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Medicaid: the lower tier of health care for women.

Being poor in the United States means being exposed to the Medicaid system, whose characteristics, as determined by both federal and state policy, affect access to health care. This paper examines those aspects of the Medicaid system which have a disparate impact on women because they are overrepresented in certain social strata, as well as some aspects which affect the ability of both sexes to utilize the health care system. Owing to the problems of women in society, women make up two-thirds of the Medicaid clientele. Thus the burdens created by the limitations of Medicaid are a significant gender issue. Policies regarding AFDC coverage and pregnancy particularly concern younger women, many of whom have problems related to marriage, childbirth, and absence of economic support from fathers which place them at risk for poverty. Regulations as to income and assets of elderly persons requiring long-term care are among the policies that affect older women whose spouses have become disabled. Mandating less restrictive eligibility standards and coverage during transition of Medicaid clients to work would help address the twin problems of inferiority and uncertainty with regard to health care.

Age Factors↗

Women and sexually transmitted diseases.

This paper presents a brief review of historical developments in women's health care. It describes the current campaign against sexually transmitted diseases (STDs) and assesses the campaign's success in light of its history and the reality of women's lives. The authors suggest that women are forced into a double-bind in which they are expected to take responsibility for the prevention of STDs although they may not have the ability to do so. Modifications are suggested which take into account gender-role socialization and social group norms.

Acquired Immunodeficiency Syndrome↗

Aging, disability, and disabled older people in India.

India is witnessing a demographic revolution, leading to a considerable increase in the proportion of older people in the population. Similarly, life expectancy of both the mentally and physically disabled has improved considerably. About 5% of Indian older people have problems with physical mobility. Aging has become a gender issue in India not only because more women are surviving into old age; they are also vulnerable and disadvantaged in many ways. In most cases they are the only caregivers available for the old and disabled. Older Indians are considered a high-risk group for multiple morbidity. It is estimated that nearly four million Indians suffer from mental problems. India has around 12 million people designated as "handicapped." However, little information is available about disabled people who grow older. The National Policy on Older Persons, which has been recently formulated, aims at providing an improved quality of life for millions of older Indians. However, the concerns of older disabled and of the disabled who grow old are still treated separately in both policy and practice.

Aged↗

Sexuality and perversion a hundred years on: discovering what Freud discovered.

The author considers how Freud's original formulation of the sexual drive may be understood in contemporary terms. Parallels between psychoanalysis, art history and the social and natural sciences underline the idea of sexuality as a construct that can be revisited. The nature of sexuality depends on how its irreducible biological basis is interpreted by a particular society at a particular time. The importance of revisiting is illustrated by Klein's concept of a position, which revisits the theoretical construct of a developmental stage. Freud's own construction of sexuality is based on his view of drive as comprising source, aim and object. Freud, in the Darwinian climate of his time, considered the object in terms of whether it served the fulfillment of the aim, but his paradigm can today be understood more broadly than Freud himself was able to. A discussion of perversion shows that psychoanalysis has moved from seeing it as defensive against instinctual derivatives to seeing it as defensive against object-relatedness. This reflects a shift in the analytic conceptualization of sexuality in general. Freud's paradigm for the sexual drive can be reconceived in terms of source, aim and quality of relatedness to object. Such a view of sexuality also has implications for gender issues, for the comparison of male and female perversion, and for the relation between sexuality and love.

Defense Mechanisms↗

[The (in)visible gender of old age in the knowledge of nursing].

It is a bibliographical study in which the scientific production of Nursing regarding Women in Old Age was surveyed. The study was based on the Catalog of Dissertations and Theses from the CD-ROM of the Center for Studies and Research on Nursing (CEPEn) of the Brazilian Nursing Association (ABEn), from 1979 to 1999. It was aimed at getting to know the deviations and/or approximations in the knowledge of Nursing by way of the object of study of the Ph.D. thesis 'Health practice and knowledge of old women in the gender perspective'. It was found out that old women have been investigated in few studies. In addition, the objects of these investigations have strongly deviated from gender issues, demonstrating the sexless aspect of old age and the denial of women's social roles.

