Gendering the Pandemic: Women's Health Disparities From a Human Rights Perspective

As COVID-19 keeps impacting the world, its impact is felt differently by people of different sexes and genders. International guidelines and research on gender inequalities and women's rights during the pandemic have been published. However, data from Taiwan is lacking. This study aims to fill the gap to increase our knowledge regarding this issue and provide policy recommendations. This study is part of a more extensive project in response to the fourth state report concerning the implementation of the Convention on the Elimination of All Forms of Discrimination against Women in Taiwan in 2022. We have drawn on the guidelines and documents published by the United Nations human rights bodies, conducted interviews with advocacy and professional practitioners, and hosted a study group comprising students and teachers from the National Taiwan University College of Public Health to supplement the interview data. The data were analyzed thematically. The results include five themes: (1) particular health risks to carers (primarily women); (2) COVID-related measures' impact on women's health and health behaviors; (3) highly gendered psychological maladjustment; (4) increase in gender-based violence and domestic violence; and (5) mental health inequities and intersectionality. The study has global implications for societies of similar sociopolitical contexts and developmental statuses. To truly live up to the standard of CEDAW and other international human rights principles, we ask that central and local government be more aware of these lived experiences and adjust their policies accordingly, accounting for gender sensitivity.

Converging economies of care? Immigrant women workers across 17 countries and four care regimes

This study analyses 17 care economies using 2016 Luxembourg Income Study data to contribute to extant debate regarding the ongoing utility of care regimes as a classificatory schema for cross-national comparison. Examining similarities and differences in the provision of low-status work in health, education, social work, and domestic services - the 'care economy' - the data reveal devaluation of the labour done by immigrant women care workers, net of national and regime-level variation. In addition, numerous similarities across liberal, corporatist, social democratic, and central and eastern European care regimes emerge, in terms of the overrepresentation of immigrant women in low status care work, and the disproportionate financial penalties these workers incur. Together, findings suggest that notwithstanding national and policy-specific differences, there has been considerable convergence across economies of care towards a 'migrant in the market' model of employment. Such large-scale evidence of this trend calls into question the ongoing efficacy of care regimes for national comparisons of migrant care work under conditions of neoliberal globalization.

Spanish residents' experiences of care during the first wave of the COVID-19 syndemic: a photo-elicitation study

PURPOSE

The main aim of this research was to explore experiences of care during the lockdown of the first wave of COVID-19 syndemic in Spain.

METHODS

This is a qualitative and explorative study using self-photo-elicitation as a data collection method. Fifteen participants (Twelve women and three men) shared 25 photographs and one video between the June 18 and August, 2020. Participants' photographs and texts were collected online. Data were analysed based on Thematic Analysis.

RESULTS

Three emerging categories were constructed: 1) the deconstruction of care: self-care and collective care 2) the crisis of care and gendered care, 2) beyond anthropocentrism: animalism and ecology. Findings indicate the need to understand "care" in terms of social reproduction, including self-care, care towards other humans and non-human animals, and collective care. Also, the need to care for planetary health and to be in contact with nature as a form of self-care and social care.

CONCLUSIONS

Care in a period of social and health crisis puts human relationships and also non-human life at the centre. Care requires adopting taking an ecological one-health perspective.

The effects of precarious employment and calling on the psychosocial health and work well-being of young and older workers in the care sector: a longitudinal study

OBJECTIVE

Employment conditions in the care sector are changing, and precarious employment (PE) is becoming more widespread, manifesting as undervaluation, adverse leadership, work overload, and inadequate control over work. This study aimed to examine changes in psychosocial health, work well-being, PE, and calling over time and explore the effects of PE and calling on psychosocial health and work well-being.

METHODS

The longitudinal study collected follow-up panel data in the three time points (2020, 2022, and 2023) from care workers (n = 1502), linear mixed effects models.

RESULTS

PE decreased (β =  - 0.02), and perceived work well-being increased (β = 0.04), but there were no change in psychosocial health (β =  - 0.01) and calling (β = 0.01) during the three-year period. Younger (< 39) care workers perceived higher levels of PE and had poorer psychological health. Moreover, PE had a negative effect on psychosocial health (β =  - 0.63) and work well-being (β =  - 0.68) and calling had a positive effect on psychosocial health (β = 0.41) and work well-being (β = 0.49) in multivariate models.

CONCLUSION

PE conditions affect work performance and employee well-being and may threaten patient care; therefore, it should be further investigated in the care sector. It is noteworthy that calling still seems to be central in care work. The results deepen the understanding of the current shortage crisis in health and social care workplaces but can also provide keys to resolving the crisis.

mHealth interventions to reduce stress in healthcare workers (fitcor): study protocol for a randomized controlled trial

BACKGROUND

Causes and consequences of chronic stress levels in the context of healthcare work are well examined. Nevertheless, the implementation and evaluation of high-quality interventions to reduce stress of healthcare workers is still missing. Internet and app-based interventions are a promising venue for providing interventions for stress reduction to a population that is otherwise difficult to reach due to shift work and time constraints in general. To do so, we developed the internet and app-based intervention (fitcor), a digital coaching of individual stress coping for health care workers.

