democratization are much more substantial than to men because their societal roles are less valued and life for most women is centered at home and, hence, is not considered to be of public concern. Thus far, democratization's costs to women have been largely overlooked, not only in terms of economic opportunities but also in terms of their impact on women's health. These costs cannot be ignored as they limit women's empowerment and endanger national health.     

The Development and Challenges in Health Care Policy and Health Care Financing in Contemporary China

China’s market-oriented reform has had great success in the past few decades. Along with the rapid economic growth of the country, the economic development also influenced various aspects of China’s social, economical, and political life. Recent debate has criticized the overheated market reform in social provision, thus arguing for the return of government interventions. However, in the health care sector, it is inappropriate to attribute all distortions to market imperfection. It is rather the design of the health care system and the lack of government interventions in regulating the health care market that obstruct the functions of health care provision. To examine the proposed hypotheses, the paper focuses on China’s medical care provision, evaluating the actual performance of China’s medical care provision in the environment of economic transition from a multidimensional analysis, hence providing forward-looking suggestions for the design of China’s health care provision. Findings from this study indicate that government interventions are indispensable in regulating the health care market as well as ensuring health care delivery.      

Frequency and Types of Partner Violence Among Mexican American College Women

Objective and Participants: The authors studied the prevalence of partner violence, by type, among Mexican American college women aged 18 to 35 years (N = 149; response rate = 85%). Results: Twelve percent of women who reported a dating partner in the past year were physically or sexually assaulted, 12.1% were stalked, and 9.1% scored as psychologically abused. Among those experiencing partner violence, almost half experienced stalking and 89% reported psychological abuse. Few women (25%) who experienced physical violence believed violence was a problem in their relationship. Conclusions: Partner violence was prevalent in this population, and participants experienced many forms of violence. Because few women experiencing physical violence report that violence is a problem in their relationship, interventions must address perceptions of violence and its impact on women's mental and physical health in college populations.     

Homelessness,housing instability,intimate partner violence,mental health,and functioning: A multi-year cohort study of IPV survivors and their children

Abstract

Homelessness and housing instability frequently accompany intimate partner violence and can negatively impact health and functioning. When children are exposed to homelessness or housing instability their ability to develop and function is compromised. The purpose of this study is to examine the differential impact of homelessness and unstable housing on health and functioning of women and their children over a 2-year period. Two hundred and seventy-seven mothers reporting intimate partner violence (stalking, physical, or sexual violence by an intimate partner) were asked about housing stability, abuse, risk for murder, mental health, employment/wages, and their child's functioning over a 2-year period. Outcomes of mothers reporting homelessness and unstable housing were compared to mothers reporting stable housing. Over one-third (36%) of the mothers reported at least one episode of unstable housing over the 2-year period and 11% reported homelessness. Measures of maternal mental health and child functioning were worse for both unstably housed and homeless women, compared to stably housed women, with a higher risk for sexual abuse and risk for murder for homeless women. New models of rapid rehousing are needed that address not only the housing problems of women who have experienced intimate partner violence but also the mental health and safety issues that the women and their children face.     

Mujeres '94

ABSTRACT

Periods of democratic transition may provide space for increased political participation by women. Often, however, women's participation inexplicably falls off after the transition period to former low levels. This article argues that the form women's participation takes in transitions is crucial to both the shape of the resulting new democracy, and the subsequent impact of the new democratic institutions on building or sustaining a women's movement. A case study of the 1992-1994 transition period in El Salvador suggests that women must be present and contribute to the transition; form autonomous organizations but remain engaged with the state; and transform their political behavior from opposition to interaction with the new state.     

'Pitbulls' and Populist Politicians: Sarah Palin,Pauline Hanson and the Use of Gendered Nostalgia in Electoral Campaigns

Abstract

Sarah Palin and Pauline Hanson were charismatic and populist politicians, whose home states of Alaska and Queensland became central to their political narrative. Both women gained political influence at times of intense debate regarding their respective countries' national identities. Voters perceived the states to be locales that evoked antiestablishment authenticity, and which echoed the historical dynamism of frontier society. The women used this association to consolidate their call for social renewal that would return politics to sections of the citizenry who felt themselves to be marginalized. The women's authority was augmented by gendered stereotypes that directed attention to their apparent vulnerability and honesty in attempting public service. Although their messages were calibrated differently, Palin and Hanson both demanded moral and political renewal, and generated intense support through their sexualized rhetoric of economic security and social nostalgia.     

Responsive engagement in mental health services for foster youth transitioning to adulthood

ABSTRACT

As youth near the transition to adulthood and aging out of the foster care system, exposure to stress increases, especially for youth who have less-than-adequate support systems. Although mental health problems among foster youth often continue into adulthood, service use decreases dramatically within a year of turning age 18. Understanding how foster youth experience mental health services as they transition from care provides social workers and other mental health professionals important insight that can lead to specific, targetable strategies. This study sought to explore what situations were helpful in supporting mental health as foster youth transitioned to adulthood. Focus groups and interviews with former foster youth and professionals informed the development of a quantitative instrument, which was used to identify the most supportive and frequently encountered situations former foster youth experienced. Findings indicate the most helpful situations were those in which professionals and mentors were flexible and responsive to their individual needs and trusted their ability to make decisions. Supportive adults who honored their choices and collaborated in decision-making were also helpful. Engaging, empowering, and partnering with transition-age youth may increase the likelihood of positive mental health outcomes for this population, offering implications for family-centered, strengths-based practice.     