Academic Dissertations as Topic↗

[Impact of contraceptive methods on women's lives: the case of tubal ligation].

This study focused on the long-term consequences of tubal ligation on women's lives. Women 30 to 49 years old living in Campinas, State of São Paulo (Brazil), were interviewed: 236 sterilized at least five years prior to the interview and 236 non-sterilized women. Their experiences with the currently used contraceptive methods were compared with regard to satisfaction, benefits, and damage attributed to the method, feelings of regret, and perception of effects on their health, body, menstruation, sex, affective and family life, job, studies, economic status, and self-esteem. Scores were created to compare the groups in relation to self-esteem, well-being/quality of life, relationship with partner, and gender issues. Satisfaction with the currently used contraceptive method was significantly higher among sterilized women, although they more frequently reported having regretted being sterilized at some moment in time. Relatively more sterilized women felt that the contraceptive method had improved their sex lives and economic status, while producing a negative effect on their menstruation. No significant difference was observed between the groups with regard to the scores studied.

Adult↗

Acceptability of emergency contraception in Brazil, Chile, and Mexico. 2 - Facilitating factors versus obstacles.

A multi-center study was performed in Brazil, Chile, and Mexico to identify factors that may facilitate or hinder the introduction of emergency contraception (EC) as well as perceptions concerning emergency contraceptive pills. Background information on the socio-cultural, political, and legal context and the characteristics of reproductive health services was collected. The opinions of potential users and providers were obtained through discussion groups, and those of authorities and policymakers through semi-structured interviews. Barriers to introduction included: perception of EC as an abortifacient, opposition by the Catholic Church, limited recognition of sexual and reproductive rights, limited sex education, and insensitivity to gender issues. Facilitating factors were: perception of EC as a method that would prevent abortion and pregnancy among adolescents and rape victims; interest in the method shown by potential users as well as by some providers and authorities. It appears possible to reduce barriers through support from segments of society committed to improving sexual and reproductive health and adequate training of health care providers.

Adolescent↗

Induced abortion during youth: social inequalities in the outcome of the first pregnancy.

This study aimed to identify the factors associated with induced abortion in the first pregnancy in young women and in the first time young men got their partners pregnant. The methodology was a household survey with face-to-face interviews in a probabilistic sample in three stages with 4,634 subjects, aged 18 to 24 years of age residing in the cities of Salvador, Rio de Janeiro, and Porto Alegre, Brazil. Logistic regression analysis was used with a hierarchical strategy for entering variables into the model. Abortion was the reported outcome of the first pregnancy for 16.7% of the women and 45.9% of the men (in relation to their partners). Key factors associated with abortion included higher schooling and the occasional nature of the relationship with the male or female partner in the respective pregnancy. Inclusion of males in the study provided new elements for understanding the abortion phenomenon, including in the gender issues in discussion of the theme. The authors recommend greater public investment to warrant access to information and means for young people to achieve their reproductive plans in a security and healthy way, respecting their sexual and reproductive rights.

Abortion, Induced↗

Military rank and AIDS proportionate mortality in the Brazilian Navy.

This study describes AIDS mortality and occupational factors among servicemen in the Brazilian Navy. This is a proportional mortality study of 2,586 servicemen's death certificates (20-72 years of age) recorded from 1991 to 1995. Death certificates and occupational histories came from the Brazilian Navy Insurance System archives. Association was measured using proportionate mortality odds ratios obtained with unconditional logistic regression. AIDS proportionate mortality was estimated at 4.8% (n = 125) and increased during the study period, particularly among servicemen under 50 years of age and those with low rank. As compared to other occupations, there was relative excess AIDS in the "management" (proportionate mortality odds ratio, PMORage-adjusted = 2.45; 95%CI: 1.27-4.71), "secretarial" (PMORage-adjusted = 2.49; 95%CI: 1.22-5.08), and "janitorial" (PMORage-adjusted = 2.61; 95%CI: 1.10-6.16) occupational groups. AIDS proportionate mortality was higher among male than female military members. Higher rates were observed in some occupational groups when the members were low ranking. Power distribution, gender issues, and low socioeconomic status require further investigation using more appropriate methods.

