Cameryn C. Garrett

The maternal health outcomes of paid maternity leave: A systematic review

Paid maternity leave has become a standard benefit in many countries throughout the world. Although maternal health has been central to the rationale for paid maternity leave, no review has specifically examined the effect of paid maternity leave on maternal health. The aim of this paper is to provide a systematic review of studies that examine the association between paid maternity leave and maternal health. We conducted a comprehensive search of electronic databases (Medline, Embase, CINAHL, PsycINFO, Web of Science, Sociological Abstracts) and Google Scholar. We searched websites of relevant organisations, reference lists of key papers and journals, and citation indices for additional studies including those not in refereed journals. There were no language restrictions. Studies were included if they compared paid maternity leave versus no paid maternity leave, or different lengths of paid leave. Data were extracted and an assessment of bias was performed independently by authors. Seven studies were identified, with participants from Australia, Sweden, Norway, USA, Canada, and Lebanon. All studies used quantitative methodologies, including cohort, cross-sectional, and repeated cross-sectional designs. Outcomes included mental health and wellbeing, general health, physical wellbeing, and intimate partner violence. The four studies that examined leave at an individual level showed evidence of maternal health benefits, whereas the three studies conducting policy-level comparisons reported either no association or evidence of a negative association. The synthesis of the results suggested that paid maternity leave provided maternal health benefits, although this varied depending on the length of leave. This has important implications for public health and social policy. However, all studies were subject to confounding bias and many to reverse causation. Given the small number of studies and the methodological limitations of the evidence, longitudinal studies are needed to further clarify the effects of paid maternity leave on the health of mothers in paid employment.

Being an XY Female: An Analysis of Accounts From the Website of the Androgen Insensitivity Syndrome Support Group

We report an investigation of the experience of being an XY female through the analysis of accounts posted on an Androgen Insensitivity Syndrome support group website. We investigated management of narrative identity following diagnosis, focusing on barriers and aids to narrative revision. Barriers included the sense of stigma arising from secrecy imposed by doctors and families in a society assuming binary sex and gender. Women were assisted in deriving new meaning from their condition by finding that others share a collective narrative of XY womanhood. The results of this research have implications for the medical and psychological management of XY females.

Understanding the low uptake of long-acting reversible contraception by young women in Australia: a qualitative study

BackgroundAustralia has high rates of teenage pregnancy compared with many Western countries. Long-acting reversible contraception (LARC) offers an effective method to help decrease unintended pregnancies; however, current uptake remains low. The aim of this study was to investigate barriers to LARC use by young women in Australia.MethodsHealthcare professionals were recruited through publicly available sources and snowball sampling to complete an interview about young women’s access to and use of LARC. The sample consisted of general practitioners, nurses, medical directors of reproductive and sexual health organisations, a sexual health educator, and health advocates. In addition, four focus groups about LARC were conducted with young women (aged 17–25 years) recruited via health organisations and a university. The data were analysed thematically.ResultsFifteen healthcare professionals were interviewed and four focus groups were conducted with 27 young women. Shared barriers identified included norms, misconceptions, bodily consequences, and LARC access issues. An additional barrier identified by young women was a perceived lack of control over hormones entering the body from LARC devices. Healthcare professionals also raised as a barrier limited confidence and support in LARC insertions. Strategies identified to increase contraceptive knowledge and access included increasing nurses’ role in contraceptive provision and education, improving sex education in schools, and educating parents.ConclusionsChallenges remain for young women to be able to make informed choices about contraception and easily access services. More research is needed around innovative approaches to increase LARC knowledge and access, including examining the role of nurses in enhancing young women’s reproductive health.

Young people's views on the potential use of telemedicine consultations for sexual health: results of a national survey

BackgroundYoung people are disproportionately affected by sexually transmissible infections in Australia but face barriers to accessing sexual health services, including concerns over confidentiality and, for some, geographic remoteness. A possible innovation to increase access to services is the use of telemedicine.MethodsYoung peoples (aged 16-24) pre-use views on telephone and webcam consultations for sexual health were investigated through a widely-advertised national online survey in Australia. Descriptive statistics were used to describe the study sample and chi-square, Mann-Whitney U test, or t-tests were used to assess associations. Multinomial logistic regression was used to explore the association between the three-level outcome variable (first preference in person, telephone or webcam, and demographic and behavioural variables); odds ratios and 95%CI were calculated using in person as the reference category. Free text responses were analysed thematically.ResultsA total of 662 people completed the questionnaire. Overall, 85% of the sample indicated they would be willing to have an in-person consultation with a doctor, 63% a telephone consultation, and 29% a webcam consultation. Men, respondents with same-sex partners, and respondents reporting three or more partners in the previous year were more willing to have a webcam consultation. Imagining they lived 20 minutes from a doctor, 83% of respondents reported that their first preference would be an in-person consultation with a doctor; if imagining they lived two hours from a doctor, 51% preferred a telephone consultation. The main objections to webcam consultations in the free text responses were privacy and security concerns relating to the possibility of the webcam consultation being recorded, saved, and potentially searchable and retrievable online.ConclusionsThis study is the first we are aware of that seeks the views of young people on telemedicine and access to sexual health services. Although only 29% of respondents were willing to have a webcam consultation, such a service may benefit youth who may not otherwise access a sexual health service. The acceptability of webcam consultations may be increased if medical clinics provide clear and accessible privacy policies ensuring that consultations will not be recorded or saved.

