Personal Attitudes or Structural Factors? A Contextual Analysis of Breastfeeding Duration

Feeding Behaviors in Infants and Toddlers Later Diagnosed with Autism Spectrum Disorder: A Systematic Review

Children with autism spectrum disorder (ASD) are five times more likely to have feeding difficulties than neurotypical peers, although the majority of evidence describes feeding difficulty in children age 2 years and older. The purpose of this study is to systematically review the literature on feeding characteristics of children age 0-24 months who were later diagnosed with ASD with an emphasis on the measurement tools used to assess these feeding behaviors. We conducted a systematic review of the literature using PRISMA guidelines. Using selected keywords, a search was conducted using PubMed, PsycINFO, and CINAHL databases for relevant articles to identify feeding characteristics in infants and toddlers (age 0-24 months) later diagnosed with ASD. Sixteen studies were selected for this review by two independent reviewers. Among the selected studies, feeding difficulties were reported in all infant oral feeding modalities (breastfeeding, bottle feeding, and complementary feeding) by infants later diagnosed with ASD. However, the evidence was conflicting among studies regarding feeding characteristics, such as sucking differences while breastfeeding, use of the spoon with feedings, and preference of solid food texture, that presented in infants later diagnosed with ASD. A lack of consistent measurement of feeding behaviors in infants later diagnosed with ASD contributes to the difficulty in comparison across studies. Future research should focus on developing targeted, validated instruments for measuring feeding difficulty in this population with emphasis on breastfeeding and bottle feeding difficulty.

A Study on User-Oriented Subjects of Child Abuse on Wikipedia: Temporal Analysis of Wikipedia History Versions and Traffic Data

BACKGROUND

Many people turn to online open encyclopedias such as Wikipedia to seek knowledge about child abuse. However, the information available on this website is often disorganized and incomplete.

OBJECTIVE

The aim of this study is to analyze Wikipedia's coverage of child abuse and provide a more accessible way for users to browse child abuse-related content. The study explored the main themes and subjects related to child abuse on Wikipedia and proposed a multilayer user-oriented subject schema from the general users' perspective.

METHODS

The knowledge of child abuse on Wikipedia is presented in the child abuse-related articles on it. The study analyzed child abuse-related articles on Wikipedia, examining their history versions and yearly page views data to reveal the evolution of content and popularity. The themes and subjects were identified from the articles' text using the open coding, self-organizing map, and n-gram approaches. The subjects in different periods were compared to reveal changes in content.

RESULTS

This study collected and investigated 241 associated Wikipedia articles and their history versions and traffic data. Four facets were identified: (1) maltreatment behavior (n=118, 48.9%); (2) people and environment (n=28, 11.6%); (3) problems and risks (n=33, 13.7%); and (4) protection and support (n=62, 25.7%). A total of 8 themes and 51 subjects were generated from the text, and a user-oriented subject schema linking the facets, themes, subjects, and articles was created. Maltreatment behavior (number of total views = 1.15 × 10⁸) was the most popular facet viewed by users, while people and environment (number of total views = 2.42 × 10⁷) was the least popular. The popularity of child abuse increased from 2010 to 2014 but decreased after that.

CONCLUSIONS

The user-oriented subject schema provides an easier way for users to seek information and learn about child abuse. The knowledge of child abuse on Wikipedia covers the harms done to children, the problems caused by child abuse, the protection of children, and the people involved in child abuse. However, there was an inconsistency between the interests of general users and Wikipedia editors, and the child abuse knowledge on Wikipedia was found to be deficient, lacking content about typical child abuse types. To meet users' needs, health information creators need to generate more information to fill the knowledge gap.

The role of emotions and injunctive norms in breastfeeding: a systematic review and meta-analysis

Breastfeeding has many known benefits, but rates vary globally. We propose two main reasons why psychological theory and interventions have not been successful to date in explaining breastfeeding behaviours. Specifically, prior research underestimates the importance of (1) specific emotions and (2) wider injunctive influences (i.e., societal and moral norms about what women feel they ought to be doing) in the breastfeeding experience. Therefore, we conducted a systematic review of quantitative, qualitative, and mixed-methods studies that explored whether injunctive norms and/ or specific emotions are associated with breastfeeding behaviours (i.e., intentions, initiation and duration). Seventy-two papers were included in this review; data were extracted and quality appraisals conducted for all included studies. A meta-analysis of effect sizes was performed with the quantitative data. A convergent qualitative synthesis of the data was conducted, resulting in the following line of argument: Breastfeeding is a social behaviour and not a personal/individual behaviour. From this line of argument, three themes with associated sub-themes were developed, highlighting the importance of both specific emotions and injunctive norms on breastfeeding behaviours. These influences are discussed in relation to both theoretical and practical implications, as well as future research.