Acquired Immunodeficiency Syndrome↗

[The relation between work, health and living conditions: Negativity and positivity in nursing work at a teaching hospital].

This article results from a research carried out among nursing professionals at the Hospital das Clínicas da Universidade Federal de Uberlândia (MG), located in Uberlândia (MG), Brazil, and aimed to examine the relations between these professionals' work, health and living conditions. Data were collected through semistructured interviews and observations in the work environment. The results indicate the common occurrence of physical and mental health problems, mainly resulting from stress and exhaustion provoked by work conditions, which cause interferences in their living conditions. Paradoxically, the results show that these workers do not realize their health treatments systematically. The analysis of their work, in combination with the gender issue and the specific nature of nursing work, contributed to a better understanding of this professional group's work, living and health conditions.

Adult↗

[Unwanted pregnancy: impact on health and society in Latin America and the Caribbean].

Engaging in sexuality and reproduction should always be something that is wanted and planned. Unfortunately, when that is not the case, one result can be unwanted pregnancy. Unwanted pregnancies have consequences for women, their families, and their countries. This document reviews the causes and results of unwanted pregnancy, emphasizing the impact that this problem has on Latin America and the Caribbean (LAC). Four reasons why unwanted pregnancy is a continuing problem in LAC are: 1) people's growing desire to have smaller families, 2) the unmet need for family planning, 3) the fact that contraceptive methods are not 100% effective, and 4) unwanted sexual relations. Unwanted pregnancies especially affect adolescent women, single women, and women over 40 years of age. Given their desperate situation with an unwanted pregnancy, some women opt for an unsafe abortion, which can lead to their death. Other women can go so far as to commit suicide, or be murdered by a family member or other person who is unhappy that the pregnancy has occurred. It has been found that women who decide to continue with the pregnancy have higher risks of suffering an illness, and the same is true for the child. Reducing unwanted pregnancies and treating post-abortion complications are key to lowering maternal mortality and morbidity. This necessitates developing mass communication programs that address gender issues, education programs for girls, and sex education programs. It is also vital to make available to all persons reproductive health services that include family planning methods. In the countries of LAC with laws that specify grounds for legally ending a pregnancy, it is necessary that health care be organized to actually provide this service, and that health care programs obtain the safest, most effective technologies now available for ending a pregnancy.

Abortion, Induced↗

Socio-cultural deterrents to family planning practices among Swazi women.

To investigate deterrents to family planning practices among Swazi women, 205 structured interviews were conducted with conveniently selected women in the four geographical regions of Swaziland. The Statistical Package for Social Sciences (SPSS) was used to analyse data. These results revealed that cultural practices, religious beliefs, gender issues and health care practices were the main barriers to the use of contraceptives among Swazi women. Recommendations were suggested regarding the education of men, women, adolescents and the entire society about contraceptive practices.

Attitude to Health↗

Influence of the U.S. military and occupational therapy reconstruction aides in World War I on the development of occupational therapy.

The development of occupational therapy was heavily influenced by an early evolved relationship between orthopedists and reconstruction aides during the first World War. Orhopedists were largely responsible for both the presence of occupational therapy in the war and the eventual acceptance (by army personnel) of women fulfilling this military function. As a result of gender issues of that time--characterized by a dearth of employment opportunities for women and by a general resistance to women in military roles--this affiliation with orthopedists in World War I served to promote occupational therapy within the military environment. This affiliation also marked an early willingness by occupational therapists to accept the medical model as one guide for clinical practice.