Despite the best intentions: a reflection on low client numbers for a pilot telemedicine sexual health service

Young adults in Australia face barriers in accessing sexual health services, including concerns about confidentiality, cost, and limited choice of doctors.1–3 The Melbourne Sexual Health Centre (MSHC) therefore initiated a 1-year pilot of free telemedicine (telephone, computer-linked video) consultations for asymptomatic people under the age of 26 years in rural Victoria. Clients contacting the service could choose a video or telephone consultation with a sexual health nurse, then receive a mailed sexually transmitted infection (STI) home-testing kit. Clients posted their sample swabs to the laboratory and telephoned MSHC for their results. Those individuals testing positive for chlamydia were contacted by a dedicated nurse to arrange free treatment. The service was extensively advertised and high usage was expected. However, during the year-long pilot, there were only 28 clients (aged 14–25 years), none of whom had a video consultation. Evaluation of clients’ views by questionnaire ( n =18) and interview ( n =4) found that they reported being satisfied and that most viewed the service as better than an in-person consultation.4 Primary reasons reported for not having a video consultation were not owning a webcam, finding video too confronting, and the convenience and familiarly of the telephone. Given the high expectations of the service and client satisfaction, the low usage was puzzling. It was decided to interview key informants with the objective of contributing to the evidence base on establishing optimum rural sexual health services. Eight people designed and …

Young Mothers’ Experiences of Receiving the Baby Bonus: A Qualitative Study

ABSTRACT The year 2014 marked the abolition of the Baby Bonus and its replacement with a substantially reduced parenting payment. While often criticised as “middle-class welfare,” or publicly denounced due to its purported misuse by disadvantaged mothers, this paper argues that the Baby Bonus provided valuable financial assistance to families experiencing high financial stress. To investigate young womens experience of receiving the Baby Bonus, 19 semistructured interviews were conducted with young mothers in Melbourne who had recently had babies. Many were experiencing financial stress and this payment provided much needed financial support for the basic costs arising from having a baby. Several mothers perceived work as a luxury that was out of reach due to high childcare costs relative to their earning capacity and therefore saw Paid Parental Leave as a further privilege unavailable to them. Our results suggest that while the concerns of policymakers to achieve the best use of scarce resources are critical, it should also be acknowledged that the policy change may have serious implications for many young mothers and may exacerbate disadvantage, and young mothers’ sense of alienation, ultimately leading to greater inequalities.

Is there a role for practice nurses in increasing the uptake of the contraceptive implant in primary care?: survey of general practitioners and practice nurses.

BACKGROUND Uptake of long-acting reversible contraception (LARC) in Australia is low. With appropriate training, practice nurses (PNs) in general practice clinics could help increase LARC uptake. METHODS General practitioners (GPs) and PNs completed a postal survey to assess contraceptive implant knowledge and attitudes towards PNs providing contraception counselling and inserting the contraceptive implant. χ(2) tests were used to detect differences between GPs and PNs. Unadjusted odds ratios (OR) for the association between demographic characteristics and knowledge and attitudes towards the contraceptive implant were calculated for GPs and PNs separately. RESULTS Four hundred and sixty-eight GPs and 1142 PNs participated. GPs had greater knowledge about LARC than PNs (59% vs 33%; P<0.01). A similar proportion of GPs and PNs (70%) agreed that PNs could become involved in contraceptive counselling. Among GPs, urban-based GPs were less likely to agree that their clinic would be supportive of the PN inserting the implant (OR=0.6; 95% CI: 0.4-0.9). Among PNs, older PNs (OR=0.5; 95% CI: 0.4-0.7) were less likely to agree that the clinic would support PNs inserting the contraceptive implant, but those with Pap test training were more likely to agree (OR=2.1; 95% CI: 1.5-3.0). CONCLUSIONS This study found high levels of acceptability for PNs to provide contraceptive counselling and insertion of the contraceptive implant. Further research is needed to evaluate the impact of potential interventions that equip PNs with the skills to consult women about contraception and insert the contraceptive implant on LARC uptake.

Prescription rates of the contraceptive implant in Australia 2008–2012: impact of patient age and area of residence

UNLABELLED Background Long-acting reversible contraceptives are an effective means of preventing unwanted pregnancies and associated negative consequences. The Sexual Health and Family Planning Association of Australia has called for efforts to address barriers to the uptake of long-acting reversible contraceptives (LARCs) in Australia, where LARC uptake is thought to be low, though comprehensive data describing use and associated factors is scarce. The aims of this study were to describe patterns of prescriptions for the etonogestrel-releasing subdermal implant (SDI) in Australia, 2008-2012, and associated factors. METHODS Records of prescriptions written through Australias Pharmaceutical Benefits Scheme from 2008 to 2012 were obtained, including patient age and geographic location. Direct, age-standardised rates (ASR) of prescriptions were calculated for each year and location, with multivariate analysis used to examine associations between prescription rates and patient age, location and proximity to family planning clinics (FPC) or Aboriginal Medical Services (AMS). RESULTS ASR of prescriptions rose ~6% per year (OR 1.06, 95%CI: 1.05-1.06) from 13.05 per 1000 (2008) to 15.76 per 1000 (2012; P<0.01). Rates were highest among 15- to 19-year-olds, increasing from 20.81 (2008) to 29.09 per 1000 (2012: P<0.01) and lowest among 45- to 49-year-olds, increasing from 3.37 to 3.73 per 1000 (P<0.01). ASR by location were significantly higher in regional than metropolitan areas. CONCLUSIONS This is the first analysis of SDI prescriptions across all ages and regions of Australia. Uptake of SDI in Australia is increasing but remains low. Significant associations were found between prescription rates and patient age and residence in regional/remote areas.