Taking charge of self: breast health practices of older rural women

The purpose of this grounded theory study was to explore breast health practices of older Vermont women residing in rural communities. Although the three components of breast health-mammography, clinical breast exam, and self-breast exam-are recommended for women 40 years and over, minimal research has empirically analyzed the breast health practices of healthy women to ascertain if, in fact, these procedures are followed, and if so, what the motivation is for doing so. Twelve women, 50-64 years, participated in face-to-face, audiotaped interviews. Data analysis, including line-by-line and constant comparative approaches, occurred concurrently with data collection. Taking Charge of Self, the generated theory, describes participants' engagement in a process of learning how to take charge of their lives. The analysis indicates that health care providers have a powerful role in the lives of women in this age group. With an increasing emphasis on health promotion and disease prevention, health care providers are positioned to cultivate and support women's development of the personal or internal motivation for health and well-being.     

The perceptions and practices of Thai health professionals providing maternity care for migrant Burmese women: An ethnographic study

BackgroundAcross the globe, many women including economic and humanitarian migrants receive inadequate antenatal care. Understanding the difficulties that migrant women encounter when accessing maternity care, including the approach of health professionals, is necessary because inadequate care is associated with increasing rates of morbidity and mortality. There are very few studies of migrant women’s access to and experience of maternity services when they have migrated from a low- to a middle-income country.AimTo examine the perceptions and practices of Thai health professionals providing maternity care for migrant Burmese women, and to describe women’s experiences of their encounters with health professionals providing maternity care in Ranong Province in southern Thailand.MethodsEthnography informed the study design. Individual interviews were conducted with 13 healthcare professionals and 10 Burmese women before and after birth. Observations of interactions (130 h) between health care providers and Burmese women were also conducted. Data were analysed using thematic analysis.FindingsThe healthcare professionals’ practices differed between the antenatal clinics and the postnatal ward. Numerous barriers to accessing culturally appropriate antenatal care were evident. In contrast, the care provided in the postnatal ward was woman and family centered and culturally sensitive. One overarching theme, “The system is in control’ was identified, and comprised three sub-themes (1) ‘Being processed’ (2) ‘Insensitivity to cultural practices’ and, (3) ‘The space to care’.Discussion and conclusionsThe health system and healthcare professionals controlled the way antenatal care was provided to Burmese migrant women. This bureaucratic and culturally insensitive approach to antenatal care impacted on some women’s decision to engage in antenatal care. Conversely, the more positive examples of woman-centered care evident after birth in the postnatal ward, can inform service delivery.     

Widening circles: an ethnographic profile of a youth group

This article introduces work-in-progress on the ethnography of a gay and lesbian youth group in Chicago. The surrounding neighborhood is sketched and aspects of the supporting agency, within which the group functions, are described. Both are seen as contributing contexts for the "coming out" process here. The youth group is described in part, including the age, ethnicity, and related factors of its composition. Youth are found to be involved in a process of dual socialization entailing roles and knowledge in the gay and straight normative communities.     

Grasping the meaning of integration in an era of (forced) mobility: ethnographic insights from an informal refugee camp

ABSTRACT

The European refugee ‘crisis’ changed the migration dynamics of many EU member states. As a result of this mass movement of refugees, the Western Balkan Route was formed. Along this way, temporary settlement camps were created to cater to the needs of people on the move. This article is based on ethnographic fieldwork that took place at the port of Piraeus (Athens, Greece) camp. Through insights from participant observation, it brings to the fore imaginaries of movement and inclusion in Central and North-Western European societies along with acts of temporary local integration as a result of arrested mobilities on the ground.     

Reproductive histories of Chinese women in rural Taiwan

In the summer of 19 5 3, a 3 % sample of the households in a rural area of Taiwan was enumerated. Special attention was paid to the fertility histories of women and, among other information, dates of births of live-born children to women living at the survey date were obtained. The data were extracted from registration records, occasionally checked by personal interview.

Women aged 45–64 had borne an average of 7.1 children. The oldest cohorts (women over 65 at survey) appeared to have a lower fertility. This is in part due to the reduction in the incidence of early widowhood, caused by the improved mortality of men since the beginning of the century.

The data are further analysed by parity and age at marriage.

Tabulations of the intervals between births of successive order, show that these remain constant with increasing birth order at about 2.7 years. The age at the last confinement was about 40 years.     