Female↗

Workplace violence: the dark side of organisational life.

This paper draws on a diverse range of research literature addressing workplace violence, which constitutes one component of the dark side of organisational life. This selective review of the literature has been drawn from the disciplines of nursing, management, psychology and organisational culture. The paper focuses bullying and mobbing in the workplace, addressing its types, causes, the characteristics of bullies and targets and the generalised impact of bullying and mobbing. It also examines whether there are gender issues pertinent to the health care sector. Consideration will also be given to the impact on the individual, group and organization, given the apparent epidemic proportions workplace violence has reached. Ultimately, the question will arise: how can the workplace violence be abolished, specifically within the health care sector, given that we live in a global environment characterised by international bullying (Crawford 1999)? This is a challenge because workplace violence is perpetuated within organisations, due either to cultures of acceptance, or fear of retribution should it be acknowledged and acted upon (or both).

Female↗

Learning to value differences. A Catholic healthcare system implements a cultural diversity education program.

Each year the U.S. labor force is becoming increasingly diverse. Many healthcare organizations are adopting plans to meet the needs of leaders who manage culturally diverse groups of employees and to ensure that the organization can continue to attract and retain employees of all cultures. In December 1988 Mercy Health Services, Farmington Hills, MI, began a cultural diversity program to increase the number of minority and women employees, especially in management and leadership positions. Its education program was designed to enhance manager and employee awareness of their own biases and those of others and to build skills in dealing with persons from a variety of cultures. Mercy Health Services first held 90-minute educational sessions for managers. The sessions covered expected demographic changes and the importance of working together. Employees then attended sessions where they practiced interactive exercises to help each person recognize his or her own biases. In the subsequent weeks the corporate human resources staff experienced an increase in the number of employee relations problems managers and nonmanagers attributed to diversity conflict. In response, Mercy developed a pilot series of awareness- and skill-building workshops for those who managed Mercy's most culturally diverse staffs. They heard lectures on racial and gender issues and watched and discussed conflict resolution videos. Most workshop participants increased their awareness of cultural bias and their commitment to learning and practicing skills to deal with conflict.

Catholicism↗

Malnutrition and gender relations in Western Kenya.

Child malnutrition, which is an increasing problem in Western Kenya, is addressed primarily through efforts to reach the individual mother with information about proper feeding of her children. A study carried out in Siaya, Kisumu and Busia Districts showed that mothers perceived nutrition problems differently, emphasizing their embeddedness in gender and family relations. In situations of marital conflict, male labour migration, and impoverishment, women must rely on support from others; thus health education should be addressed to husbands, grandmothers and mothers-in-law as well as mothers.

Child↗

'She has made me feel human again': an evaluation of a volunteer home-based visiting project for mothers.

This paper provides a description and phenomenological interpretation of the Sutherland Family Network, a volunteer home visiting project in the Sutherland Shire, Sydney, Australia. Home visitation is undergoing a revival in health and welfare systems. Research and experience has shown home visitation to be an effective strategy in attempts to prevent child abuse and neglect, in all its forms. Programmes utilizing volunteers are just one form of home visitation. They do, however, raise a number of industrial, socio-political and gender issues, which have been addressed in this study. Phenomenological analysis was used to describe the experiences of the coordinator, the volunteers, and the mothers who have been involved in the project. The study is based on interviews conducted with the coordinator, 10 volunteers and 15 mothers between February and July 1996. The Sutherland Family Network provides service to new mothers, of any parity, in families at low risk of child abuse and neglect. Befriending was their main role as volunteers. Volunteers were trained not to give advise or counselling. Training also ensured against volunteer exploitation. A unique approach of this volunteer project was a focus on the new mother, rather, than the children. New mothers became involved in the Network mainly due to either emotional or physical isolation, or depression. Major functions of the Network were to provide a service of friendship, and to link mothers with other community groups and professionals.

Journal Article↗