Mothers' Attachment Style as a Predictor of Breastfeeding and Room-Sharing Practices

OBJECTIVE

To prospectively assess breastfeeding and room-sharing practices during the infant's first 6 months and investigate whether mothers' own adult attachment style predicts the initiation and course of these recommended parenting behaviors.

METHOD

This study included 193 mother-infant dyads living in the Netherlands. Diary methodology was used to generate 27 weekly measures of breastfeeding and room-sharing during the infant's first 6 months. Multilevel mixed effects models were used to examine trajectories of breastfeeding and room-sharing and to test whether mothers' own adult attachment style predicted the initiation and course of these behaviors, adjusting for covariates.

RESULTS

Most (86%) mothers initiated breastfeeding immediately after birth and the rates of breastfeeding declined steadily over the 6 months (b = -2.47, SE = 0.19, p < .001). Mothers with higher attachment avoidance showed faster decreases in breastfeeding than less avoidant mothers (b = -1.07, SE = 0.21, p < .001). Sixty-four percent of mothers engaged in room-sharing after birth which also decreased steadily over the 6 months (b = -3.51, SE = 0.21, p < .001). Mothers' attachment style did not predict the initiation or course of room-sharing.

CONCLUSIONS

Given the major implications of breastfeeding and room-sharing for infants' health, safety, and development, the pediatrics community has issued clear guidelines encouraging these behaviors. Yet many new parents do not adhere to the recommended practices. This study identifies mothers' adult attachment style as a predictor of breastfeeding over time that could be incorporated into interventions for parents.

From initiation to cessation: Turning points and coping resources in the breastfeeding experience of first-time mothers

While most mothers initiate breastfeeding, many do not continue for recommended durations. This study aimed to understand the gap between breastfeeding initiation and duration through an in-depth exploration of first-time mothers' breastfeeding experiences. Contextual factors that may facilitate or deter breastfeeding maintenance were explored by identifying common turning points (significant events or periods promoting a change in thoughts/behaviors or facilitating maintenance) described by mothers with varied breastfeeding durations. In semistructured interviews conducted from March to June 2015, twenty-eight first-time mothers in Iowa were asked to describe their breastfeeding experiences from initiation through cessation. Using thematic analysis, seven turning points, consistent across varied durations and experiences were identified: breastfeeding problems, the unknowns, recurring stressors, living new life with baby, reentering social roles, special occasions, and letting go. Turning points were usually associated with stressful situations, and mothers described intrapersonal (e.g., determination) and interpersonal (e.g., social support) coping resources as facilitators of breastfeeding maintenance. These findings highlight contextual factors that may trigger turning points, representing critical intervention periods, and the importance of enhancing support networks. Interventions to facilitate longer breastfeeding durations should consider key turning points and availability of coping resources to determine strategies that best fit the mother at each point.

Reasons for Stopping Exclusive Breastfeeding Between Three and Six Months: A Qualitative Study

PURPOSE

Scant published qualitative literature exists focusing on why exclusive breastfeeding rates decline between three and six months. This study aims to develop an understanding of why exclusive breastfeeding tails off so dramatically between three and six months after birth in New Zealand.

DESIGN AND METHODS

A generic qualitative methodology was employed in this study and social constructionism selected as the main epistemological framework underpinning the research. This study was carried out between September 2013 and July 2014, involving face-to-face interviews with 30 women who were characterised as highly motivated to complete six months exclusive breastfeeding prior to the birth of their child. In order to gain an in-depth understanding of the research material, thematic analysis of the interview transcripts was completed using manual coding techniques.

RESULTS

After thematic analysis of the data four key themes were identified: 1) The good employee/good mother dilemma. 2) Breastfeeding is lovely, but six months exclusively is demanding. 3) Exclusive breastfeeding recommendations should be individualised. 4) Introducing solids early as a cultural practice.