The influence and meaning of the birth environment for nulliparous women at a hospital-based labour ward in Sweden: An ethnographic study

BackgroundLabour and birth are sensitive physiological processes substantially influenced by environmental and psychosocial factors.AimTo explore the influence and meaning of the birth environment for nulliparous women giving birth in either one of two differently designed birthing rooms at a hospital-based labour ward.MethodsFive months of ethnographic fieldwork was conducted at a labour ward in Sweden, consisting of participant observations of 16 nulliparous women giving birth in either a ‘Regular’ birthing room (n = 8) or a specially designed, ‘New room’ (n = 8). Data included field notes, informal interviews, reflective notes, and individual interviews with eight women after birth. The data was analysed through an ethnographic iterative hermeneutic analysis process.FindingsThe analysis identified the birth environment as consisting of the physical space, the human interaction within it, and the institutional context. The analytic concept; Birth Manual was conceived as an instrument for managing labour in accordance with institutional authority. Significant to the interpretation of the influence and meaning of the birth environment were two abstract rooms: an Institutional room, where birth was approached as a critical event, designating birthing women as passive; and a Personal room, where birth was approached as a physiological event in which women’s agency was facilitated.ConclusionInstitutional authority permeated the atmosphere within the birth environment, irrespective of the design of the room. A power imbalance between institutional demands and birthing women’s needs was identified, emphasising the vital role the birth philosophy plays in creating safe birth environments that increase women’s sense of agency.     

Health effects of child work: Evidence from rural Vietnam

We test whether work in childhood impacts on health. We focus on agricultural work, the dominant form of child work worldwide. Data are from the Vietnam Living Standards Survey, 1992–93 and 1997–98. We correct for both unobservable heterogeneity and simultaneity biases. Instruments are land holdings and commune labour market and school quality indicators. We examine three indicators of health: weight-for-age Z-score; reported illness; and, height growth. There is clear evidence of a healthy worker selection effect. We find little evidence of a contemporaneous negative impact of child work on health but, particularly for females, work undertaken during childhood raises the risk of illness up to five years later. For boys, the risk is increasing with the period of time in work. There is no evidence that work impedes the growth of the child. This work was undertaken as part of the Understanding Children's Work project, an inter-agency program between the International Labour Organisation, UNICEF and the World Bank. The views expressed are those of the authors alone and do not reflect positions of the sponsoring organisations. We are grateful to the Government of Vietnam for permission to use the data. We thank two referees for very helpful comments. Responsible editor: Alessandro Cigno.     

Fertility beyond the frontier: indigenous women,fertility, and reproductive practices in the Ecuadorian Amazon

Recent research suggests that after decades of population decline, indigenous populations of the lowland tropics of Latin America are now experiencing rapid growth. At the same time, conservationists have pronounced indigenous lands as a key to the future of Amazon forests. As such, conservationists should have a good understanding of indigenous demography and impacts on conservation and development. Yet, there is little depth to understanding of these demographic changes and a dearth of quantitative research on the reproductive practices of indigenous populations. This study addresses these gaps through analyses of a household survey of 648 women of reproductive age from five distinct ethnic populations in the Ecuadorian Amazon. We estimate fertility, analyze reproductive intentions and contraceptive use, and determine the unmet need for reproductive health services. The analyses confirm high fertility rates and high levels of unmet need for contraception. With regard to program and policy implications, we conclude by arguing that isolation and cultural barriers present unique challenges to meet the reproductive health needs of these populations. Innovative approaches, such as those merging population–health–environment topics, may be most relevant for meeting these challenges.

Older women and family care in Hong Kong: differences in filial expectation and practices

Cultural aspects of aging have great importance on how older women and men are being treated, in particular in Asia where patriarchal practices dominate. Further, changes in the structure of the Chinese family alter this supportive function, and changes in traditional values affect the nature of the care and support provided to older women and men. This proposition was investigated by a quantitative study involving a survey of 390 older persons in Hong Kong. There are great discrepancies in informal support for older women and men. Older women are less likely to live with adult children; more likely to need financial assistance; and more likely to receive poor informal support. There is evidence that informal support for the elderly is changing in Hong Kong, and older women are being disadvantaged, experiencing insufficient and unavailability of informal support.     

