Low-income women in an Oregon city of approximately 35,000 inhabitants have limited access to prenatal care services during their pregnancies. The purpose of this study was to uncover the impacts of several factors on the experiences of twenty-seven health department clients with public health department prenatal care practitioners and with local private obstetricians. Ethnographic interviews were conducted with the clients, two health department practitioners, two local obstetricians, and one local direct-entry midwife. The focal finding that emerged from the research was that the clients preferred the care of the health department practitioners to that of obstetricians, even though the health department providers could not deliver the women's babies. The major impacts on the clients' experiences included fragmented service delivery and availability, economic and social restrictions on prenatal care options, biomedical constructs of a healthy pregnancy, and provider role constructions and attitudes towards Medicaid recipients and uninsured pregnant women. Local physicians' mechanistic philosophy, professional dominance and profit orientation afforded them a narrow understanding of the needs and identities of low-income women. Local public health workers are less professionally autonomous than medical doctors but their service orientation allowed them the potential to better serve low-income clients. Based on the twenty-seven clients' perceptions of their care providers and the services available to them, recommendations are made for more empowering, comprehensive prenatal care services in this county. Recommended changes to the public health system entail expanded funding for more appropriate programs and to establish continuity of care for health department clients from pregnancy through the postpartum period. The incorporation of direct-entry midwives into the prenatal and birthing care options open to low-income women is also recommended. Senate Bill 1063, which creates a process for direct-entry midwives to become state-licensed in order to be reimbursed by the Office of Medical Assistance Programs for perinatal services, is considered in terms of its implications for low-income women, the Oregon community of direct-entry midwives, and the texture of Oregon reproductive health care. / Graduation date: 1994

Battery is a major health care issue that, despite increased recognition, fails to be detected in health care institutions. Without adequate detection, referral to social and community services are less likely to occur, rendering women victims vulnerable to continued risk physically, psychologically and medically. This study seeks to describe actual detection and referral practices in an emergency department at a large teaching hospital in Quebec, as well as explore health care professionals' knowledge about and practices regarding the detection and referral of battered women. Its aim is to better understand the pathways and barriers to detection and referral of abused women in order to enhance current practice responses in emergency departments. To examine detection and referral rates and predictors of battery, 200 medical charts from the emergency department were reviewed. Supplementing analyses of the charts were in depth interviews with ten health care professionals working in the emergency department. From these sources of data, it became apparent that neither detection nor referral occur in any systematic fashion. Whereas health care professionals seem to know a great deal about battery, their actual practice appears to be contradictory. Gynecological problems and woman's age were not found to be related to detail in charts but physical injuries were. Whereas a positive relationship was found between detection and referral in the chart reviews, everyday practice showed inadequacy in both areas. Implications for social work contributions to health care practice related to battery are offered.

Thesis (Ph.D.)--McMaster University, 2004. / Advisor: Charlene Miall. Includes bibliographical references (leaves 274-282)

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No description available.

Using the qualitative methodology of grounded theory, decision-making about health and illness situations was studied in a sample of six women members of the Church of Jesus Christ of Latter-Day Saints (Mormons). The purpose of the study was to identify the process used by Mormon women in deciding when to use available healing alternatives, namely self care, the laying on of hands, biomedical practitioners expertise, and social support networks. The identified process, called the "Mormon Woman's Decision-Making Road-Map to Health," is composed of the categories of Protecting Health, Diagnosing a Problem, Considering Possible Treatment Actions, and Evaluating Treatment Effectiveness. The process described in the Road Map to Health model is helpful to health care professionals who seek to understand and influence the health care decision-making of their clients.

A model for health care utilization was applied to a sample of low income women. Demographic Predisposing, Psychosocial Predisposing, Illness Level, and Enabling indicators were examined separately for African American (n = 266), Anglo American (n = 200), and Mexican American (n = 210) women. Structural Equation Modeling revealed that for African American and Anglo American women, Illness Level, the only significant path to Utilization, had a mediating effect on Psychosocial Predisposing indicators. The model for Mexican Americans was the most complex with Enabling indicators affecting Illness Level and Utilization. Psychosocial Predisposing indicators were mediated by Illness Level and Enabling indicators which both directly affected Utilization. Implications of the results for future research are addressed.

Background: Medical tourism is arising in Asian countries and in Hong Kong, the maternal tourism is evolving due to the influx of non-entitled pregnant women from mainland China for deliveries. The visitors were attracted not only by the technical advancement of Hong Kong healthcare system, but its special administrative background which grants the babies with a permanent resident identity as well as the citizenship benefits regardless to their parental status. Besides, the parents could avoid penalties from the "One Child Policy" in China. With the limited healthcare resources, non-local mothers started to compete with the local mothers for obstetric services. The community raised their concerns in developing of maternity tourism and verbalised their demands in protecting local rights and equity to resources. Aims and Objectives: There are limited published researches available on maternal tourism or the specific situation faced by Hong Kong. By analysing grey literature, this paper would like to suggest the impact exerted on the healthcare system by the influx of non-eligible mothers with a medical tourism framework. Results: The impact of non-local-mother deliveries on healthcare system were discussed in the areas of governance, delivery, financing, human resources and regulation. Future research could be done on assessing the priorities in the framework components and the direction, effectiveness of the management strategies for non-entitled deliveries. / published_or_final_version / Public Health / Master / Master of Public Health

The convergence of compelling evidence that transmission of HIV from a pregnant woman living with HIV to her foetus can be significantly interrupted due to advances in antiretroviral and obstetrical interventions, and worrisome epidemiologic data documenting a rise in HIV infection among Canadian women, spurred the development in Canada and world wide of policies and programmes aimed at increasing the number of pregnant women who are tested for HIV. Responding to innovative therapy reducing perinatal HIV transmission risk by increasing the number of pregnant women who agree to test for HIV is clearly an important prevention objective. However, the process must be accomplished in a way that is of most benefit to the pregnant woman herself and in a way that does not compromise a pregnant woman's rights to the established Canadian principles of HIV counselling and testing. / Working with pregnant women in Ontario, the province with the highest level of HIV infection among Canadian women, this thesis articulates and interprets their experiences of prenatal HIV counselling and testing and details their perspectives on best practices. The pregnant women's evidence-based recommendations for the re-design of prenatal HIV testing programmes are provided. These unique data have important utility for federal and provincial policy makers as HIV counselling and testing policies and programmes that encompass and are grounded in pregnant womens' experiences and perspectives are likely to be maximally acceptable and thereby increase the number of pregnant women who can be apprised of prophylactic treatment to take care of their own health needs as well as those of their unborn children. / In order for pregnant women to increase control over their own health and that of their unborn children, there is clear value in all pregnant women being afforded the opportunity to know their HIV status. However, the voices of the women in this study suggest that the autonomy rights of pregnant women may well be at risk in a programme in which the current emphasis is on potential HIV infection of the foetus rather than on potential or actual infection of the pregnant woman.

This research sought to identify the determinants of nonuse and high use of physician services and assess whether or not patterns of nonuse and high use changed over time. The population of interest was a group of elderly unmarried women who participated in the Longitudinal Retirement History Survey from 1969 to 1979. Andersen and Newman's (2) health care services utilization model served as the conceptual framework for this research. Of specific interest was the relationship between age strata and health care behavior. Age proved to be a stratifying variable within the health care delivery system. Over the ten year survey period, the health care behavior of preretirement and postretirement nonusers and high users differed significantly. A decline in nonuse was also associated with the transition years. This finding could be attributed to the "near poor" becoming eligible for Medicare. In any event, these data show that utilization of physician services is likely to increase among some unmarried women in their middle 60's.