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PubMed1994

A gender analysis of policy formation: the case of fetal abuse.

In this paper we argue the value to policy research of taking a feminist perspective on policy issues. We show the development of fetal abuse as a policy issue and how the often unconscious patriarchal stance taken by those participating in the debate has led to fetal abuse being defined as an issue that arises from the negligence of women, when an equally good case can be made for male fetal abuse. We then show how this definition of the problem followed from the patriarchal belief systems of those who framed the issue.

Abnormalities, Drug-Induced↗
PubMed1987

A short answer to "who decides"?

Technology increases the control which experts and the medical professions exercise over conception, pregnancy, and childbirth. However, it is women and women alone who should make the ultimate decisions regarding their own childbearing.

Attitude to Health↗
PubMed1987

Psychological effects of the new reproductive technologies.

Four psychological principles help us to understand the psychological effects of the new technologies: (1) Special circumstances of parenting and birth will stimulate fantasies in parents and children, which in turn influence the child's personality and identity; (2) Human parenting does not require a biological connection; nonbiological parents can be equally effective nurturers; (3) Good parenting involves a psychological interaction beginning at birth, so that early and permanent opportunity for attachment is important for normal development; (4) New technologies relieve the psychological pain of infertility and provide benefit by giving some individuals the opportunity to be parents. The psychology of surrogate mothers is also discussed.

Female↗
PubMed2005

Pregnancy intention from men's perspectives: does child support enforcement matter?

CONTEXT: Most research on pregnancy intention has focused on women's perspectives and characteristics. Because decisions about sexual activity and contraceptive use usually involve both men and women, it is important to understand factors associated with men's intentions-for example, child support enforcement-to maximize the potential for reducing unwanted pregnancies. METHODS: Data from the 1982-2002 waves of the National Longitudinal Survey of Youth were used in multinomial logit analyses to examine the determinants of pregnancy intention from men's perspectives. RESULTS: Forty-six percent of pregnancies reported by never-married men were unwanted, compared with 21% of those reported by married men. Stronger child support enforcement was marginally associated with men's decreased likelihood of being involved in an unwanted pregnancy compared with no pregnancy (coefficient, -0.14) and of being involved in an unwanted pregnancy compared with a wanted pregnancy (-0.15). Without the improvement of child support enforcement over the survey period, the rate of unwanted pregnancies would have been an estimated 7% higher than the observed rate. CONCLUSIONS: Strengthening child support enforcement may have a positive impact on preventing unwanted pregnancies. Programs designed to reduce unwanted pregnancies and nonmarital births should include information on child support enforcement to increase their success.

Adolescent↗
PubMed2004

Predictors of Urban fathers' involvement in their child's health care.

OBJECTIVE: Fathers make important contributions to many aspects of children's well-being, but relatively few studies have evaluated father involvement in their child's health care. The objective of this study was to explore the extent to which fathers are involved in their children's health care and identify those factors that are associated with greater involvement. METHODS: A convenience sample of 104 English-speaking, urban fathers with children younger than 7 years were recruited to complete an anonymous, structured interview. Fathers self-reported the number of well-child visits (WCVs) that they had ever attended and which factors had influenced their attendance. Bivariate and multivariate analyses were used to identify those factors that predicted greater involvement. RESULTS: Eighty-nine percent of the fathers had attended at least 1 WCV. Fifty-three percent had high involvement, ie, had attended > or =40% of the American Academy of Pediatrics recommended visits for their child's age. In multivariate modeling, factors that were significantly associated with high involvement in attending WCVs included attendance at the child's delivery (odds ratio [OR]: 7.3 [1.7-30.4]), younger child age (OR: 0.96 [0.94-0.99]), older father age (OR: 1.2 [1.2-1.3]), the child's having health insurance (OR: 4.1 [1.3-12.0]), and having >1 child (OR: 0.22 [0.06-0.72]). CONCLUSIONS: The factors identified suggest ways that pediatric providers can support fathers' involvement in their children's health care. Providers should focus on encouraging greater involvement early, especially for younger fathers and those with older children. In addition, support of universal health coverage for children might, in addition to other obvious benefits, enhance a father's engagement with his child's health care.

Adult↗
PubMed2006

Fathers and the well-child visit.