Anxiety and fear of childbirth as predictors of postnatal depression in nulliparous women

Background and purposePerinatal mental health problems have been studied in more than 90% of high income countries but this information is available only for 10% of low and middle income countries. A study on the relationship between anxiety during pregnancy and postpartum depression has not been performed in Iran. This prospective study aimed to investigate whether anxiety and fear of childbirth during pregnancy is an independent predictor of postpartum depressive symptoms.MethodsIn this prospective longitudinal study participants were 160 women with a gestational age of 28–30 weeks from 10 prenatal care clinics in Qom, Iran. Subjects were interviewed and the State-Trait Anxiety Inventory (STAI) and Childbirth Attitudes Questionnaire (CAQ) were completed at 28 and 38 weeks of gestation. They were followed up 45 days and 3 months after childbirth. Postpartum depression was defined as a score ≥ 13 on the Edinburgh Postpartum Depression Scale (EPDS).ResultsAntenatal state anxiety (odds ratio [OR] = 3.2; P = 0.002 and OR = 2.91; P = 0.007 at 28 and 38 weeks of gestation, respectively) and trait anxiety (OR = 3.33; P = 0.001 and OR = 3.30; P = 0.003 at 28 and 38 weeks of gestation, respectively) increased the risk of postpartum depression 45 days after birth (P < 0.05). Likewise, the presence of antenatal state and trait anxiety at 28 and 38 weeks of gestation significantly increased the risk of postpartum depression during the first three months after childbirth (P < 0.05). On the contrary, prenatal fear of childbirth was not a significant predictor of postpartum depression symptoms (P > 0.05).ConclusionsThe findings from this study suggest that antenatal state and trait anxiety, assessed by interview, is an important predictor of postpartum depression. Therefore, it should be routinely screened in order to develop specific preventive interventions.     

Challenges of rural women living with obstetric fistula: A phenomenological study

BackgroundObstetric fistula is a devastating complication caused by a prolonged and obstructed labor. It is estimated that about 2 million girls and women continue to live with obstetric fistula while between 50,000–100,000 women worldwide develop obstetric fistula each year. This condition continues to persist and remains a major problem in Ghana and other developing countries.AimTo explore the challenges and post-surgery integration needs among rural women living with obstetric fistula.MethodA critical exploratory research methodology based on phenomenology was used to conduct in-depth one-on-one interviews. A non-probability and purposive sampling were done to identify thirty-six (36) women between the ages of 25 and 65. The interviews were recorded electronically and transcribed verbatim. A systematic analysis of data was then done to identify and categorize emerging themes.ResultsThe results from the study showed that those who lived with obstetric fistulae experienced psychosocial, physical and economic challenges. Dominant among the psychological challenges identified were disruptions in social relations, divorce and loss of baby through neonatal death. Physical challenges include rashes and sores, foot drop, incontinence of urine. Economically, these women lost their source of livelihood and were heavily dependent on other family members. Support from family was also found to be key towards the post-surgery integration of the women.ConclusionObstetric fistula is a dilapidating condition that needs to be addressed at the micro, mezzo and macro level. Based on the findings of the study, recommendations were made to improve emergency obstetric care for women especially for women living in rural communities.     

Importance of fatalism in understanding mammography screening in rural elderly women

This study examined the relationship between demographic factors and other correlates of fatalism, and assessed the impact of fatalistic beliefs on the participation in breast cancer screening in rural women. The subjects were 220 women aged 50 and over recruited from 6 large rural counties in South Carolina. Data were collected using a demographic questionnaire and the revised Powe Fatalism Inventory. Results show significant associations between fatalism and increased age (p = 0.005), race (p = 0.0001), doctor recommendation (p = .0034) and decreased educational level (p = 0.001). Fatalism was associated with noncompliance with mammography screening in univariate analysis among African-American women (OR = .362; 95% CI: 1.11, 11.8). After adjusting for possible confounders (age, education, and doctor recommendation), fatalism was not significantly associated with noncompliance with screening. These results illustrate age, race, and education may be important predictors of fatalism and that fatalism may be one barrier that has previously gone unmeasured and unchallenged in understanding screening behavior in older women.     

'Western Union daddies' and their quest for authenticity: an ethnographic study of the Dominican gay sex tourism industry

This article draws on ethnographic research among two categories of male sex workers in the Dominican Republic in order to describe the relationships between gay male tourists and the Dominican men they hire on their trips to the Caribbean. Drawing on both qualitative interview data and quantitative surveys, the discussion examines the usefulness of theories of 'authenticity,' as they have been applied in the analysis of tourist practices more generally, in accounting for the behaviors and practices of male sex workers and their foreign gay clients. While the flow of international remittances from 'Western Union daddies' to their Dominican 'boys' creates a continuous reminder of the utilitarian nature of the exchange, both sex workers and clients are motivated to camouflage this instrumentality in their construction of a more 'authentic,' fulfilling relationship. The article examines the consequences of this ambivalent negotiation for the emotional and economic organization of gay male sex tourism in the Caribbean.     

