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The overall objective of this research was to elucidate the ecosystem of women’s health social enterprises (WHSEs) based in the United States. The Aim I was to conduct a secondary data analysis of a random national sample of non-profit WHSEs based in the United States regarding their characteristics and areas of intervention. Aim II was to conduct a qualitative assessment of a sample of WHSEs based in the United States regarding their perspectives on the ecosystem of WHSEs. Aim I utilized the GuideStar database and assessed enterprise size, geographic location, financial distress, health intervention area, and health activity category using descriptive statistics, statistical tests, and multivariable regression analysis via SPSS. Aim II utilized in-depth interviewing and grounded theory analysis via MAXQDA 2018 to identify novel themes and core categories while using an established framework for mapping social enterprise ecosystems as a scaffold.

Aim I findings suggest that WHSE activity is more predominant in the south region of the United States but not geographically concentrated around cities previously identified as social enterprise hubs. WHSEs take a comprehensive approach to women’s health, often simultaneously focusing on multiple areas of health interventions. Although most WHSEs demonstrate a risk for financial distress, very few exhibited severe risk. Risk for financial distress was not significantly associated with any of the measured enterprise characteristics. Aim II generated four core categories of findings that describe the ecosystem of WHSE: (1) comprehensive, community-based, and culturally adaptive care; (2) interdependent innovation in systems, finances, and communication; (3) interdisciplinary, cross-enterprise collaboration; and (4) women’s health as the foundation for family and population health. These findings are consistent with the three-failures theory for non-profit organizations, particularly that WHSEs address government failure by focusing on the unmet women’s health needs of the underserved populations (in contrast to the supply of services supported by the median voter) and address the market failure of over exclusion through strategies such as cross-subsidization and price discrimination. While WHSEs operate with levels of financial risk and are subject to the voluntary sector failure of philanthropic insufficiency, the data also show that they act to remediate other threats of voluntary failure.

Aim I findings highlight the importance of understanding financial performance of WHSEs. Also, lack of significant associations between our assessed enterprise characteristics and their financial risk suggests need for additional research to identify factors that influence financial performance of WHSE. Aim II findings show that WHSEs are currently engaged in complex care coordination and comprehensive biopsychosocial care for women and their families, suggesting that these enterprises may serve as a model for improving women’s health and health care. The community-oriented and interdisciplinary nature of WHSE as highlighted by our study may also serve as a unique approach for research and education purposes. Additional research on the ecosystem of WHSE is needed in order to better inform generalizability of our findings and to elucidate how WHSE interventions may be integrated into policies and practices to improve women’s health.

Purpose – This study identifies the multiple contributions of the Salvadoran women's movement in sustaining mass mobilization under the threat of public health care privatization.

Methodology/approach – A case study methodological approach shows how the emergence of an autonomous women's movement in El Salvador in the late 1980s and early 1990s “spilled over” (Meyer & Whittier, 1994) to assist in the maintenance of the health care campaigns in the late 1990s and early 2000s.

Findings – We observed three arenas in which the women's movement played pivotal roles in the anti-health care privatization struggle: (1) women-based organizations; (2) leadership positions within larger coalitions brokering the participation of diverse social sectors; and (3) key advocacy roles inside the state. These three contributions of the women's movement increased the overall level of mobilization and success against health care privatization.

Research limitations – The study centered on one major group of health care consumers. The role of other civic organizations should be examined in future research.

Originality/value of chapter – The study demonstrates that in the era of globalization, women's movements form a critical part of the social movement sector facilitating the construction of large coalitions protecting consumers from neoliberal restructuring in areas such as public health care.

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.

The association between income distribution and measures of health has been well established such that societies with smaller income differences between rich and poor people have increased longevity (Wilkinson, 1996). While more egalitarian societies tend to have better health, in most developed societies people lower down the social scale have death rates two to four times higher than those nearer the top. Inequities in income distribution and the consequent disparities in health status are particularly problematic for many women, including single mothers, older women, and women of colour. The feminization of poverty is the rapidly increasing proportion of women in the adult poverty population (Doyal, 1995; Fraser, 1987).

