Motherhood, health status, and health care

Gender and non-communicable diseases in Mexico: a political mapping and stakeholder analysis

BACKGROUND

Mexico and other low- and middle-income countries (LMICs) present a growing burden of non-communicable diseases (NCDs), with gender-differentiated risk factors and access to prevention, diagnosis and care. However, the political agenda in LMICs as it relates to health and gender is primarily focused on sexual and reproductive health rights and preventing violence against women. This research article analyses public policies related to gender and NCDs, identifying political challenges in the current response to women's health needs, and opportunities to promote interventions that recognize the role of gender in NCDs and NCD care in Mexico.

METHODS

We carried out a political mapping and stakeholder analysis during July-October of 2022, based on structured desk research and interviews with eighteen key stakeholders related to healthcare, gender and NCDs in Mexico. We used the PolicyMaker V5 software to identify obstacles and opportunities to promote interventions that recognize the role of gender in NCDs and NCD care, from the perspective of the political stakeholders interviewed.

RESULTS

We found as a political obstacle that policies and stakeholders addressing NCDs do not take a gender perspective, while policies and stakeholders addressing gender equality do not adequately consider NCDs. The gendered social and economic aspects of the NCD burden are not widely understood, and the multi-sectoral approach needed to address these aspects is lacking. Economic obstacles show that budget cuts exacerbated by the pandemic are a significant obstacle to social protection mechanisms to support those caring for people living with NCDs.

CONCLUSIONS

Moving towards an effective, equity-promoting health and social protection system requires the government to adopt an intersectoral, gender-based approach to the prevention and control of NCDs and the burden of NCD care. Despite significant resource constraints, policy innovation may be possible given the willingness among some stakeholders to collaborate, particularly in the labour and legal sectors. However, care will be needed to ensure the implementation of new policies has a positive impact on both gender equity and health outcomes. Research on successful approaches in other contexts can help to identify relevant learnings for Mexico.

Gender gap in annual preventive care services in France

BACKGROUND

In France, screening for cardiovascular risk factors is recommended during annual preventive visits. However, data are lacking on the temporal trend in women's uptake to preventive care services, and in cardiovascular and mortality outcomes. The aim of the study was to investigate the participation and mortality of women in annual preventive care services in a major preventive medicine center in France.

METHOD

Ee conducted repeated cross-sectional studies including a total of 366,270 individuals who had a first examination at the Centre d'Investigations Préventives et Cliniques, France, between January 1992 and December 2011.

FINDINGS

Women's participation was low below 50 years of age, then increases from 50 to 70 years, and is lower for women older than 70 years. The gap in female participation was more pronounced among individuals with high education, low social deprivation, and no depressive symptoms. Compared with the general population, the screened population had significantly lower standardized mortality ratios (SMRs) among both men and women, for all age ranges. Screened women aged 18-49 years showed a lower mortality gain compared with men of the same age; SMRs did not differ significantly by sex for individuals over 50 years.

INTERPRETATION

In this community-based sample, compared with men, women's participation to annual preventive care services was lower, and screened women had a lower mortality gain. Despite the demonstrated benefit of annual check-ups on health, there is a gender gap in adherence to preventive programs and in efficiency of screening programs, especially in the young age range. This gap in cardiovascular disease prevention may result in poorer cardiovascular health in women. Urgent adaptations to overcome this gender gap in preventive screening in France are warranted.

FUNDING

Bamba Gaye is supported by the Fondation Recherche Médicale grant.

Motherhood Health Penalty: Impact of Fertility on Physical and Mental Health of Chinese Women of Childbearing Age

Background

The negative consequences of childbearing on mothers are called the motherhood penalty, and it manifests in the aspects of women's physical and mental health. In May 2021, China relaxed its birth policy that allowed a married couple to have three children. It gives women the opportunity to have more children, but also may increase more risks to mothers' physical and mental health.

Objectives

The objectives of this study were to clarify the relationships between the fertility and the physical/mental health of women of childbearing age and empirically confirm the existence of the motherhood health penalty in China.