The Impact of Women’s Work on Gendered Health Inequities

ABSTRACT

How does the work that American women perform, both in the formal economy (paid labor) and in the caring economy (caring for children and households) negatively affect their health? The World Health Organization’s social determinants of health model is used to illuminate the causes of gendered health inequities. The social determinants of gendered health inequities that are correlated with women’s work include globalization, cultural norms, an imbalance of power between men and women, the feminization of work, the gendered pay gap, unequal responsibilities in the caring economy, the lack of recognition of the value of caring work, stress, and poverty.     

Breaking free from siloes: intersectionality as a collective action frame to address toxic exposures and reproductive health

ABSTRACT

There has been increasing interest in collaborative approaches between the environmental justice (EJ) and reproductive justice (RJ) movements to address the higher burden of toxic exposures and associated reproductive health outcomes in vulnerable communities. This study examined the collective action frames (CAFs) of advocates at the EJ/RJ nexus. CAFs highlight how advocates identify problems and solutions, and motivate action. The use of intersectionality was identified as a main CAF used in three key ways: breaking free from identity-based, issue-based, and movement-based siloes. First, interviewees described breaking free from identity-based siloes by identifying risks of toxic exposures that result from intersecting social locations (e.g. gender, race/ethnicity, income, immigration status) and by equally prioritizing multiple aspects of their identities as they engage in advocacy. Second, they described breaking free from issue-based siloes by developing multi-issue agendas that address a complex web of interrelated problems impacting health. Third, they described breaking free from movement-based siloes by developing cross-movement collaborations to address issues of mutual concern. Among multiple reasons given for cross-movement collaborations, advocates perceived them as valuable in order to disrupt social, political, and economic power imbalances that shape environmental reproductive health inequities, as well as other health and social inequities. Based on these findings, we suggest that intersectionality is a master frame, and thus may be useful to advocates in other social movements addressing intersectional issues. Understanding an intersectionality frame can help to inform advocacy approaches to promote health and health equity, particularly those focused on policies and structural drivers of health.     

Invisible labor,invisible bodies: how the global political economy affects reproductive freedom in the Philippines

ABSTRACT

Feminist scholars have critically demonstrated the links between the global political economy, social reproduction and gender-based violence. This article builds on this scholarship by investigating restrictions to reproductive freedom and their connection to the depletion of women’s bodies in the global political economy. Specifically, I use the Depletion through Social Reproduction (DSR) framework to reveal how the work of social reproduction is harnessed to service economic activity at the cost of rights to bodily integrity with the aid of religious fundamentalist ideologies that (re)inscribe discourses of female altruism such as the “self-sacrificing mother” ideal. Drawing on the case of the Philippines, I argue that the control of women’s bodies is integral to the Philippines’ economic strategy of exporting care workers in a competitive global political economy. This strategy is abetted by local Catholic religious fundamentalists who challenge reproductive rights reform at various levels of policy-making and legitimize the lack of investment to sustain social reproduction in the household, community and country as a whole. This article suggests that the neoliberal global economy is increasingly reproduced through women’s labor at the cost of their bodily integrity and reproductive freedoms.     

GEOGRAPHICAL PERSPECTIVES ON SAFE MOTHERHOOD IN THE HILL COUNTRY OF SRI LANKA: A CASE STUDY OF THE DORAGALA TEA PLANTATION IN PUSSELLAWA

ABSTRACT

In comparison with other South Asian countries, Sri Lanka maintains well-developed health care systems. Nonetheless, limited health care services are provided to mothers and children in the hill country. This research raises a series of questions concerning current challenges for safe motherhood, such as health care services already present, spatial distribution of health care professionals, and health policy in the hill counties of Sri Lanka. The authors argue that to understand the existing infrastructure of health care systems and future challenges to provision of health care services, it is important to depict the spatial location of health care units and to recognize the complexity of interactions between these units and the social, economic, and health environment. Such assessment provides a human geography approach that investigates health care systems in spatial dimensions. This study uses the geographical techniques of Geographic Information Systems and Global Positioning Systems to answer the fundamental questions of “what is where,” “why is it there,” and “why do we care.” The questions underline the importance of spatial methodology in assessment of safe motherhood and the importance of accurate and precise knowledge about the status of maternal health.     

A gender-informed model to train community health workers in maternal mental health

The New Haven Mental Health Outreach for MotherS (MOMS) Partnership is a community-academic partnership that works to develop public health approaches to ensure that pregnant and parenting women living in the City of New Haven achieve the highest possible level of mental health. The MOMS Partnership developed a training model for community health workers specializing in maternal mental health. Six community health workers (termed Community Mental Health Ambassadors or CMHAs) were trained on key topics in this gender-informed maternal mental health curriculum. Pre- and post-test questionnaires assessed changes in attitudes, perceived self-efficacy and control using standardized scales. The results indicated preliminary acceptability of the training curriculum in transforming knowledge and attitudes about maternal mental health among community health workers.