The medicalization thesis derives from a classic theme in the field of medical sociology. It addresses the broader issue of the power of medicine – as a culture and as a profession – to define and regulate social behavior. This issue was introduced into sociology 50 years ago by Talcott Parsons (1951) who suggested that medicine was a social institution that regulated the kind of deviance for which the individual was not held morally responsible and for which a medical diagnosis could be found. The agent of social control was the medical profession, an institutionalized structure in society that had been given the mandate to restore the health of the sick so that they could resume their expected role obligations. Inherent in this view of medicine was the functionalist perspective on the workings of society: the basic function of medicine was to maintain the established division of labor, a state that guaranteed the optimum working of society. For 20 years, the Parsonian interpretation of how medicine worked – including sick-role theory and the theory of the profession of medicine – dominated the bourgeoning field of medical sociology.

Erica S. Breslau, Ph.D., M.P.H. is a scientific program director in the Applied Cancer Screening Research Branch, in the Behavioral Research Program within the Division of Cancer Control and Population Sciences at the National Cancer Institute. Dr. Breslau’s research interests focus on women’s oncology issues in general, and specifically as they pertain to the social, behavioral, and psychological influences associated with breast, gynecological and colorectal cancer screening. Recent efforts include ensuring that research is able to inform and improve the quality of health services among women disproportionately affected with breast and cervical cancer through the dissemination of evidence-based intervention approaches. She has conducted population-based research in the area of infectious diseases, including HIV/AIDS and sexually transmitted diseases in military populations, and has implemented large-scale health promotion approaches to improve the adoption of prevention practices. Dr. Breslau received her Ph.D. in Public Health from The Johns Hopkins Bloomberg School of Public Health, and her Master’s in Public Health from Tulane University, School of Public Health and Tropical Medicine.Vasilikie Demos is a Professor of Sociology at the University of Minnesota-Morris. She has studied ethnicity and gender in the United States and is currently completing a monograph on her study of Kytherian Greek women based on interviews in Greece and among immigrants in the United States and Australia. With Marcia Texler Segal, she is co-editor of the Advances in Gender Research series and Ethnic Women: A Multiple Status Reality (General Hall, 1994). She is a past president of Sociologists for Women in Society and of the North Central Sociological Association, and has been an Honorary Visiting Professor at the University of New South Wales in Australia.Heather Hartley is an Assistant Professor of Sociology at Portland State University. Dr. Hartley’s research interests include the sociology of health and medicine, the sociology of gender, the sociology of sexualities, and political sociology. Within these general specialty areas, her work focuses on the politics of women’s health, the pharmaceutical industry and the changing distribution of power within the health care system.Beth E. Jackson is a Doctoral Student in Sociology at York University in Toronto, Canada. Drawing on the traditions of feminist epistemologies and critical social studies of science, her dissertation research puts questions of epistemic authority and the nature of evidence into the specific context of public health and epidemiology. Specifically, she explores the conditions, contexts, tools and processes through which public health knowledge claims are made, by focusing on a particular technology of “population health” i.e. the National Population Health Survey (NPHS) (a longitudinal, biennial survey of the mental and physical health of Canadians and their use of health care services). Her research also speaks to policy implications of “situated” data and evidence – in this case, the implications of how “women’s health” is defined, and the extent to which a gendered analysis of health is considered in the construction and analysis of the NPHS.Jennie Jacobs Kronenfeld is a Professor in the Department of Sociology, Arizona State University. She conducts research in the areas of health policy, health across the life course, health behavior including preventive health behavior, and research into AIDS in geographically mobile populations. She has recently authored Health Care Policy: Issues and Trends (Praeger, 2002). She has conducted research in a variety of topics related to child health, including recruitment into CHIP (child health insurance program) and has published a book on the impact of school based health clinics, Schools and the Health of Children (Sage, 2000). She is a past president of Sociologists for Women in Society and past chair of the Medical Sociology Section of the American Sociological Association.Nancy Luke is an Assistant Professor of Research in the Population Studies and Training Center at Brown University and a Research Fellow in the Center for Population and Development Studies at Harvard University. Her primary research interest is the impact of social organization on health