OBJECTIVE: Societal and economic shifts have expanded the roles that fathers play in their families. Father involvement is associated with positive cognitive, developmental, and sociobehavioral child outcomes such as improved weight gain in preterm infants, improved breastfeeding rates, higher receptive language skills, and higher academic achievement. However, father involvement in health care has been studied little, especially among nonmarried, minority fathers. Fathers are a significant part of the child's medical home, and comprehensive involvement of both parents is ideal for the child's well-being and health. Well-child visits (WCVs) represent opportunities for fathers to increase their involvement in their child's health care while learning valuable information about the health and development of their child. The objective of this study was to explore fathers' involvement in, experience and satisfaction with, and barriers to WCVs using qualitative methods. METHODS: In-depth, semistructured, qualitative interviews were conducted in 2 cities with a subsample of fathers who were participating in the national Fragile Families and Child Wellbeing Study. The 32 fathers who participated in our study come from a nested qualitative study called Time, Love, and Cash in Couples with Children. Fathers in our study reside in Chicago or Milwaukee and were interviewed about health care issues for 1.5 hours when the focal child was 3 years of age. Questions focused on the father's overall involvement in his child's health care, the father's attendance and experiences at the doctor, health care decision-making between mother and father, assessment of focal child's health, gender/normative roles, and the father's health. The open-ended questions were designed to allow detailed accounts and personal stories as told by the fathers. Coding and analysis were done using content analysis to identify themes. Particular themes that were used for this study focused on ideals of father involvement and dis/satisfaction, barriers to, and experiences in the health care system. RESULTS: Of the 50 fathers from the Time, Love, and Cash in Couples with Children study in the 2 cities, 3 had moved out of the state, 6 were in jail, 7 had been lost in earlier follow-up, and 1 had died, leaving 33 eligible respondents. Of those, 1 refused to participate, resulting in a final sample of 32 fathers and an adjusted response rate of 97%. The mean age was 31 years, and the sample was 56% black, 28% Hispanic, and 15% white; 53% were nonmarried. Only 2 fathers had attained a college degree or higher, and 84% of the fathers were employed at the time of the interview. The majority (53%) had attended a WCV and 84% had been to see a doctor with their child in the past year. Reasons for attending a WCV included (1) to gather information about their child, (2) to support their child, (3) to ask questions and express concerns, and (4) to gain firsthand experience of the doctor and the WCV. Fathers reported positive and negative experiences in their encounters with the health care system. The 3 main contributors to fathers' satisfaction with health care professionals were (1) inclusive interactions with the physician, (2) the perception of receiving quality care, and (3) receiving clear explanations. The negative experiences were often specific instances and noted along with positive comments. The negative experiences that were mentioned by the fathers included feeling viewed suspiciously by health care staff, being perceived as having a lesser emotional bond with their child than the mother, and the perception that they were receiving a lower quality of service compared with the mother. Major barriers to attending WCVs include employment schedules as well as their relationship with the focal child's mother. For example, some fathers stated that they did not attend WCVs because that was a responsibility that the mother assumed within the family. Other fathers lacked confidence in their parenting skills, which resulted in lower involvement levels. Also mentioned were health care system barriers such as inconvenient office hours and a lack of access to their child's records. Despite the presence of several barriers that seem to prevent fathers from attending WCVs, many fathers (20 of 32;63%) mentioned "situational flexibility," which enables them to overcome the stated barriers and attend doctor visits. For example, some fathers viewed the seriousness of the visit such as "ear surgery" as a reason to rearrange their schedules and attend a doctor visit with their child. CONCLUSION: The majority of fathers from our sample have attended a WCV, and most have been to their child's doctor in the past year; WCVs and doctor appointments are ways in which fathers are involved in their child's health care. Fathers detailed specific reasons for why they attend WCVs, such as to support their child, ask questions, express concerns, and gather information firsthand. The fathers reported more positive than negative experiences with the health care staff, and, overall, they are satisfied with their experiences with the health care system. Reasons for satisfaction include feeling as though their questions had been dealt with seriously and answered appropriately. However, the fathers in our study did report a variety of barriers to health care involvement, including conflicting work schedules, a lack of confidence in their parental role, and health care system barriers. Professionals who care for children and families need to explore creative ways to engage fathers in the structured health care of their children. For example, pediatricians can stress the benefits of both parents being involved in their child's health care while reframing the importance of WCVs. Understanding that many fathers have situational flexibility when it comes to health care encounters may encourage physicians to suggest more actively that fathers attend WCVs. Pediatricians can also support existing public policies such as the national 2003 Responsible Fatherhood Act that provides grants and programs that promote the father's role in the family and advocate for additional policies that would foster quality father involvement. Continued collaboration among families, physicians, and other health care professionals is essential to support father involvement and ensure positive health outcomes for children.