CONCLUSIONS

Most studies have linked barriers to six months exclusive breastfeeding to difficulties within the mother-infant dyad, as well as negative maternal socioeconomic and socio-demographic characteristics. However, this study has shown that the maintenance of six months exclusive breastfeeding is also challenging for this group of mothers who were socially advantaged, well-educated and highly motivated to breastfeed their babies exclusively for six months.

Maternity Leave Access and Health: A Systematic Narrative Review and Conceptual Framework Development

Background Maternity leave is integral to postpartum maternal and child health, providing necessary time to heal and bond following birth. However, the relationship between maternity leave and health outcomes has not been formally and comprehensively assessed to guide public health research and policy in this area. This review aims to address this gap by investigating both the correlates of maternity leave utilization in the US and the related health benefits for mother and child. Methods We searched the peer-reviewed scholarly literature using six databases for the years 1990 to early 2015 and identified 37 studies to be included in the review. We extracted key data for each of the included studies and assessed study quality using the "Weight of the Evidence" approach. Results The literature generally confirms a positive, though limited correlation between maternity leave coverage and utilization. Likewise, longer maternity leaves are associated with improved breastfeeding intentions and rates of initiation, duration and predominance as well as improved maternal mental health and early childhood outcomes. However, the literature points to important disparities in access to maternity leave that carry over into health outcomes, such as breastfeeding. Synthesis We present a conceptual framework synthesizing what is known to date related to maternity leave access and health outcomes.

Postnatal Depression

Although breastfeeding has multiple benefits for baby and mother, including maternal mental well-being, many mothers terminate breastfeeding earlier than they desire. We examined two key factors in breastfeeding duration and maternal mental health––breastfeeding efficacy and family–work conflict. Specifically, we examined the moderating role of family–work conflict in the process of breastfeeding efficacy as a predictor of maternal depression by way of duration. In a sample of 61 first-time mothers, we found that breastfeeding duration mediated the relation between prenatal breastfeeding efficacy and depression at 9 months postpartum for working mothers who experienced low levels of family-to-work conflict. That is, for mothers with low family-to-work conflict, higher expected breastfeeding efficacy during pregnancy predicted a longer duration of breastfeeding, which in turn was associated with lower depression at 9 months postpartum. However, for working mothers with high family-to-work conflict, breastfeeding duration did not emerge as an indirect effect on the relation between efficacy and depression. These findings have important implications for a healthy family–work balance to help new mothers adjust when they return to the workforce and as they transition to parenthood.

Work-place predictors of duration of breastfeeding among female physicians

OBJECTIVE

To identify work-related predictors of breastfeeding duration among female physicians.

STUDY DESIGN

Data on 238 children were obtained from 50 female physicians, whose main affiliation was with Johns Hopkins University (Baltimore, MD), and 80 female physicians, whose main affiliation was with the University of Florida (Gainesville, FL). We used a mixed linear model to determine which variables were significant predictors of breastfeeding duration when controlling for maternal demographics and taking into account the clustering of observations on study location and mothers.

RESULTS

Although female physicians intended to breastfeed 56% of the infants for at least 12 months and 97% of infants were breastfed at birth, only 34% of infants continued to receive breast milk at 12 months. Duration of lactation among female physicians correlated with the following work-related factors: (1) not having to make up missed call/work that occurred as result of pregnancy or maternity leave; (2) longer length of maternity leave; (3) sufficiency of time at work for milk expression; and (4) perceived level of support for breastfeeding efforts at work from colleagues, program director, or division/section chiefs.

CONCLUSION

Our findings support the importance of work-related factors in breastfeeding maintenance among female physicians and suggest that a tailored intervention, providing time and institutional encouragement, might result in significant improvement in their breastfeeding duration.