Materials and Methods

Using a nationally representative dataset from the China Labor-force Dynamics Survey 2018, we examined the effects of fertility on the physical and mental health of Chinese women of childbearing age. Physical health was self-rated, and mental health was assessed according to the Center for Epidemiological Studies Depression scale. The instrumental variable approach and the models of inverse probability of treatment weighting of propensity scores and regression adjustment were employed to overcome the endogeneity between fertility and health of women.

Results

The empirical results showed that the total number of births had significant adverse impacts on the physical and mental health of women of childbearing age, which empirically demonstrated the existence of the motherhood health penalty in China. The results of heterogeneity analysis indicated that the physical and mental health of the rural women was more easily affected by childbearing compared with that of the urban samples. In a mechanism analysis, the pathways of income and the multiple roles played by mothers were found to mediate the impacts of the total number of births on the physical and mental health of women. The robustness checks showed that the results of this study were robust.

Conclusions

The findings of this study extend the motherhood penalty to the health domain, and they have important implications for improving healthcare policy for women of childbearing age in China and other countries and regions and promoting gender equality in the healthcare field.

The impact of socioeconomic position (SEP) on women's health over the lifetime

The "social gradient of health" refers to the steep inverse associations between socioeconomic position (SEP) and the risk of premature mortality and morbidity. In many societies, due to cultural and structural factors, women and girls have reduced access to the socioeconomic resources that ensure good health and wellbeing when compared with their male counterparts. Thus, the objective of this paper is to review how SEP - a construct at the heart of the Social Determinants of Health (SDoH) theory - shapes the health and longevity of women and girls at all stages of the lifespan. Using literature identified from PubMed, Cochrane, CINAHL and EMBASE databases, we first describe the SDoH theory. We then use examples from each stage of the life course to demonstrate how SEP can differentially shape girls' and women's health outcomes compared with boys' and men's, as well as between sub-groups of girls and women when other axes of inequalities are considered, including ethnicity, race and residential setting. We also explore the key consideration of whether conventional SEP markers are appropriate for understanding the social determinants of women's health. We conclude by making key recommendations in the context of clinical, research and policy development.

Toxic Stress and Vulnerable Mothers: A Multilevel Framework of Stressors and Strengths

Toxic stress is associated with poor health outcomes that extend across the life span. Although caregivers can protect their children from toxic stress through supportive caregiving, this can be challenging for vulnerable mothers living in socioeconomically disadvantaged environments. We aim to advance the science of toxic stress prevention by exploring the stressors and strengths experienced by vulnerable mothers through application of a theoretical framework, Bronfenbrenner's bioecological model. Following Arksey and O'Malley's five-stage scoping study framework, 179 articles were included. Key information was abstracted and each article was reviewed for relevance to the bioecological model. Results revealed that the sources of stress and strength are multilayered, transactional, and have a complex influence on caregiving in families at risk of toxic stress. Future research should include empirical investigations of the complex relationships among these stressors and strengths, and the development of preventive interventions to support vulnerable families at risk of toxic stress.

Factors associated with depression among homeless mothers. Results of the ENFAMS survey

PURPOSE

Women are disproportionately likely to suffer from depression. This is especially true for those who experience socioeconomic hardship, such as homelessness. In France, among homeless mothers many are migrant. However, it is not clear whether risk factors associated with depression are specific for this group or the same as in the general population. Our objective was to describe socio-demographic, relational, living and housing conditions and health factors associated with depression among homeless mothers.

METHODS

The ENFAMS survey, conducted via face-to-face bilingual interviews with a representative sample of homeless families in the Paris region (January-May 2013, n = 733 mothers). Mothers reported their socio-demographic characteristics, housing conditions including residential mobility, as well as physical and mental health. Depression was ascertained using the Composite International Diagnostic Interview (CIDI). Factors associated with mother's depression were studied in weighted Poisson regression models with robust error variance.

RESULTS

The prevalence of depression among participating mothers was 28.8%. In multivariate analyses, depression was associated with fluency in French (PR = 1.88 95% CI 1.40; 2.51), suicide risk (PR = 2.26, 95% CI 1.82; 2.82), post-traumatic stress disorder (PR = 1.97, 95% CI 1.50; 2.60), and unmet health needs (PR = 1.68, 95% CI 1.09; 2.57).