and well-being, particularly among women and adolescents. She is presently co-Principal Investigator of two research projects, both of which include collection of household survey and ethnographic data. A project in Kenya studies the influence of marriage and economic transactions on sexual behavior in an area of high HIV/AIDS prevalence, and a project in India examines women’s empowerment in a context where norms sanction intimate partner violence. She has also collaborated with numerous non-governmental organizations on research projects pertaining to reproductive health and gender equity in developing countries. Dr. Luke has a Ph.D. in Demography and Sociology from the University of Pennsylvania and an M.A. from Johns Hopkins School of Advanced International Studies.Deborah Parra-Medina, Ph.D., M.P.H., is Assistant Professor at the University of South Carolina with joint appointments in the Department of Health Promotion, Education and Behavior (HPEB) and Women’s Studies. She received her Ph.D. in Epidemiology at the UC San Diego, an M.P.H. in Health Promotion at San Diego State University and a B.A. in Social Science at UC Berkeley. She has extensive experience working with under-served communities, having worked in several chronic disease prevention and control efforts including cancer screening, tobacco control, weight loss and nutrition. Her research based on a participatory action model emphasizes the intersections of race, class and gender and the influence of socio-cultural environment on adaptive and maladaptive health behaviors. This perspective is exemplified in her current research. She is Principle Investigator of the SC American Legacy Empowerment (SCALE) Evaluation Project that is examining how to effectively engage youth as agents for social change within the context of tobacco prevention and control. Dr. Parra-Medina was recently awarded a pilot study grant from NCI, the broad goal of this project is to foster individual and organizational empowerment among the emerging Hispanic population in South Carolina in relation to cancer prevention and health promotion through the development of the South Carolina Hispanic Health Coalition: Partnership for Cancer Prevention (PCP).Colleen Reid recently completed her Ph.D. in Interdisciplinary Studies in health promotion research at the University of British Columbia in Vancouver, Canada. Her doctoral dissertation was a feminist action research project with a group of women on low income. Together they examined the relationship between exclusion and health, the women’s varied discourses of poverty and health, and the promises and challenges of engaging in feminist action research. Dr. Reid has also been involved in community health research projects with organizations including the Vancouver YWCA, AIDS Vancouver, Literacy B.C., and the B.C. Centre of Excellence for Women’s Health.Elianne Riska is von Willebrand-Fahlbeck Professor of Sociology at Åbo Akademi University, Finland since 1985. She has been Chairperson of the Department of Sociology 1985–1997 and Director of the Institute of Women’s Studies at Åbo Akademi University 1986–1993. Elianne Riska received her Ph.D. in Sociology at the State University of New York at Stony Brook in 1974. She was an Assistant Professor and an Associate Professor of Sociology in the Department of Sociology and College of Human Medicine at Michigan State University from 1974 to 1981. She was Academy Professor of the Academy of Finland 1997–2002. She is currently the President of the Research Committee of the Sociology of Health (RC15) of the International Sociological Association (2002–2006). Her most recent books are Gender, Work and Medicine (Sage, 1993), Gendered Moods (Routledge, 1995) and Medical Careers and Feminist Agendas: American, Scandinavian, and Russian Women Physicians (Aldine de Gruyter, 2001).Marcia Texler Segal is Associate Vice-Chancellor for Academic Affairs, Dean for Research and a Professor of Sociology at Indiana University Southeast. Her research and consulting focus on education and on women in Sub-Saharan Africa and on ethnic women in the United States. With Vasilikie Demos, she is co-editor of the Advances in Gender Research series and Ethnic Women: A Multiple Status Reality (General Hall, 1994). She is a past president of the North Central Sociological Association and past chair of the American Sociological Association Sections on Sex and Gender and Race, Gender and Class.Lynn Weber is a Director of the Women’s Studies Program and Professor of Sociology at the University of South Carolina. For the 2002–2003 year, she is Visiting Professor in the Consortium for Research on Race, Gender, and Ethnicity and the Department of Women’s Studies at the University of Maryland. Her research and teaching explore the intersections of race, class, gender, and sexuality particularly as they are manifest in women’s health, in the process of upward social mobility and work, and in the creation of an inclusive classroom environment. In 2001 and 2002, she published two books, Understanding Race, Class, Gender, and Sexuality: A Conceptual Framework and Understanding Race, Class, Gender, and Sexuality: Case Studies (NY: McGraw-Hill) which are intended to move the field of intersectional scholarship ahead by serving as a guide to facilitate intersectional analyses and to foster more integrative thinking in the classroom. Dr. Weber is also co-author of The American Perception of Class.