Adult↗
PubMed2006

Parents benefit from eating offspring: density-dependent egg survivorship compensates for filial cannibalism.

Why should animals knowingly consume their own young? It is difficult to imagine many circumstances in which eating one's own young (i.e., filial cannibalism) actually increases an individual's fitness; however, filial cannibalism commonly co-occurs with parental care in fishes. The evolutionary significance of filial cannibalism remains unclear. The most commonly accepted explanation is that filial cannibalism is a mechanism by which caring males gain energy or nutrients that they reinvest into future reproduction, thereby increasing net reproductive success. There is mixed support for this hypothesis and, at best, it can only explain filial cannibalism in some species. A recent alternative hypothesis suggests that filial cannibalism improves the survivorship of remaining eggs by increasing oxygen availability, and thus increases current reproductive success. This theory has received little attention as of yet. We evaluated the hypothesis of oxygen-mediated filial cannibalism in the sand goby by examining the effect of oxygen and egg density on the occurrence of filial cannibalism, evaluating the effects of partial clutch cannibalism on the survivorship of remaining eggs, and comparing potential costs and benefits of filial cannibalism related to the net number of eggs surviving. Indeed, we found that oxygen level and egg density affected the occurrence of cannibalism and that simulated partial clutch cannibalism improved survivorship of the remaining eggs. Additionally, because increased egg survivorship, stemming from partial egg removal, compensated for the cost of cannibalism (i.e., number of eggs removed) at a range of cannibalism levels, filial cannibalism potentially results in no net losses in reproductive success. However, oxygen did not affect egg survivorship. Thus, we suggest a more general hypothesis of filial cannibalism mediated by density-dependent egg survivorship.

Animals↗
PubMed2004

[Fathers' participation in childbirth at a public hospital: institutional difficulties and motivations of couples].

Participation by fathers in the process of childbirth, an aspect of the humanization of obstetric care, helps foster the fathers' involvement in raising their children. This participation provides psychosocial support for pregnant women during labor and delivery, sharing of the experience by the couple, and father-child bonding. The focus of this ethnographic research was the impact of this process on fathers participating in childbirth at a State hospital in Rio de Janeiro, with two stages: participant observation of labor and delivery and eleven interviews with fathers who had been present at delivery. Fathers' participation was influenced by: the motivation of mothers and fathers; social representations of delivery and fatherhood; and exclusion of fathers from reproductive health and pediatrics services. The father's participation was not valued by the attending staff as either a source of emotional support for the mother or as part of fatherhood. The following are necessary: inclusion of fathers in prenatal care, delivery, and pediatrics services; the training of staff to work with the families; social discussion of fatherhood and health services policies to ensure the presence of fathers during labor and childbirth.

Adult↗
PubMed2006

[Paternal involvement in the care of small children: an ethnographic study of low-income families].

The present study focused on father's involvement in the health care of small children (under six years) in low-income families. An ethnographic study was performed with interviews and participatory observation. We visited families in an outlying low-income urban neighborhood in Northeast Brazil, for nine months. Children appeared as a fundamental dimension in the lives of men and women, constituting a common reason for forming a family nucleus. The paternal role involved three key dimensions: education, in which the father was essential; body care, usually considered a female attribution; and preservation of integrity, considered an obligation for all family members. Despite the fact that traditional identification of gender roles still persists, based on contrasting discourses and practices, in all families (and especially in nuclear ones) there were dimensions in which men participated actively, demonstrating physical and emotional proximity with their children.

Anthropology, Cultural↗
PubMed2007

[Fatherhood: The male experience from a gender focus].

Pregnant and postpartum women frequently complain about the limited involvement of their partners with their children, beginning in pregnancy. The current study thus aimed to understand men's feelings towards fatherhood during this period of their lives. The research adopted a qualitative approach and a gender-theory focus. The universe included men whose children were being treated at a pediatric outpatient clinic, and data were collected through semi-structured home interviews. Subjects' testimony was analyzed using discourse analysis, the basic principle of which is to recognize the most abstract levels of the text, identified by themes organized in blocks of meaning and allowing the construction of empirical categories. Study subjects' social position towards fatherhood shows that the model that men assume as father-providers coexists with that of the man who seeks to be a "new father", whose affective bond with the son or daughter begins during pregnancy, thus representing a break with traditional fatherhood.

