Socially disadvantaged women's views of barriers to feeling safe to engage in decision-making in maternity care

BackgroundAlthough midwifery literature suggests that woman-centred care can improve the birthing experiences of women and birth outcomes for women and babies, recent research has identified challenges in supporting socially disadvantaged women to engage in decision-making regarding care options in order to attain a sense of control within their maternity care encounters.ObjectiveThe objective of this paper is to provide an understanding of the issues that affect the socially disadvantaged woman's ability to actively engage in decision-making processes relevant to her care.Research designThe qualitative approach known as Interpretative Phenomenological Analysis was used to gain an understanding of maternity care encounters as experienced by each of the following cohorts: socially disadvantaged women, registered midwives and student midwives. This paper focuses specifically on data from participating socially disadvantaged women that relate to the elements of woman-centred care-choice and control and their understandings of capacity to engage in their maternity care encounters.FindingsSocially disadvantaged women participants did not feel safe to engage in discussions regarding choice or to seek control within their maternity care encounters. Situations such as inadequate contextualised information, perceived risks in not conforming to routine procedures, and the actions and reactions of midwives when these women did seek choice or control resulted in a silent compliance. This response was interpreted as a consequence of women's decisions to accept responsibility for their baby's wellbeing by delegating health care decision-making to the health care professional.ConclusionThis research found that socially disadvantaged women want to engage in their care. However without adequate information and facilitation of choice by midwives, they believe they are outsiders to the maternity care culture and decision-making processes. Consequently, they delegate responsibility for maternity care choices to those who do belong; midwives. These findings suggest that midwives need to better communicate a valuing of the woman's participation in decision-making processes and to work with women so they do have a sense of belonging within the maternity care environment. Midwives need to ensure that socially disadvantaged women do feel safe about having a voice regarding their choices and find ways to give them a sense of control within their maternity care encounters.     

Motherhood Penalties and Living Arrangements in China

Past research on the “motherhood wage penalty” has been based on data from nuclear families, leaving open the possibility that the motherhood wage penalty may be lower or even absent in multigenerational families. In this article, the wage gap between mothers and nonmothers is examined in nuclear and multigenerational families in the context of contemporary China, which has a long tradition of patriarchal families. Using 1993 to 2006 China Health and Nutrition Survey data, the magnitude and variation of motherhood penalty is explored with fixed effects models among 1,058 women. The results show that each additional child lowers hourly wages by about 12%. In addition, the motherhood penalty is largest for women living with their husbands' parents, smaller for women not living with parents, and nil for women living with their own parents.     

Maternal Employment,Community Contexts,and the Child‐Care Arrangements of Diverse Groups

Integrating family and child data from the Early Childhood Longitudinal Study–Birth Cohort with contextual data from the census, this study examined associations among maternal employment, aspects of communities related to child‐care supply and demand, and the early care and education arrangements of 4 year olds in Mexican‐origin, Black, and White families. Children with employed mothers were more likely to be in informal care arrangements than in early childhood education, regardless of racial/ethnic background. For children in Mexican‐origin families, selection into informal care over early childhood education was more likely in zip codes with greater demand for care as measured by higher female employment. Utilization of parent care versus early childhood education was also more likely for children in Mexican‐origin and Black families in zip codes with higher female employment. Constraints associated with maternal employment thus hindered children from enrolling in early childhood education, and community contexts posed challenges for some groups.     

Family Characteristics and Mate Selection: Evidence From Computer‐Assisted Dating in Japan

Research on mate selection rarely considers singles' preferences for their future partners' family configurations and experiences. Using online dating records from a matchmaking agency in Japan, a society with a strong emphasis on family and kinship, we examine how singles' responses to date requests correspond to potential mates' family circumstances. Results showed that singles' preferences for potential partners' family characteristics stem from a concern about future obligations toward the partner's family and stereotypes associated with certain family traits. Singles are less likely to accept requests from those from large families, which are seen as traditional. Being from a large family, however, hampers individuals' dating chances more if they are firstborn and have no brothers, two conditions that make them the designated child to care for elderly parents. We also find that Japanese singles seek partners with more of the universally valued family traits rather than traits similar to their own.     