In 1920 Margaret Sanger called voluntary motherhood “the key to the temple of liberty” and noted that women were “rising in fundamental revolt” to claim their right to determine their own reproductive fate (Rothman, 2000, p. 73). Decades later Barbara Katz Rothman reflected on the social, political and legal changes produced by reproductive-rights feminists since that time. She wrote: So the reproductive-rights feminists of the 1970s won, and abortion is available – just as the reproductive-rights feminists of the 1920s won, and contraception is available. But in another sense, we did not win. We did not win, could not win, because Sanger was right. What we really wanted was the fundamental revolt, the “key to the temple of liberty.” A doctor’s fitting for a diaphragm, or a clinic appointment for an abortion, is not the revolution. It is not even a woman-centered approach to reproduction (2000, p. 79).

Previous research assumes that economic development is the key to increasing the food supply and alleviating child malnutrition. However, economic development alone does not promise that income is distributed fairly, nor does it guarantee that other human needs will be fulfilled. What has been missing from cross-national research is an analysis of how gender inequality shapes women’s abilities to effectively maintain food security. The current study contributes to this literature by exploring the multidimensional effects of women’s empowerment on child stunting and wasting.

Pooling data from the Demographic and Health Surveys and the World Bank, the analysis estimates a series of multi-level models that examine the country-level influences on malnutrition, while also accounting for household and maternal characteristics that affect food security at the individual level.

Results suggest that improvements in women’s education, control over reproduction, representation in national politics, and life expectancy correspond to improvements in child malnutrition. Notably, the effects of gender inequality are comparable to or larger than those of economic development. The multi-level modeling technique illustrates how social forces that are larger than the individual shape the chances of experiencing food insecurity.

Cross-national data are limited in scope and cannot prove causality. Further research is also needed to better understand the process by which women wield advances in rights and empowerment to affect food security.

If policymakers want to facilitate food security in poor countries, they should not disregard the potential of policies that will promote more equitable rights for women.

With an aim to investigate the recent state of the feminist clinics and their negotiation of medical authority in a time of increased technoscientific biomedicalization, and capitalistic health-care system, I conducted a study of two feminist health centers in the Northeast of the United States in 2001–2002. In this chapter, I discuss how the two centers (a nonprofit collective and a for-profit center with a more hierarchical structure) negotiated medical authority in organizational terms as impacted by the larger context of medicine and its interaction with the state, capitalist health-care system, and antiabortion forces. The chapter concludes with a discussion of demedicalization as a multilevel process and implications for feminist care (service delivery) and U.S. Women's Health Movement.

I begin my historical analysis of the co-evolution of reproductive norms and desires, approaches to fertility control, and the meaning assigned to contraceptives with an examination of the Grafenberg Ring, the first modern IUD. The Grafenberg ring, developed in the late 1920s by a German doctor, Ernst Gräfenberg, was a small ring made of silkworm gut and coiled silver that can be compressed to be inserted into the uterus. The Grafenberg ring appeared at a time when changes in social attitude towards sexuality had formed a favorable climate for a new contraceptive method. The device was greeted with much interest from the European birth control movement, and Gräfenberg was invited to speak at the Third Congress of the World League for Sexual Reform held in London in 1929 and at the Seventh International Birth Control Conference in Zurich in 1930 (Davis, 1971).