The health care system as a social determinant of health: qualitative insights from South Australian maternity consumers

Health systems and policies are important determinants of health because they influence the type and quality of health care available to a population. This study included semi-structured qualitative interviews and a questionnaire to collect demographic data and household details for a purposeful sample of 38 mothers and 24 fathers from four socioeconomic areas of metropolitan South Australia who had at least one child aged between 1 and 6 years of age. The participants reported that birth experiences within the predominantly medicalised maternity system were at odds with the expectations of a significant proportion of contemporary consumers that maternity care will leave them not only with a healthy mother and baby, but also with no undue adverse impacts on their physical, mental and relationship health. There appears to be no formal mechanism in place for regular consumer feedback of experiences into system and service planning

Demographic fertility research: a question of disciplinary beliefs and methods

This is a post-peer-review, pre-copy edited version of an extract/chapter published in Religion, spirituality and the social sciences: Challenging marginalisation. Details of the definitive published version and how to purchase it are available online at: http://www.policypress.co.uk/Bristol, U

Why planned attended homebirth should be more widely supported in Australia

This article argues that the continuing reluctance on the part of professional and bureaucratic bodies in Australia to provide for and support planned attended homebirth for low-risk women is unfounded according to the research evidence. It also suggests that such lack of support might be encouraging some planned but intentionally unattended homebirths to occur in Australia, particularly as in recent years there appears to have been an increase in popularity in freebirth (or do-it-yourself homebirth). The article calls for RANZCOG and Australian state health departments to support planned attended homebirth for low-risk women in the face of what is now a considerable amount of evidence showing its safety, when compared with unplanned homebirth and hospital birth. The article raises a number of challenging issues for obstetricians, midwives and managers or planners of maternity services

Maternity care: a human rights issue?

All women need the ability to access midwifery-led care at the primary or first level of care, enabling them to have control over, and decide freely and responsibly about, their reproductive health. In establishing women’s control of their own reproductive health, there is likely to be a reduction in reliance on unnecessary interventions in birth. The choices of maternity care provided in Australia are at present discriminatory. On the pretence of fundinglimitations, community based midwifery-led models of care are not widely available. Such options are limited to so called ‘alternative birthing’ arrangements for a limited number of women, mainly in low socio-economic groups or ‘at risk’ groups such as teenagers and Aboriginal women. Whilst the increased mortality and morbidity rates, and poor social circumstances, of women in these groups clearly demonstrate their need for better care, these women may be further marginalised by being identified as needing special attention. Furthermore, we argue that a strategic reallocation of present funding from mainstream medicalised care would enable all women to access midwifery-led models of care, which are not only generally more cost effective than standard care but importantly offer them the option of choosing one-to-one midwifery (Maternity Coalition 2002). Until Australian governments stop limiting the real maternity care choices available to women, and make a political commitment to provide care based on consumer needs, rather than health professionals’ preferences, Australian women will not be able to exercise their fundamental human right to decide freely on matters related to their reproductive health, for these decisions are currently strongly constrained by what governments are prepared or encouraged to provide

Critical social determinants of childbirth outcomes in remote mountains: Voices of women from Nepal

Objectives: Despite efforts made by the Government of Nepal to reduce maternal and newborn mortality nationally, the rate is still significantly higher in remote mountain areas. This research aimed to fill a gap by asking women about socio-cultural factors influencing childbirth outcomes in remote mountain areas of Nepal. Methods: This study used a qualitative approach guided by the principles of social constructionist and feminist critical theories to derive factors influencing women’s experiences of giving birth and childbirth outcomes. In-depth interviews were conducted with 25 pregnant and postnatal women. A thematic approach was used for data analysis. Results: Childbirth outcomes in remote areas are influenced by the broader social determinants; specifically, physical access to hospital services; remoteness, poverty, and food insecurity; and disconnect between policy, practice, and reality. Conclusions: Women’s voices highlight the influence of critical determinants in determining childbirth outcomes, a situation which requires an immediate policy shift to a social determinants approach to improve maternal and newborn survival rates