Development, content validity, and piloting of an instrument designed to measure managers' attitude toward workplace breastfeeding support

Manager attitude is influential in female employees' perceptions of workplace breastfeeding support. Currently, no instrument is available to assess manager attitude toward supporting women who wish to combine breastfeeding with work. We developed and piloted an instrument to measure manager attitudes toward workplace breastfeeding support entitled the "Managers' Attitude Toward Breastfeeding Support Questionnaire," an instrument that measures four constructs using 60 items that are rated agree/disagree on a 4-point Likert rating scale. We established the content validity of the Managers' Attitude Toward Breastfeeding Support Questionnaire measures through expert content review (n=22), expert assessment of item fit (n=11), and cognitive interviews (n=8). Data were collected from a purposive sample of 185 front-line managers who had experience supervising female employees, and responses were scaled using the Multidimensional Random Coefficients Multinomial Logit Model. Dimensionality analyses supported the proposed four-construct model. Reliability ranged from 0.75 to 0.86, and correlations between the constructs were moderately strong (0.47 to 0.71). Four items in two constructs exhibited model-to-data misfit and/or a low score-measure correlation. One item was revised and the other three items were retained in the Managers' Attitude Toward Breastfeeding Support Questionnaire. Findings of this study suggest that the Managers' Attitude Toward Breastfeeding Support Questionnaire measures are reliable and valid indicators of manager attitude toward workplace breastfeeding support, and future research should be conducted to establish external validity. The Managers' Attitude Toward Breastfeeding Support Questionnaire could be used to collect data in a standardized manner within and across companies to measure and compare manager attitudes toward supporting breastfeeding. Organizations can subsequently develop targeted strategies to improve support for breastfeeding employees through efforts influencing managerial attitude.

Cautionary tales about extended breastfeeding and weaning

Extended breastfeeding is uncommon and accorded limited research attention in the United States. In this article I analyze in-depth interviews with 66 breastfeeding mothers in Northern California. Mothers reveal their understanding of extended breastfeeding through descriptions of the surveillance of breastfeeding and cautionary tales. I examine the form and content of cautionary tales, emphasizing the pervasive culture of surveillance that underpins their relevance to nursing mothers. I interpret the cautionary tales in light of the dyadic encounter of breastfeeding, maternal identity, and norms about older breastfeeding children. The analysis is relevant to future explorations of early weaning in other regions.

Perspectives of managers toward workplace breastfeeding support in the state of Michigan

Managers' attitudes influence female employees' perceptions of workplace breastfeeding support. Five focus groups were conducted with managers in the state of Michigan (N = 25) to assess their attitudes toward supporting breastfeeding. All focus group discussions were recorded, transcribed verbatim, and analyzed for themes. Participants supported efforts by managers and companies to assist breastfeeding employees, but the extent of accommodations they supported varied. Most participants reported no company breastfeeding policy or were unaware of their company having one and showed mixed attitudes about needing a policy. Participants acknowledged the potential for lower productivity and coworker jealousy toward time for breastfeeding or expressing milk but believed that benefits of support included employee recruitment and retention. Participants demonstrated some understanding of breastfeeding benefits. They identified barriers and facilitators for breastfeeding support at both the organizational and individual levels. Results of this study will be used for instrument development to measure managers' attitudes toward supporting breastfeeding.

Spoiled Milk: An Experimental Examination of Bias Against Mothers Who Breastfeed

Drawing from the objectification literature, three experiments tested the hypothesis that breastfeeding mothers are the victims of bias. In Study 1, participants rated a woman who had breastfed as incompetent. Study 2 replicated these effects and determined that the bias was specific to conditions that sexualized the breast. In Study 3, participants interacted with a confederate in which attention was drawn to her as a mother, as a mother who breastfeeds, as a woman with sexualized breasts, or in a neutral condition. Results showed the breastfeeding confederate was rated significantly less competent in general, in math and work specifically, and was less likely to be hired compared to all other conditions, except for the sexualized breast condition. Importantly, the breastfeeding mother emphasis and the sexualized breast emphasis resulted in equally negative evaluations. Results suggest that although breastfeeding may be economical and healthy, the social cost is potentially great.

Managing breastfeeding and work: a Foucauldian secondary analysis

AIM

This paper is a report of a secondary analysis of the experiences of employed breastfeeding mothers.

BACKGROUND

Health promotion policies exhort mothers to feed their infants breastmilk exclusively for the first 6 months and partially until the age of 2 years. More mothers are returning to paid employment less than a year after having a baby. Combining breastfeeding and paid work is an issue for nursing and midwifery as predominantly female professions caring for women and their children.

METHOD

Foucauldian discourse analysis was used for a secondary analysis of interviews performed in 2005 with 20 women who continued to breastfeed on their return to work. The discursive positions and disciplinary practices were identified and analysed.