CONCLUSIONS

Homeless mothers have high levels of depression and associated psychiatric comorbidities. Associated risk factors appear to be both specific for this group and shared with mothers in the general population. Improvements in the monitoring of mental health difficulties as well as access to appropriate medical care in this vulnerable population may help improve health and social outcomes.

Intra-group Stigma: Examining Peer Relationships Among Women in Recovery for Addictions

This grounded theory study explores how women with histories of addiction perceive stigma while in treatment. In-depth interviews were conducted with 30 women participating in a residential drug treatment center. Previous research has found that support from peers during recovery can be critical to managing illnesses. In fact, researchers have postulated that peers can be a more effective form of support than even family. This study extends existing literature indicating that peer support systems can be supportive, however they can also can be perceived as negative support that impose stigmas. Findings reveal that women perceive stigmas due to how various types of drug use violate societal expectations and conflict with notions of deservingness. Specifically, the "hard users" (i.e., women who use heroin or crack cocaine) perceive stigmas regarding how their drug use violates norms of womanhood. Moreover, the "soft users" (i.e., those who use alcohol or marijuana) perceive stigmas that their drug use is considered undeserving of support. This paper explores the factors that contribute to stigma amongst populations who potentially face marginalization from larger society. Implications for treatment and group work are discussed.

An ecological perspective on rural, low-income mothers' health

Using structural equation modeling, this study examined interactions among factors traditionally associated with health outcomes within a sample of rural low-income mothers. Prior research has established that education, employment, income, marital status, and health insurance coverage independently predict health outcomes. However, no studies have examined the simultaneous influence of these factors as conceptualized from an ecological systems perspective. Results indicate that when the multiple factors are considered simultaneously, different effects emerge. Implications are that the context in which these women live and the interactions between and among key influencing factors must be considered when addressing health challenges in rural areas.

A cross-sectional examination of the mental health of homeless mothers: does the relationship between mothering and mental health vary by duration of homelessness?

OBJECTIVES

This study draws on baseline data from the At Home/Chez Soi demonstration project to examine the association between parenting status and mental health among homeless women and whether the association varies by duration of homelessness.

SETTING

Structured interviews were conducted with participants in five cities across Canada including Moncton, Montreal, Toronto, Vancouver and Winnipeg.

PARTICIPANTS

Eligibility criteria included those with legal adult status, with a mental illness, and who lacked a regular, fixed shelter. All 713 women who participated in the larger project were selected for inclusion in this analysis.

MEASURES

The mental health conditions of interest include depression, post-traumatic stress disorder (PTSD), alcohol dependence and substance dependence.

RESULTS

The relationship between parenting status and depression, as well as PTSD, varied by duration of homelessness. Among women who had been homeless for less than 2 years, no relationship was found between parenting status and depression, or PTSD. However, among women who had been homeless for 2 or more years, the odds of depression was twice as high among parenting women compared with others (aOR=2.05, p≤0.05). A similar relationship was found between parenting status and PTSD (aOR=2.03, p≤0.05). The odds of substance dependence was found to be 2.62 times greater among parenting women compared with others and this relationship did not vary by duration of homelessness (aOR=2.62; 95% CI 1.86 to 3.69). No relationship was found between parenting and alcohol dependence.

CONCLUSIONS

Overall, the findings from this study suggest that there is a relationship between long-term homelessness and mothers' risk of poor mental health. Given the multiple demands mothers face, a failure to recognise their unique needs is likely to contribute to intergenerational legacies of homelessness and mental health problems.

TRIAL REGISTRATION NUMBER

World Health Organization's International Clinical Trials Registry Platform (ISRCTN66721740 and ISRCTN57595077).

Is there an association between maternal pap test use and adolescent human papillomavirus vaccination?

PURPOSE

To identify the association between mother's recent receipt of a Pap test and daughter's uptake and completion of the three-shot human papillomavirus (HPV) vaccination series.

METHODS

We used cross-sectional data from the 2008 to 2010 Behavioral Risk Factor Surveillance System from 9 U.S. states and Puerto Rico and logistic regression models to examine the association between mother's receipt of a Pap test in the past 3 years and daughter's uptake and completion of the three-shot HPV vaccination series among adolescent girls aged 9-17 years (N = 4,776).