Adult↗
PubMed2000

Genetic testing of the general population: ethical and informatic concerns.

Whether we like it or not, genetic testing will almost certainly become routine medical practice within the next 25 years. Integrated circuit chips already exist that can perform 400 genetic tests simultaneously, thus greatly reducing the costs. At least one company is already working on a prototype for a handheld genetic tester that would allow primary care physicians to perform hundreds or thousands of genetic tests on a simple blood smear in just a few minutes. "Genetic report cards" for children are not very far off at all. The use of such widespread testing poses a variety of ethical dilemmas. One problem that has not been appreciated sufficiently, however, is the question of how to interpret the test results. Because of the ways the genes implicated in diseases are discovered and marketed, quantitative analysis of the tests can be extremely misleading. The difficulty is that we simply do not have sufficient information about variance in genetic and other factors in the general population to make accurate projections of a patient's risk, given the presence of a gene. This uncertainty is obscured, however, when we provide the patient with a numerical analysis of risk because it is well established that people tend to overestimate the information content of numerical projections. This situation is made far worse by the fact that we do not have enough adequately trained genetic counselors to handle the load that will soon be placed on them (and studies have shown that physicians are generally very poorly prepared to act as accurate sources of information on complex genetic issues). For these reasons, I argue that access to genetic testing should be treated the same way as access to new medical procedures and medications--namely, withheld from the general public until proven safe and effective in large-scale trials. This is certain to be an unpopular policy, but it seems the only way to prevent a great deal of abuse of genetic tests.

Ethics, Medical↗
PubMed1979

Medicine and patriarchal violence: the social construction of a "private" event.

Our objectives are to describe the pattern of abuse associated with battering and to evaluate the contribution of the medical system and of broader social forces to its emergence. A pilot study of 481 women who used the emergency service of a large metropolitan hospital in the U.S. shows that battering includes a history of self-abuse and psychosocial problems, as well as repeated and escalating physical injury. In addition, although the number of battered women using the service is 10 times higher than medical personnel identify, the pattern of abuse that constitutes battering emerges only after its initial effects are presented and in conjunction with specific medical intervnetions and referrals. Examination of intervention and referral patterns suggests a staging process by which battering is socially constructed. At first, the physical trauma associated with abuse is medicated symptomatically. But the patient's persistence, the failure of the cure, and the incongruity between her problems and available medical explanations lead the provider to label the abused woman in ways that suggest she is personally responsible for her victimization. Although secondary problems such as depression, drug abuse, suicide attempts, or alcoholism derive as much from the intervention strategy adopted as from physical assault or psychopathology, they are treated as the primary problems at psychiatric and social service referral points where family maintenance is often the therapeutic goal. One consequence of this referral strategy is the stabilization of "violent families" in ways that virtually insure women will be abused in systematic and arbitrary ways. The use of patriarchal logic by medical providers ostensibly responding to physical trauma has less to do with individual "sexism" than with the political and economic constraints under which medicine operates as part of an "extended patriarchy." Medicine's role in battering suggests that the services function to reconstitute the "private" world of patriarchal authority, with violence if necessary, against demands to socialize the labors of love.

Emergency Service, Hospital↗
PubMed2000

Reforming gendered health care: an assessment of change.

Health policy in the United States has changed dramatically over the past three decades, with the main concern shifting from expanded health care coverage to containment of health care costs. The current focus on providing cost-effective health services, reflected in the growth of managed care initiatives, has elevated concern about the quality of health care. The authors contend that quality of health care has always been the key focus in the women's health movement, which evolved in the late 1960s as the first significant challenge to modern medicine. In this article, they apply the analytic lens of gender to develop a fresh perspective on U.S. health care organizations and policies, examining the six broad demands of the feminist consumer model of health care, all of which hinge on the issue of quality care for women, to determine whether women's health needs are now being better addressed. The authors conclude that, despite some notable gains in the roles of women as consumers and providers of health care, many of the new health reforms have replicated and solidified the historical inequities in the health care system.

Community Participation↗
PubMed1995

Negative evaluations of men's nurturant touching of young children.

