Elizabeth Hoban

Contentious issues in research on trafficked women working in the sex industry: Study design, ethics, and methodology

The trafficking of women and children for work in the globalized sex industry is a global social problem. Quality data is needed to provide a basis for legislation, policy, and programs, but first, numerous research design, ethical, and methodological problems must be addressed. Research design issues in studying women trafficked for sex work (WTSW) include how to (a) develop coalitions to fund and support research, (b) maintain a critical stance on prostitution, and therefore WTSW, (c) use multiple paradigms and methods to accurately reflect WTSWs reality, (d) present the purpose of the study, and (e) protect respondents’ identities. Ethical issues include (a) complications with informed consent procedures, (b) problematic access to WTSW, (c) loss of WTSW to follow‐up, (d) inability to intervene in illegal acts or human rights violations, and (e) the need to maintain trustworthiness as researchers. Methodological issues include (a) constructing representative samples, (b) managing media interest, and (c) handling incriminating materials about law enforcement and immigration.

Excess gestational weight gain: an exploration of midwives' views and practice

BackgroundExcess gestational weight gain (GWG) can affect the immediate and long term health outcomes of mother and infant. Understanding health providers’ views, attitudes and practices around GWG is crucial to assist in the development of practical, time efficient and cost effective ways of supporting health providers to promote healthy GWGs. This study aimed to explore midwives’ views, attitudes and approaches to the assessment, management and promotion of healthy GWG and to investigate their views on optimal interventions.MethodsMidwives working in antenatal care were recruited from one rural and one urban Australian maternity hospital employing purposive sampling strategies to assess a range of practice areas. Face-to-face interviews were conducted with 15 experienced midwives using an interview guide and all interviews were digitally recorded, transcribed verbatim and analysed thematically.ResultsMidwives interviewed exhibited a range of views, attitudes and practices related to GWG. Three dominant themes emerged. Overall GWG was given low priority for midwives working in the antenatal care service in both hospitals. In addition, the midwives were deeply concerned for the physical and psychological health of pregnant women and worried about perceived negative impacts of discussion about weight and related interventions with women. Finally, the midwives saw themselves as central in providing lifestyle behaviour education to pregnant women and identified opportunities for support to promote healthy GWG.ConclusionsThe findings indicate that planning and implementation of healthy GWG interventions are likely to be challenging because the factors impacting on midwives’ engagement in the GWG arena are varied and complex. This study provides insights for guideline and intervention development for the promotion of healthy GWG.

Cervical cancer services for Indigenous women: advocacy, community-based research and policy change in Australia.

SUMMARY Collaborative research undertaken in the state of Queensland, Australia, resulted in major changes in cervical cancer screening and treatment for Indigenous women. Guided by an Indigenous statewide reference group and with an Indigenous researcher playing a lead role, qualitative data were collected using interviews, focus groups, and larger community meetings; and case studies were conducted with health workers and community members from diverse rural, remote and urban communities, to explore the different cultural and structural factors affecting understanding and awareness of cervical cancer and Indigenous womens use of and access to health services for screening, diagnosis and treatment. These data were supplemented by an analysis of clinical data and health service checklists. We discuss the methodology and summarize the key social and structural factors that discourage women from presenting for screening or returning for follow-up. These include womens misunderstanding of cervical cancer screening, fear of cancer, distrust of health services, poor recall and follow-up systems, and the economic and social burden to women presenting for treatment. We describe how the research process and subsequent activities provided Indigenous women with a vehicle for their own advocacy, resulting in important policy and program changes.

Cambodian migrant women's postpartum experiences in Victoria, Australia.

OBJECTIVE to explore the postpartum experiences of Cambodian born migrant women who gave birth for the first time in Victoria, Australia between 2000 and 2010. DESIGN an ethnographic study with 35 women using semi-structured and unstructured interviews and participant observation; this paper draws on interviews with 20 women who fit the criteria of first time mothers who gave birth in an Australian public hospital. SETTING the City of Greater Dandenong, Victoria Australia. PARTICIPANTS twenty Cambodian born migrant women aged 23-30 years who gave birth for the first time in a public hospital in Victoria, Australia. FINDINGS after one or two home visits by midwives in the first 10 day postpartum women did not see a health professional until 4-6 weeks postpartum when they presented to the MCH centre. Women were home alone, experienced loneliness and anxiety and struggled with breast feeding and infant care while they attempted to follow traditional Khmer postpartum practices. IMPLICATIONS FOR PRACTICE results of this study indicate that Cambodian migrant women who are first time mothers in a new country with no female kin support in the postpartum period experience significant emotional stress, loneliness and social isolation and are at risk of developing postnatal depression. These women would benefit from the introduction of a midwife-led model of care, from antenatal through to postpartum, where midwives provide high-intensity home visits, supported by interpreters, and when required refer women to professionals and community services such as Healthy Mothers Healthy Babies (Victoria Department of Health, 2011) for up to 6 weeks postpartum.

Structural Vulnerability, Disability, and Access to Nongovernmental Organization Services in Rural Cambodia

Despite the recognition that people with disability are among the poorest and most marginalized, breaking the disability–poverty cycle has proven challenging. Although UN agencies, most donors, and nongovernmental organizations have disability and development policies, many programs perpetuate disability-based discrimination. Little research examines why such programs fail to achieve sustained livelihood improvement for people with disability. Findings from this study that explored the experience of disability in Cambodia suggest that programs must explicitly address social and cultural norms and power relations. Recommendations for inclusive practice are presented. Listening to the voices of people with disability is the crucial first step.

