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Women, men and public health-how the choice of normative theory affects resource allocation.

Women live longer than men in almost all countries, but men are more privileged in terms of power, influence, resources and probably morbidity. This investigation aims at illustrating how the choice of normative framework affects judgements about the fairness in these sex differences, and about desired societal change. The selected theories are welfare economics, health sector extra-welfarism, justice as fairness and feminist justice. By means of five Swedish proposals aiming at improving the population's health or "sex equity", facts and values are applied to resource allocation. Although we do not claim a specific ethical foundation, it seems to us that the feminist criterion has great potential in public health policy. The overall conclusion is that the normative framework must be explicitly discussed and stated in issues of women's and men's health.

Ethical Theory↗

A death in the family: household structure and mortality in rural Liaoning: life-event and time-series analysis, 1792-1867.

"Through a discrete-time life-event analysis of triennial household register data from a northeast Chinese village, Daoyi, between 1774 and 1873, we find that an individual's probability of dying, which we treat as an indicator of access to resources and the nature of household roles, was affected by the composition of their coresident kin.... Widows and widowers had higher mortality than the currently married. Orphans had higher mortality than children with at least one parent present. Reflecting the dependence of a wife's status on whether she had produced an heir for her husband, married women in young adulthood and middle age who had at least one son had substantially lower mortality than those without. Reflecting the strength of the claim that elderly males could make on household resources, children with coresident grandfathers had higher mortality than those without. Even though sons were supposed to be a form of old-age security, however, the death rate of the elderly was not reduced by the presence of sons and grandsons."

Age Factors↗

Reproductive health. An ethical perspective.

There are a number of important ethical issues involved in the area of women's reproductive health care. Only a few of these could be covered in this short paper. Abortion is perhaps the most controversial issue of all and raises a number of ethical issues related to the rights of the woman versus the rights of the fetus. Since abortion is legal in the United States, the issue of the role of the obstetrician-gynecologist is discussed, particularly as related to the shortage of physicians willing to perform the procedure and the paucity of abortion training in obstetrics/gynecology residency programs. Other issues discussed include teen pregnancy, contraceptive research and pharmaceutical company contraceptive pricing strategies, high rates of maternal mortality in the developing world and human immunodeficiency virus and acquired immunodeficiency syndrome among women and children.

Abortion, Legal↗

Wound drainage for caesarean section.

BACKGROUND: Subcutaneous and sub rectus sheath wound drains are sometimes used in women who have undergone caesarean section. The indications for using drains vary by clinician. OBJECTIVES: To compare the effects of using a wound drain with not using a wound drain at caesarean section, and of different types of drain, on maternal health and healthcare resource use. SEARCH STRATEGY: This review draws on the search strategy developed for the Cochrane Wounds Group as a whole. Electronic databases (MEDLINE, EMBASE, Cinahl and CAB Health), and the reference lists of included articles were also searched up to June 2004 SELECTION CRITERIA: Studies were included if they allocated women to groups at random and they compared any type of wound drain with no wound drainage, or with any other type of drain, in women undergoing caesarean section. DATA COLLECTION AND ANALYSIS: Trials were evaluated for appropriateness for inclusion and methodological quality without consideration of their results. This was done by two reviewers according to pre-stated eligibility criteria. MAIN RESULTS: Seven trials (1993 women) were included in the review. Meta-analysis found no difference in the risk of wound infection, other wound complications, febrile morbidity or endometritis in women who had wound drains compared with those who did not. There was some evidence that caesarean sections may be about five minutes shorter and that blood loss may be slightly lower when drains were not used. AUTHORS' CONCLUSIONS: There is no evidence in the seven small trials included to suggest that the routine use of wound drains at caesarean section confers any benefit on the women involved. These trials do not answer the question of whether wound drainage is of benefit when haemostasis is not felt to be adequate. Further large trials are justified using blinded outcome assessment to examine the role of different types of wound drain at caesarean section. Comparing the use of drains in women with different degrees of obesity and in women having first or repeat caesareans and intrapartum or prelabour caesarean sections would be of interest. Women's views and experience of drains have not been studied in these trials.

Cesarean Section↗