82 female and 65 male, mostly unmarried undergraduate students read one of 16 versions of a brief scenario depicting a man or woman either engaging or not engaging in nurturant touching of young children. Subjects then rated story characters on masculinity and goodness scales and on scales measuring likelihood of social acceptance and future instrumental achievement. Men and women who engaged in nurturant touching were rated low on masculinity and high on goodness and social acceptance. Men rated male characters lowest on goodness and women rated male characters highest on goodness. Women who engaged in nurturant touching were given the highest goodness and social acceptance ratings. It was concluded that some men may avoid engaging in nurturant touching of young children due to gender stereotyping.

Adult↗
PubMed1992

Paternalistic interventions with the gravely disabled.

Interfering in the affairs of the gravely disabled has received attention in areas such as philosophy, theology, law, politics, and sociology. For such persons to be declared incompetent and have guardians appointed to care for them, a balancing is required of the right to personal freedom against the right to care. When consideration is given to the underlying principles of autonomy and beneficence, a case can be made for weak paternalistic interventions with persons of diminished capacity who are clearly endangered and in whom the conduct involved is substantially nonvoluntary. Examples are given of beneficial results occurring in persons with alcohol dependence or alcohol-related brain damage on whom a paternalistic intervention involving financial management was imposed with the aim of seeing that basic needs were met and that spending on alcohol was not excessive.

Alcoholism↗
PubMed1995

Aggressivity among sons of substance-abusing fathers: association with psychiatric disorder in the father and son, paternal personality, pubertal development, and socioeconomic status.

An association between childhood aggression and risk for subsequent development of a substance abuse disorder is now well-accepted. In order to better understand the relationship between the presence of paternal substance abuse and aggression among their offspring, 10-12 year old sons of fathers with (n = 34) and without (n = 39) a history of a substance abuse disorder were contrasted on demographics, aggressivity, biological indices of reproductive maturation, and the presence of psychiatric diagnoses. In addition, personality factors, the potential for physical abuse, and psychiatric diagnoses were also ascertained among their fathers. Sons of substance-abusing fathers were found to be significantly more aggressive than sons of nonsubstance abusers. However, they also differed from comparison boys on the basis of SES and school grade attained, as well as the proportion with specific psychiatric disorders. Substance-abusing fathers differed from nonsubstance-abusing men in terms of personality factors and the presence of specific psychiatric disorders, including antisocial personality. They also showed significantly higher child abuse potential scores. A multiple regression analysis of factors contributing to aggression in the boys revealed that a paternal personality factor characterized by stress reactivity, alienation, and aggression was the most robust contributor to aggression among the boys. The boys' diagnoses of attention deficit disorder, oppositional defiant disorder, and lower household socioeconomic status were also significant predictors of aggressivity. Contrary to expectations, paternal, psychiatric diagnoses, substance abuse status, and potential for physical abuse were noncontributory. The results suggest potential mechanisms by which both aggression and risk for substance abuse may be transmitted from father to son.

Aggression↗
PubMed1995

Homovanillic acid and dopamine-beta-hydroxylase in male youth: relationships with paternal substance abuse and antisocial behavior.

Recent research suggests that dopaminergic/noradrenergic system dysfunction may be associated with substance abuse and/or antisocial behavior. In order to determine whether male youth of fathers with these disorders would manifest differences in these systems when compared with youth of nonsubstance-abusing or nonantisocial fathers, levels of homovanillic acid (HVA), the metabolite of dopamine (DA) and dopamine-beta-hydroxylase (DBH), the enzyme facilitating the conversion of dopamine to norepineprhine, were studied in offspring blood samples. The subjects were 65 male youth aged 6-15 years admitted to a residential center because of behavioral disorders. Parental substance abuse and antisocial behavior were assessed through interviews, rating scales, and/or chart review. HVA and DBH were determined from blood samples obtained after admission. The findings indicated that youth of substance-abusing fathers had significantly greater levels of HVA than yough of nonsubstance-abusing fathers. Younger (< 12.0 years) boys of antisocial fathers had significantly lower DBH activity than comparably aged youth of nonantisocial fathers. The results suggest that common generational links in substance abuse and antisocial behavior in males may be associated with detectable biological parameters in susceptible youth.

Adolescent↗
PubMed1993

Has informed consent finally arrived in Australia? A comment on the law following the decision of the High Court of Australia in Rogers v. Whitaker.

A struggle is going on all over the world between medical paternalism and patient autonomy. The battlegrounds include clinics, hospitals, academic settings and the courts. The High Court has awarded the most recent round, six to nothing, to autonomy, but the fight is by no means over. The judgements, the current law in Australia, and the implications for medical practice are discussed.

Adult↗