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Native American (NA) women's health needs in general are underresearched, and use of holistic, community-informed, and resilience-based approaches are rare. Despite…
Native American (NA) women's health needs in general are underresearched, and use of holistic, community-informed, and resilience-based approaches are rare. Despite extensive documentation of the continuing health inequalities between NA women and the general US population, little research examines what healthcare infrastructure and healthcare provider factors most impact, and exacerbate, these health disparities. The purpose of the study was to provide insight into the healthcare experiences of NA women. A qualitative descriptive research methodology with “hues” of an ethnographic life-history approach was used. Data were collected through qualitative semi-structured life-history interviews with 31 NA women from the Gulf Coast region of the United States. All women identified healthcare obstacles and barriers. These barriers were predominately comprised of Healthcare Infrastructure Barriers, which entailed: (1) Cost and Insurance Barriers; (2) Concerns about Western Medication; (3) Language Barriers; (4) Distance to Medical Facilities or Specialists; and (5) Long-wait Times, and Negative Provider Relationships, which included: (1) Rushed or Rude Provider Interactions; (2) Providers not Listening, or Ignoring Patient Concerns; (3) Poor, Inaccurate, or Inadequate Care or Diagnosis; (4) Discrimination in Healthcare; and (5) The need for Personal Relationships with Providers. These findings suggest that healthcare infrastructure issues and poor healthcare provider relationships are important structural issues that contribute to health disparities. The findings from this study have important implications for the type of training those working in healthcare services receive to be more sensitive to the needs of NA women and suggest that NA women may need unique support when accessing healthcare.
There has been substantial interest in US cesarean rates, which increased from 5% of deliveries in the 1970s to nearly one-third of births by the mid-2000s. Explanations…
There has been substantial interest in US cesarean rates, which increased from 5% of deliveries in the 1970s to nearly one-third of births by the mid-2000s. Explanations typically emphasize individual risk factors (e.g., advanced maternal age, increased BMI, and greater desire for control over delivery) of women giving birth, or address institutional factors, such as the medicalization of childbirth and the culture of liability leading physicians to practice defensive medicine. We focus here on another non-medical explanation – childbirth education (CBE). CBE is an important, underexplored mechanism that can shape women’s expectations about labor and birth and potentially lead them to expect, or desire, a cesarean delivery as a normalized outcome. We analyze data from three waves (2002, 2006, 2013) of the Listening to Mothers national survey on US women’s childbearing experiences (n = 3,985). Using logistic regression analysis, we examined both mode of delivery (vaginal versus cesarean), and attitudes about future request for elective cesarean among both primiparous and multiparous women. Despite previous research suggesting that CBE increased the likelihood of vaginal delivery, we find that CBE attendance was not associated with likelihood of vaginal delivery among either primiparous or multiparous women. However, both primiparous and multiparous women who attended CBE classes were significantly more likely to say they would request a future, elective cesarean. Furthermore, these effects were in the opposite direction of effects for natural birth attitudes. Our findings suggest that contemporary CBE classes may be a form of “anticipatory socialization”, potentially priming women’s acceptance of medicalized childbirth.
There is extensive research documenting the physical outcomes of childbirth, but significantly less on socio-psychological outcomes. Investigating women’s perception of…
There is extensive research documenting the physical outcomes of childbirth, but significantly less on socio-psychological outcomes. Investigating women’s perception of dignified treatment during birth contributes to a salient, under-examined aspect of women’s childbirth experiences.
We use a two-part conceptualization of dignity, respect and autonomy, to understand how birth experiences and interactions either facilitate or undermine women’s perceived dignity. Data came from the Listening-to-Mothers I survey, the first nationally representative study of postpartum women in the United States (n = 1,406). Through linear regression analysis, we separately modeled women’s perception of respectful treatment and women’s perception of medical autonomy during birth.
Overall women reported high scores for both autonomy and respect. Differences between the models emerged related primarily to the role of interventions and provider support. While women’s perceived dignity is related to elements that she brings in to the delivery room (e.g., birth knowledge, health status), much variation was explained by the medical encounter itself (e.g., type of medical interventions, pain management, nurse support, and number of staff present).
This study is cross-sectional, and required either a telephone or internet access, thus limiting the full generalizability of findings. Two findings have direct practical relevance for promoting women’s dignity in childbirth. First, the number of staff persons present during labor and birth was negatively associated with both respect and autonomy. Second, that women with high levels of knowledge about their legal rights during childbirth were more likely to report high scores on the dignity scale. Limiting staff in the delivery room and including knowledge of legal rights in childbirth education or during prenatal visits may be two mechanisms to promote dignity in birth.
These findings address an important, under-examined aspect of women’s childbirth experiences. This study investigates how different birth experiences and interactions either promote or violate childbearing women’s perception of dignity, and has significant implications for the provision of maternal healthcare. The results reinforce the importance of focusing on the socio-psychological dimensions of childbirth.
In this chapter, the authors focus on a range of Australian news articles selected for their relevance to key themes in the area of child abuse and examine two high…
In this chapter, the authors focus on a range of Australian news articles selected for their relevance to key themes in the area of child abuse and examine two high profile cases of child abuse deaths that were extensively reported on by the media and led to system reform. Challenges for media reporting on child abuse in Australia including a changing media landscape, lack of available child abuse data and lack of publicly available serious case reviews are discussed. The authors argue that there is a need for attention to be paid to children's resistance and agency in the context of violence and abuse to counter the objectification of children and uphold their rights. Following Finkelhor (2008), the authors argue that media reporting on child abuse in Australia reflects a general approach to child abuse that is fragmented, with different types of abuse viewed as separate from one another, and call for a more integrated understanding of child abuse. The authors highlight the complexity of media responses to child abuse in Australia, noting that while the social problem of child abuse can be misrepresented by the media, media reporting has also triggered significant systemic reform and advocated for children in cases where other systems failed them.
Rather than organize as traditional firms, many of today’s companies organize as platforms that sit at the nexus of multiple exchange and production relationships. This…
Rather than organize as traditional firms, many of today’s companies organize as platforms that sit at the nexus of multiple exchange and production relationships. This chapter considers a most basic question of organization in platform contexts: the choice of boundaries. Herein, I investigate how classical economic theories of firm boundaries apply to platform-based organization and empirically study how executives made boundary choices in response to changing market and technical challenges in the early mobile computing industry (the predecessor to today’s smartphones). Rather than a strict or unavoidable tradeoff between “openness-versus-control,” most successful platform owners chose their boundaries in a way to simultaneously open-up to outside developers while maintaining coordination across the entire system.