Unsafe Abortion as a Birth Control Method Maternal Mortality Risks Among Unmarried Cambodian Migrant Women on the Thai-Cambodia Border

Reproductive health research and policies in Cambodia focus on safe motherhood programs particularly for married women, ignoring comprehensive fertility regulation programs for unmarried migrant women of reproductive age. Maternal mortality risks arising due to unsafe abortion methods practiced by unmarried Cambodian women, across the Thai-Cambodia border, can be considered as a public health emergency. Since Thailand has restrictive abortion laws, Cambodian migrant women who have irregular migration status in Thailand experimented with unsafe abortion methods that allowed them to terminate their pregnancies surreptitiously. Unmarried migrant women choose abortion as a preferred birth control method seeking repeat “unsafe” abortions instead of preventing conception. Drawing on the data collected through surveys, in-depth interviews, and document analysis in Chup Commune (pseudonym), Phnom Penh, and Bangkok, the authors describe the public health dimensions of maternal mortality risks faced by unmarried Cambodian migrant women due to various unsafe abortion methods employed as birth control methods.

The inter-section of political history and health policy in Asia--the historical foundations for health policy analysis.

One of the challenges for health reform in Asia is the diverse set of socio-economic and political structures, and the related variability in the direction and pace of health systems and policy reform. This paper aims to make comparative observations and analysis of health policy reform in the context of historical change, and considers the implications of these findings for the practice of health policy analysis. We adopt an ecological model for analysis of policy development, whereby health systems are considered as dynamic social constructs shaped by changing political and social conditions. Utilizing historical, social scientific and health literature, timelines of health and history for five countries (Cambodia, Myanmar, Mongolia, North Korea and Timor Leste) are mapped over a 30-50 year period. The case studies compare and contrast key turning points in political and health policy history, and examines the manner in which these turning points sets the scene for the acting out of longer term health policy formation, particularly with regard to the managerial domains of health policy making. Findings illustrate that the direction of health policy reform is shaped by the character of political reform, with countries in the region being at variable stages of transition from monolithic and centralized administrations, towards more complex management arrangements characterized by a diversity of health providers, constituency interest and financing sources. The pace of reform is driven by a countrys institutional capability to withstand and manage transition shocks of post conflict rehabilitation and emergence of liberal economic reforms in an altered governance context. These findings demonstrate that health policy analysis needs to be informed by a deeper understanding and questioning of the historical trajectory and political stance that sets the stage for the acting out of health policy formation, in order that health systems function optimally along their own historical pathways.

Rural Women’s Experience of Living and Giving Birth in Relief Camps in Pakistan

Background: Women are more vulnerable than men in the same natural disaster setting. Preexisting gender inequality, socio-cultural community dynamics and poverty puts women at significant risk of mortality. Pregnant women are particularly vulnerable because of their limited or no access to prenatal and obstetric care during any disaster or humanitarian emergency setting. Methods: In-depth interviews were conducted with 15 women who gave birth during the 2011 floods in Sindh Province, Pakistan. Thematic analysis explored women’s experiences of pregnancy and giving birth in natural disaster settings, the challenges they faced at this time and strategies they employed to cope with them. Results: Women were not afforded any control over decisions about their health and safety during the floods. Decisions about the family’s relocation prior to and during the floods were made by male kin and women made no contribution to that decision making process. There were no skilled birth attendants, ambulances, birthing or breastfeeding stations and postnatal care for women in the relief camps. Women sought the assistance of the traditional birth attendants when they gave birth in unhygienic conditions in the camps. Conclusion: The absence of skilled birth attendants and a clean physical space for childbirth put women and their newborn infants at risk of mortality. A clean physical space or birthing station with essential obstetric supplies managed by skilled birth attendants or community health workers can significantly reduce the risks of maternal morbidity and mortality in crisis situations.

Infant feeding intentions among first time pregnant women in urban Melbourne, Australia

OBJECTIVE to identify first time pregnant womens infant feeding intentions for the first 2 years of life. DESIGN a qualitative phenomenological approach was used, with semi-structured interviews as the primary method of data collection. SETTING two of Eastern Healths antenatal clinics in the outer east region of Melbourne, Australia. PARTICIPANTS seven first time pregnant women from an Eastern Health antenatal clinic. MAIN OUTCOME MEASURE womens infant feeding intention for the first 2 years of life. MAIN FINDINGS all the participants intend to breast feed their infant for around 6 months. Women rely heavily on information about infant feeding options from friends, books and the internet, as the information provided by health professionals was found to be inadequate, acquired late in the pregnancy and difficult to access. KEY CONCLUSIONS the information women receive from midwives at antenatal appointments and parenting classes about infant feeding options is inadequate, as women are not satisfied with the timing, amount and usefulness of the information they receive. IMPLICATIONS FOR PRACTICE in order to see an increase in the rate of breast feeding it is imperative to create supportive environments for women to breast feed, and for midwives and health professionals to provide information and continued support for women in both the pre- and postnatal period.

'Locked in space': Rurality and the politics of location

Despite rapid urbanisation, developing countries are predominantly rural, with more than 55 per cent of the world’s population living in rural areas (IFAD 2011: 3). At least 70 per cent of the world’s very poor people—that is, those living on less than US