RESULTS

Approximately one-quarter of adolescent girls began the HPV vaccination series, and 13.6% completed the three-shot series. Uptake and completion were more likely among girls whose mothers had obtained a Pap test within the past 3 years-for HPV uptake, odds ratio: 1.342, 95% confidence interval: 1.073-1.692; for HPV completion, odds ratio: 1.904; 95% confidence interval: 1.372-2.721-but the relationship between mother's recent Pap test and vaccine uptake was explained by the mother's use of a personal doctor and obtaining a routine physical examination in the past year.

CONCLUSIONS

HPV vaccination uptake and completion were more likely among adolescent girls whose mothers obtained a recent Pap test. Interventions designed to educate mothers on the importance of HPV vaccination and to facilitate relationships between physicians and mothers may prove successful at increasing HPV vaccination among adolescent girls.

Low-income Euro-American mothers' perceptions of health and self-care practices

OBJECTIVE

Health promotion activities may decrease preventable diseases and health system overuse. This study examined how low-income Euro-American mothers described their health/wellness, self-care practices (SCP), and SCP benefits, barriers, and interpersonal influences (norms, modeling, and social support) affecting their SCP.

DESIGN AND SAMPLE

This descriptive qualitative study used a convenience sample of 10 low-income, English-speaking mothers, 25-43 years old, seeking women's/children's health services at a large urban Texas health clinic.

MEASURES

Data were collected via face-to-face interviews, using a standardized semistructured interview guide; data were analyzed using Miles and Huberman's qualitative research methods.

RESULTS

All participants primarily described themselves positively and as mothers and workers. Most viewed health and wellness as distinct but typically included physical and emotional well-being. Mothers valued health and SCP for personal and family reasons. All identified SCP benefits. Most identified SCP barriers. Women viewed themselves as vital to family function and well-being, learned SCP primarily from parents during childhood, and described limited support for SCP.

CONCLUSIONS

The results provide a better understanding of participants' self-care decision making and are useful in designing appropriate clinical health promotions. Reducing health inequities in low-income women requires further study of the underlying causes and development of effective policies and measures to address them.

Social roles and alcohol consumption: a study of 10 industrialised countries

The empirical evidence as regards the precise associations between alcohol use and social roles, and these associations across genders and cultures is heterogeneous. The literature tends to focus on two central but conflicting theories. The first - classic role theory - assumes that a higher number of social roles is associated with a more structured life and thus fewer opportunities to drink heavily. The second - the multiple burden hypothesis - posits that the increasing complexity of multiple social roles leads to higher stress levels, and thus to increased alcohol use. Survey data on 25-54-year olds in 10 western industrialised countries which participate in the Gender, Alcohol and Culture: An International Study (GenACIS) project were used to test whether holding the three main social roles - partnership, parenthood, and paid labour - had a more protective or a more detrimental association with problematic alcohol use than holding fewer roles. Age and education were included as possible confounders, while the outcome variables were risky single occasion drinking (RSOD) and heavy-volume drinking. For both men and women and in almost all countries, the study found that those who had all three roles were least likely to drink heavily or engage in RSOD, thus supporting the assumptions of classic role theory. It also found that the protective effect of multiple roles was more consistent for RSOD. There were a few countries where a two-role model gave a better fit. Results for Germany (RSOD), Switzerland, and the Unites States (heavy-volume drinking) indicate that the role of paid labour appears to be particularly relevant for risky alcohol use among women. Despite some variability in the association between paid labour and heavy drinking or RSOD among women, in almost all countries the greater the number of roles a person held, the lower their risk of this type of alcohol use was.

The psychological health of sole mothers in Australia

OBJECTIVE

To determine the psychological wellbeing of sole mothers in Australia.

DESIGN

Cross-sectional analyses of survey data from The Australian Longitudinal Study on Women's Health.

PARTICIPANTS

9689 younger women (aged 22-27 years) surveyed in 2000 and 12 338 mid-age women (aged 47-52 years) surveyed in 1998.