FINDINGS

Combining breastfeeding and paid work required negotiating the positions of good mother and good worker. Being a good mother conferred health benefits on infants. Being a good worker required the mothers to constrain their breastfeeding practices. The practices performed by the mothers involved stockpiling breastmilk, maintaining milk supply, preparing the baby ready for absence, making sacrifices and remaining silent and invisible as a breastfeeding worker.

CONCLUSION

Breastfeeding workers have the potential to threaten the focus of the workplace. They discipline themselves to minimize their disruptive potential. Such strategies serve to maintain the marginalization of breastfeeding in the workplace and to keep women's efforts to continue breastfeeding invisible. The work of breastfeeding workers needs to be better recognized and supported.

Reproductive-aged women's knowledge and attitudes regarding infant-feeding practices: an experimental evaluation

Using an experimental design, this study assessed knowledge, attitudes, and intentions regarding infant feeding practices among Canadian female university undergraduates (N = 285). Participants completed a survey of knowledge, attitudes, and intentions with respect to infant-feeding practices. Two versions of the survey were randomly distributed to participants: one containing a photograph of a woman breastfeeding her infant (n = 131) and the other containing a photograph of the same women bottle-feeding her infant (n = 154). Findings indicated that the majority of the sample had been breastfed (84%) and intend to breastfeed their own offspring (97%). The intention to breastfeed future offspring was predicted by knowledge, attitudes, and perceptions of social norms. Participants reported more positive attitudes toward visual depictions of breastfeeding compared with bottle-feeding but less positive views of breastfeeding in public compared with bottle-feeding in public. Participants also significantly underestimated the health benefits and optimal duration of breastfeeding. The findings highlight gaps in knowledge that may contribute to premature cessation of breastfeeding among Canadian women and suggest the need for breastfeeding education.

Variables associated with breastfeeding duration

OBJECTIVE

To identify the variables associated with breastfeeding duration.

DATA SOURCES

The health science reference databases of CINAHL, PubMed, and the Cochrane Database of Systematic Reviews.

STUDY SELECTION

Meta-analyses, Cochrane reviews, literature reviews, and quantitative and qualitative studies published in English from 1998 through 2008.

DATA EXTRACTION

Data included all variables, both positive and negative, that were found to influence the outcome of breastfeeding duration.

DATA SYNTHESIS

Demographic factors that influence breastfeeding duration are race, age, marital status, education, socioeconomics, and Special Supplemental Nutrition Program for Women, Infants, and Children status. Biological variables consisted of insufficient milk supply, infant health problems, maternal obesity, and the physical challenges of breastfeeding, maternal smoking, parity, and method of delivery. Social variables included paid work, family support, and professional support. Maternal intention, interest, and confidence in breastfeeding were psychological variables.

CONCLUSION

Human lactation is a complex phenomena and the duration of breastfeeding is influenced by many demographic, physical, social, and psychological variables.

Which mothers wean their babies prematurely from full breastfeeding? An Australian cohort study

AIM

To identify the maternal and infant characteristics associated with an early transition from full breastfeeding to complementary or no breastfeeding during the first 2 months of life in a large, representative cohort of Australian infants.

METHOD

Multinomial logistic modelling was performed on data for infants with complete breastfeeding and sociodemographic data (N = 4679) including maternal age, education, smoking, employment, pregnancy and birth outcomes.

RESULTS

Ninety-one percent of women initiated breastfeeding. Sixty-nine percent of infants were being fully breastfed at 1 month, and 59% were fully breastfed at 2 months. Maternal characteristics - age less than 25 years, smoking in pregnancy, early full-time postnatal employment and less educational attainment - were associated with early breastfeeding cessation. Infant factors - multiple birth, caesarean birth, infant or first birth - were associated with a transition to complementary breastfeeding in the first postnatal month.

CONCLUSION

Breastfeeding duration is substantially affected by breastfeeding outcomes in the first postpartum month. The first month is an important window for evidence-based interventions to improve rates of full breastfeeding in groups of women identified as at risk of early breastfeeding cessation.

Breastfeeding self-efficacy in women of African descent

OBJECTIVE

To determine whether breastfeeding self-efficacy predicts the duration and pattern of breastfeeding in a sample of Black women of African descent.

DESIGN

Descriptive, longitudinal, cohort study. Participants were recruited during the postpartum hospitalization and followed monthly for 6 months or until complete weaning. Breastfeeding self-efficacy was measured using the Breastfeeding Self-Efficacy Scale--Short Form (BSES-SF) (Dennis, 2003).