Health conditions in rural and urban areas of developing countries

The poor quality and meagre supply of data prohibit conclusions as to the relationship of health status to rural-urban residence in underdeveloped countries. Demographic indicators of health, specifically infant mortality and average life expectancy, do not seem to vary systematically according to rural-urban residence in the less developed countries ofAsia, Africa and Latin America. Further differences between rural and urban areas in availability of health services and facilities do not always conform with apparent differences between the areas in health status. However, nutritional standards, housing conditions, and sanitation, water supply and other pertinent environmental circumstances account to some extent for differences observed in health status between rural and urban inhabitants of these countries.     

Ultrasonometric profiling of incidence and risk of osteoporosis in rural women

BACKGROUND: It is estimated that over 200 million people worldwide have osteoporosis. The prevalence of osteoporosis is continuing to escalate with the increasingly aging population. The major complication of osteoporosis is an increase in fragility fractures leading to morbidity, mortality, and decreased quality of life. This investigation profiled the incidence and risk of osteoporosis in adult women from a rural setting using ultrasonic bone scanning technology. METHODS: Between 2001 and 2005, adult female subjects (n = 323) in the age range of 40-87 were drawn from an independent, community dwelling, convenience sample. Bone mineral density T-scores were evaluated using heel ultrasonometry. Demographic and risk factor data, Merck Osteoporosis Evaluation SCORE questionnaire data, and the Osteoporosis Risk Assessment questionnaire data were analyzed. RESULTS: Results of these scans indicate that 25% of the total population had a T-score < or = -1.0, implying a 1.5- to 2.0-fold increase in risk ratio of hip or spinal fracture for each standard deviational decrease. Age at menopause and weight had a positive correlation with T-scores. While the overall scores on the Merck SCORE questionnaire were inversely correlated to T-scores, no significant correlation was found between the Osteoporosis Risk Assessment questionnaire and T-score data. Additionally, women who had taken estrogen had significantly higher T-scores (p = 0.038) than those who had not. CONCLUSION: That approximately 25% of this sample has low bone mass or osteoporosis underscores the importance of early screening in order to develop preventative awareness and provide education on bone health management. This finding has particularly important ramifications, since the sample was rural women, who typically have limited access to diagnostic bone density procedures.     

Family planning: knowledge, attitude and practice of childbearing women in rural areas]

Knowledge, attitude, and practice (KAP) of family planning techniques, is seen as potentially a very effective means for promoting the fundamental principles, objectives, and practices of family planning. In September 1983, a 2-part survey was conducted in the northeast rural area of Hubei province, China, to learn how much local women knew about birth control techniques, devices, available information, and services, as well as personal attitudes and apprehensions toward family planning. The data, based on the ages and educational backgrounds of the surveyed women, are analyzed. The 2nd part of the survey measured the difference in attitudes between women and men regarding the desired number and sex of offspring. While 99% of the surveyed women supported family planning, many expressed a strong desire to learn more about family planning, particularly as related to government policies.     

Reporting of fertility events by men and women in rural Gambia

We conducted a survey of male and female fertility in rural villages in The Gambia and compared men and women's reports of recent pregnancy events in the aggregate and of children ever born for matched couples. Despite widespread polygyny and sex differences in fertility, men's and women's reports were similar. Small sex differences in reports of recent stillbirths and neonatal deaths were found. For matched couples, husbands reported 0.23 more children ever born than their wives on average, but discordant reporting had little effect on recent marital fertility rates. Modeling of discordant reports indicates that fertility reports are more likely to be underestimated by both men and women for their earliest marriages. Reliable fertility data can be collected from men in this population.     

Health expectancies in Japan: gender differences and policy implications for women

Based on prospective observation of elderly people in the community in Japan, we compared the time-course of development and progression of physical disability between women and men. Men experienced disability at a younger age and at a faster rate than did women. The duration of time spent with disability in women was twice as long as in men. Consequently, women consume about two-thirds of the total resources of formal caregiving services in Japan. Women in Japan are increasingly educated, postponing marriage to higher ages, and less likely to care for parents in the home. Given these changes in family structure and social norms, the capacity for informal family caregiving has decreased dramatically. A recently enacted national long-term care insurance system may further change the picture of caregiving.