MAIN OUTCOME MEASURES

Demographic characteristics and economic status; prevalence of suicidal thoughts, self-harm, and psychoactive medication use; depression (Center for Epidemiologic Studies Depression Scale) and psychological health (the Mental Health Component Score of the Medical Outcome Short Form Health Survey [SF-36]).

RESULTS

Among the younger women, sole mothers were more likely than other women to have experienced suicidal thoughts (odds ratio [OR], 2.18; 95% CI, 1.45-3.27) and self-harm (OR, 3.25; 95% CI, 1.97-5.38). Among the younger and mid-age women, sole mothers were the group most likely to have used medication for depression (ORs, 2.75 [95% CI, 1.76-4.30] and 2.29 [95% CI, 1.56-3.37], respectively). They were more than twice as likely to have experienced depression, and had significantly poorer psychological health (P < 0.001). After adjusting for economic status, only depression and psychological health remained significantly associated with sole motherhood, and the strength of these relationships was reduced.

CONCLUSIONS

Economic status partly accounts for the relatively poorer psychological health of sole mothers. Sole mothers are more likely than other women to experience debilitating psychological health problems.

Social transfers and the health status of mothers in Norway and Canada

The unconditional health status of lone mothers is worse than that of married mothers in Canada but not in Norway. Even controlling for demographic characteristics and health behaviours in Canada, the health status of lone mothers is worse. Only after we control for income does the differential in health status between married and lone mothers in Canada disappear. An important difference between the countries is that lone mothers are much less likely to be poor in Norway because they receive more generous social transfers. A simulation which involves 'giving Canadian mothers Norwegian transfers,' illustrates the possibility of significant gains in socioeconomic status and health of poor mothers in Canada.

An integrative review of separation in the context of victimization: consequences and implications for women

Given the number of divorces that occur each year as well as the high rates of intimate partner violence, it is critical that divorce/separation and victimization be considered in research and in clinical practice with women. However, the separation/divorce research and victimization research has often been conducted independently, with limited attention to integration. The integration of these two domains is critically important in facilitating the understanding of these issues for women. This article has 5 main purposes: (a) to review the research on the general consequences of separation; (b) to review the research on the consequences of separation when children are involved; (c) to review the research on the consequences of victimization; (d) to integrate the separation and victimization research to examine separation in the context of victimization; and (e) to discuss the implications of separation in the context of victimization for practice and research.

Joy to the world! A (healthy) child is born! Reconceptualizing 'harm' in wrongful conception

The wrongful conception action holds both a troubled past and future. As a response to rapid technological advancement in the area of reproduction, this action has introduced complex legal and ethical issues in the courts' efforts to respond to the question: 'Can parenthood ever constitute an injury?' At the heart of this dilemma lies the manner by which both law and society conceptualize 'harm'--is this 'part of the normal vicissitudes of life' or a harmful event? But this question is not decided within a legal vacuum and public policy factors have deeply influenced the nature and existence of case law in this field. In the context of the controversial cases of McFarlane v Tayside Health Board [2000] and Rees v Darlington Memorial Hospital [2002], this article critically examines how 'harm' is judicially characterized and explores the various tensions emerging from conflicting harm constructs. In arguing that the courts must seek to find a balanced approach between public policy concerns and reproductive autonomy, this article will present a fresh theoretical perspective to the conceptualization of harm based on autonomy as the central organizing principle.

A reexamination of smoking before, during, and after pregnancy

OBJECTIVES

This study examined the patterns and correlates of maternal smoking before, during, and after pregnancy.

METHODS

We examined socioeconomic, demographic, and clinical risk factors associated with maternal smoking in a nationally representative cohort of women (n = 8285) who were surveyed 17 +/- 5 months and again 35 +/- 5 months after delivery.

RESULTS

Smoking rates among women with a college degree decreased 30% from before pregnancy to 35 months postpartum but did not change among the least educated women. Risk factors clustered, and a gradient linked the number of risk factors (0, 2, 4) to the percentage smoking (6%, 31%, 58%, P <.0001).

CONCLUSIONS

The period of pregnancy and early parenthood is associated with worsening education-related disparities in smoking as well as substantial clustering of risk factors. These observations could influence the targeting and design of maternal smoking interventions.