SETTING

A large urban teaching hospital in New England.

PATIENTS/PARTICIPANTS

Women who self-identified as being of African descent with full-term infants who were planning to breastfeed (N=125).

MAIN OUTCOME MEASURES

Breastfeeding pattern was determined by the total number of feedings the infant received in the past 24 hours and how many of these were breast milk. Duration of breastfeeding was defined as the number of weeks until complete weaning.

RESULTS

Higher levels of breastfeeding self-efficacy predicted longer duration and a more exclusive pattern of breastfeeding at 1 and 6 months postpartum, consistent with prior research (p<.01). Planned pattern of feeding predicted actual pattern of feeding at 1 month postpartum (p<.01). Returning to work after 12 weeks was protective of breastfeeding to 6 months postpartum (p<.01).

CONCLUSION

Theory-based interventions to enhance self-efficacy will help improve breastfeeding outcomes.

'Natural versus taught': competing discourses in antenatal breastfeeding workshops

This article is an analysis of talk in breastfeeding workshops that are part of National Childbirth Trust antenatal classes. Using audio-recordings from breastfeeding workshops antenatal classes, the data were analysed using a qualitative, discursive methodology based in part on the premises outlined by Potter and Wetherell (1987) and Edwards and Potter (1992, 2001). The analysis demonstrates how there are two main discourses of breastfeeding constructed by the breastfeeding counsellor-breastfeeding as natural, and breastfeeding as learnt. In particular, it notes how these two main discourses of breastfeeding that are seemingly in competition with one another, operate concurrently within the teaching of breastfeeding, and enable the breastfeeding counsellor to manage issues and concerns around breastfeeding.

Assessing the validity of measures of an instrument designed to measure employees' perceptions of workplace breastfeeding support

OBJECTIVE

Breastfeeding rates among working mothers are lower than among mothers who are not employed. An ecological framework suggests that health behaviors, such as breastfeeding, are influenced by intrapersonal and environmental factors. There is no existing instrument to measure women's perception of the workplace environment in providing breastfeeding support. The objective of this study was to pilot an instrument measuring perceptions of the work climate for breastfeeding support among working women.

STUDY DESIGN

Data were collected from self-administered mailed questionnaires filled out by 104 pregnant women or women who had recently given birth and were employed and breastfeeding.

RESULTS

Dimensionally analyses supported the two-dimensional model suggested by the literature. Internal consistency reliability coefficients were high (near 0.90), and the correlation between the subscales was moderately strong (0.68).

CONCLUSIONS

Only a single item exhibited misfit to the scaling model, and that item was revised after review.

Development of an instrument designed to measure employees' perceptions of workplace breastfeeding support

OBJECTIVE

Breastfeeding rates remain low in the United States, especially among working women. Unfortunately, no quantitative instrument exists to facilitate the examination of why women who return to work discontinue breastfeeding sooner than the general population. The objective of this study was to develop an instrument to measure female employees' perceptions of breastfeeding support in the workplace, which would be suitable for piloting with the target population.

STUDY DESIGN

Examination of the literature, reviews with experts, and one-on-one interviews with women who had experience combining breastfeeding and work were used to create the instrument subscales and items. Examination of the literature was used to develop four subscales: company policies/work culture, manager support, co-worker support, and workflow. Expert review resulted in the addition of a fifth subscale, the physical environment of the breastfeeding space. One-on-one interviews were used to ensure that the item wording was appropriate for the target population.

RESULTS

Eighteen items were added, and 15 were reworded based on comments from the expert review and from the interviews. The resulting survey contained 54 items that required either categorical yes/no or Likert scale responses.

CONCLUSIONS

Results from this process indicate the survey subscales and items adequately reflect women's perceptions of breastfeeding support in the workplace and the instrument is appropriate for piloting with new mother employees.

Is breastfeeding fair? Tensions in feminist perspectives on breastfeeding and the family

Breastfeeding is widely acknowledged to have health benefits for mothers and infants. Because it is sex-specific, it challenges the feminist principle of gender-neutral childbearing. Various feminist theories addressing breastfeeding from the perspective of gender ideology, cultural feminism, and history are reviewed and contrasted. Employment and race disparities are addressed within feminist contexts. Feminist health activism is suggested as a unifying perspective.