National review of maternity services 2008: women influencing change

<p>Abstract</p> <p>Background</p> <p>In 2009 the Australian government announced a major program of reform with the move to primary maternity care. The reform agenda represents a dramatic change to maternity care provision in a society that has embraced technology across all aspects of life including childbirth.</p> <p>Methods</p> <p>A critical discourse analysis of selected submissions in the consultation process to the national review of maternity services 2008 was undertaken to identify the contributions of individual women, consumer groups and organisations representing the interests of women.</p> <p>Results</p> <p>Findings from this critical discourse analysis revealed extensive similarities between the discourses identified in the submissions with the direction of the 2009 proposed primary maternity care reform agenda. The rise of consumer influence in maternity care policy reflects a changing of the guard as doctors' traditional authority is questioned by strong consumer organisations and informed consumers.</p> <p>Conclusions</p> <p>Unified consumer influence advocating a move away from obstetric -led maternity care for all pregnant women appears to be synergistic with the ethos of corporate governance and a neoliberal approach to maternity service policy. The silent voice of one consumer group (women happy with their obstetric-led care) in the consultation process has inadvertently contributed to a consensus of opinion in support of the reforms in the absence of the counter viewpoint.</p

The fertility and menopause related information needs of younger women with a diagnosis of breast cancer: A qualitative study

The use of chemotherapy and endocrine therapies in the treatment of pre-menopausal women carries with it reproductive and gynaecological implications which younger women may find both unpleasant and discordant with plans for childbearing. This study aims to investigate the fertility- and menopause-related information needs of younger women with a diagnosis of early breast cancer. A retrospective qualitative methodology was chosen. Twenty-four women aged between 26 and 45 years at diagnosis participated in focus group interviews and telephone interviews. Many women thought that the information they had received in the past about fertility and menopausal symptoms was either insufficient or unavailable. Some women felt that, while information on fertility and menopause issues had not been paramount at the time of diagnosis, it became increasingly important after diagnosis. Participants spoke about the need to revisit or review fertility- and menopause-related information with their doctors during the course of treatment. Many women believed that information about fertility should be given prior to or during treatment decision-making, and that information related to the management of menopausal symptoms should be delivered during or after treatment when menopausal symptoms begin. Consultation with a fertility and/or menopause specialist-rated as the most preferred mode of receiving fertility- and menopause-related information. Clinical implications are drawn from the results of this study to assist clinicians and researchers to improve their communication with younger patients about the fertility- and menopause-related side effects of breast cancer treatment. Copyright © 2003 John Wiley & Sons, Ltd

Preventing abuse in accommodation services: from procedural responses to protective cultures

This article reviews current approaches of disability accommodation services to addressing the abuse and neglect of people with intellectual disability who live in them.We review international literature and provide practice examples from accommodation services for people with intellectual disability in Australia to develop a framework of current research, policy and practice in this area. The results of this review show that dominant policy and practice approaches do not give adequate consideration to the prevention and protection of people from harm, focusing primarily on responding to individual instances of maltreatment. Managerial, compliance-based systems may be deflecting attention from recognizing and responding more effectively to abuse and neglect at individual, systemic and structural levels. The current dominant approach fails to develop a culture of prevention and protection for people with intellectual disability. Further, somesystemic and structural preconditions are setwhich make abuse and neglect less likely to be prevented