Professional discretion and length of work experience: what findings from focus groups with care managers in elder care suggest

ABSTRACT

Research has explored how care managers in elder care – who often function as ‘street-level bureaucrats’ – regard professional discretion. The way in which length of work experience affects care managers’ use of professional discretion remains, however, unexplored. This article present findings from 12 focus groups with 60 care managers. By bringing attention to how care managers experience the needs assessment process, this article sheds light on how these ‘street-level bureaucrats’ struggle when they try to balance their clients’ needs against institutional frameworks and local guidelines. Length of work experience seems to play a role in how care managers claim to use professional discretion. Experienced care managers describe how they deviate from the guidelines at times in order to create an increased scope of action in their decision-making process. Those with less time in the profession describe greater difficulties in this respect. Findings suggest that research should explore if length of work experience plays a role in the actual way in which care managers assess needs and make decisions. As such, they contribute to our understanding of how needs assessment processes are navigated by professionals while also pointing towards the nature of professional discretion in gerontological social work.     

Examining the Nursing Home Physical Environment Through Policy-Driven Culture Change

A critical need exists to challenge approaches to nursing home care due to rigid organizational factors and hospital-like culture. It has been argued that resident care needs to move toward a person-centered approach by addressing the organizational, social, and physical environments in nursing home facilities, a process often known as culture change. In response to this need, the Centers for Medicare & Medicaid Services (CMS) has created funding for pay for performance (P4P) nursing home incentive programs to allow nursing home providers to receive CMS reimbursements for culture change in the facilities. Through care staff interviews, site observations, and a document review, this qualitative study assesses the impact of a Midwestern state P4P incentive program in three participating nursing homes. Using an environment and behavior (E-B) policy orientation framework, this study examines culture change through a focus on policy, the physical environment, place attachment, and social and psychological processes in the study settings.     

Assessing social work and nursing students’ intentions to work with dying patients

This study assessed social work and nursing students’ intentions to provide end-of-life care, based on the Theory of Planned Behavior. A total of 181 social work and nursing students completed a questionnaire examining intentions to provide end-of-life care, attitudes, subjective norms, perceived control, death anxiety, subjective knowledge, and sociodemographic characteristics. Students manifested a moderate level of intentions to provide end-of-life care, with nursing students indicating higher levels of intentions than social work students. Multiple regression analyses revealed that attitudes, subjective norms, and previous experience were the main predictors of intentions to provide end-of-life care. Recommendations for academic programs are discussed.     

Tracing disorder across theories of autism,empathy, and mental health care

Abstract

Categories of mental disorders are generally understood through a biomedical paradigm of clinical research, diagnosis, and intervention. Here, diagnoses operate as professional tools, facilitating care organization and information exchange across diverse social contexts. In this article, I focus on how the diagnosis of autism-spectrum disorder operates in this manner. Autism conceived as a biomedical disorder is then contrasted with proposals by the neurodiversity movement, who understand core qualities of autism as alternative expressions of otherwise normal processes of brain development. Finally, I supplement these conversations with insights from Gerald Edelman’s theory of neural plasticity and Felix Guattari’s paradigm of ethico-aesthetic care. Understood together, these allow mental disorders and community care generally to be reconceived in terms of networks of expressive, embodied, and dynamically embedded rhythms that transcend individual persons. This serves, additionally, to illustrate a concept of empathy that traverses neurological, psychological, and sociocultural domains.     

‘We are actually,after all,just children’: caring societies and South African infantilisation of adults with intellectual disability

This article comments on infantilisation by attending to South African adult intellectual disability (ID) care through an intersubjective ethics of care lens, and shows how such an ethic can shine light on shifting our responses towards ID. Care performance data were gathered from three sources within two South African specialist ID care sites – from 10 adult residents, 16 nurses as spatiotemporal carers, and three wards as ethnographic sites. Deeply embedded and interwoven throughout various care practices is the disabling of adults with intellectual impairment when literally referred to as ‘children’. These adult-unmaking processes constitute practices that fall short of Tronto and Kittay’s caring societies ethic. Care exchanges generate relational and intersubjective spaces in which people are understood as never meeting full criteria for personhood. Infantilising care dynamics require urgent attention if we wish to change ways in which ID is viewed and responded to in South Africa.