A framework to research the social determinants of ICTs for e-health

This article discusses the challenges of combining significantly different methodological approaches to investigate citizens' access to e-health. We define the term access beyond broadband connectivity (material access), to also include motivation, skills and different type of usages, which in e-health ranges from accessing online healthcare information, services and clinical treatment, to self-support. Around the globe, e-health has continued to expand with the expectations that it will both reduce healthcare expenditure and improve quality and access to healthcare for all citizens. However, emerging evidence suggests that, if not managed carefully, e-health will further exacerbate health inequities because those with poorer health are often those with lower or no information and communication (ICT) use

Use of mobile phones as a vehicle to increase internet use to improve health and wellbeing in South Australia

A report on research conducted under the Health in All Policies Health Lens Initiative for the Department of Health South Australia and the Department of Further Education, Employment, Science & TechnologyThis report is written to help inform policy directions to achieve the Broadband Usage target in the South Australian Strategic Plan while supporting improved population health under the SA Government’s Health In All Policies program. This report details potential solutions to increase broadband use via mobile phones for lower-income and socioeconomically disadvantaged South Australians. Solutions were suggested in late 2009 by 30 Adelaide residents in three focus groups (age range 25 to 55). Additional solutions come from an associated project in late 2008 with 55 Adelaide residents on general digital technology use, and from a literature scan in late 2009 of solutions to increase mobile internet use elsewhere in the world, particularly for lower-income and socioeconomically disadvantaged groups

Maternity Coalition: Australia's national maternity consumer advocacy organization

This chapter tells the story of the Maternity Coalition (MC), an Australian advocacy organization which represents an often ‘forgotten’ strand of the women’s movement — the maternalist feminist emphasis on reclaiming women’s rights in birth and breastfeeding. Having originated in the late 1980s to lobby state government inquiries for improved maternity services in the Australian states of New South Wales and Victoria, by 2008 the organization was established nationally and was acknowledged as a key stakeholder in the incoming federal government’s agenda for improving maternity care. This chapter first examines how the Maternity Coalition developed, its rationale and mothering discourse, and then considers challenges which the organization faces in the early 21st century. Developing from a state-based to a national organization, MC faces internal sustainability difficulties in terms of communicating and managing a voluntary organization mostly comprised of busy young mothers. The external challenges are also considerable—MC aims to change the entrenched system of maternity services but in a cultural context which values technology and professional expertise and a political economic context in which the medical profession holds significant power. Nonetheless, Australia’s Maternity Coalition has achieved a national profile and credibility, bringing women’s rights to options and optimal care in birth to public attention at a level not achieved in many comparable countries

Environmental history of the Willunga Basin 1830s to 1990s

Environmental History is a relatively new field of study which seeks to establish historic trends relative to environmental change and to use the insight gained to assist future management. As yet there are few such Australian studies on a detailed regional basis. The Willunga Basin is an important region within South Australia in physical, economic and social terms, but it currently experiences a variety of environmental problems, including a minimal amount of native vegetation, winter flooding and gully erosion. It was perceived that these problems could benefit from some knowledge of the area's environmental history. Therefore , using a range of sources and methods, historical trends were established in the key aspects of rainfall, surface and groundwater drainage, gully erosion, vegetation , population, settlement and land use, and these trends were t hen compiled to provide this Environmental History of the Willunga Basin from t he 1830s to the 1990s. It was ascertained that the Willunga Basin environment had changed significantly in some respects since -the first Europeans moved into the area in the 1830s. The nature, timing and magnitude of various changes were compared to provide some explanation of the contemporary environmental problems. These were found to have resulted from both human and non- human forces. Although one significant non-human change was a long-term decline in average annual rainfall over the 155 years from 1839 to 1993, European land use activities introduced since settlement in 1840 had often combined with natural processes and events to produce change. Extensive and intensive land use changes had made the environment more susceptible to change or had accelerated natural change in a particular direction.Thesis (B.A.(Hons.)) -- University of Adelaide, Dept. of Geography, 199