METHODS

We applied the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) statement as a guideline for the present protocol. A randomized controlled trial will be conducted. There are five different intervention groups and one waiting control group. To achieve the sample sizes required by power analysis (G*Power) (β-error 80%; effect size 0.25), the sample sizes of the respective scenarios will be at best as follows: 336 care workers from hospitals, 192 administrative health personnel, 145 care workers from stationary elderly care homes, and 145 care workers from ambulatory care providers in Germany. Participants will randomly be assigned to one of five different intervention groups. A crossover design with a waiting control group is planned. Interventions will be accompanied by three measurement points, first a baseline measure, second a post-intervention measure directly after completion of the intervention, and a follow-up measure 6 weeks after completion of the intervention. At all three measurement points, perceived team conflict, work-related experience patterns, personality, satisfaction with internet-based training, and back pain will be assessed using questionnaires, as well as heart rate variability, sleep quality, and daily movement will be recorded using an advanced sensor.

DISCUSSION

Workers in the health care sector increasingly face high job demands and stress levels. Traditional health interventions fail to reach the respective population due to organizational constraints. Implementation of digital health interventions has been found to improve stress coping behavior; however, the evidence in health care settings has not been established. To the best of our knowledge, fitcor is the first internet and app-based intervention to reduce stress among nursing and administrative health care personnel.

TRIAL REGISTRATION

The trial was registered at DRKS.de on 12 July 2021, registration number: DRKS00024605.

Working More and Making Less: Post-Retirement Aged Immigrant Women Care Workers in Canada

Care work is typically undervalued and precarious. However, little is currently known about the financial outcomes of immigrant women care workers as they reach post-retirement age, or their access to effective social policy supports. Using Canada as a case example, this study analyzes the Longitudinal Immigration Database to compare the income trajectories of women aged 65-95 who entered the country via the Care Worker immigration entry class to immigrant women from two other immigration streams (one focused on higher skill economic contributions, the other on family reunification). Estimating a series of growth curve models (n = 28,775), results reveal that between 2007-2017, despite engaging in paid employment longer, Care Worker women were less able to make contributions to a private pension plan prior to retirement and more likely to depend on public pension benefits after reaching retirement age, relative to other immigrant women. Additionally, Care Worker women had lower predicted total income and experienced downward mobility during the post-retirement period. Together, the findings reinforce the importance of considering the financial circumstances of immigrant care workers as they age and highlight a need for renewed government investment in social supports to reduce inequalities tied to the gendered and racialized devaluation of low-wage caring occupations.

"Not everyone can do this": childcare context and the practice of skill in emotional labor

Scholarship remains divided about whether emotional labor is 'skilled'. Interrogating gendered skill constructs that render emotions in work invisible, I examine two organizational contexts in the Early Childhood Education and Care (ECEC) sector: family and center-based care. I draw from 43 interviews, primarily with Latina and White women workers, reflecting feminized and racialized workplaces. I also draw from ethnographic and observational data. Challenging the particular devaluation of family-based care, findings reveal that the practice of skill in emotional labor is organizationally shaped across less and more institutionalized forms of ECEC. Examining worker critiques of professionalization norms and credential-based skill metrics, autonomy is also identified as a pre-requisite for embodied, tacit and discretionary skills in the emotional labor of ECEC.

Video connecting families and social robots: from ideas to practices putting technology to work

Technology use is a socially embedded process, especially when it comes to older adults and care. However, the restrictions associated with the COVID-19 pandemic have limited social contact to protect vulnerable groups in care homes, and even if technology use has increased in other areas, there is little known about the potential uptake of communication technology and changes in social interaction in the care context during a lasting crisis. This paper explores changes in communication technology use triggered by the pandemic at two care homes, using a qualitative diary study, online interviews and observations, and in-situ interviews within the care home with residents and workers. Our findings point to increasing use of tablets and video conference software triggered by COVID-related experiences, with implications for living and working in care homes. We also characterise the isolation experience of the residents, the workers' concerns about the residents and changes in social interaction. We observed new areas of technology usage, associated changing work practices, technical affinity issues and context-specific attitudes towards future technologies. While the pandemic has triggered the use of communication technology in care homes on a small scale, this has also caused increasing workload and in particular articulation work, which requires support structures and the re-definition of work roles.

Building community-centered social infrastructure: a feminist inquiry into China's COVID-19 experiences

The global COVID-19 pandemic has revealed the essential role of care work in sustaining life, health, and maintaining the basics of everyday existence. It has also made visible the disproportionate burden of care work on women that existed before the outbreak, which has intensified rapidly and been gravely exposed during the pandemic. In this article, we take China as a case study to investigate the gendered impact of this pandemic and further problematize the landscape of care provision. With a feminist political economy perspective, we introduce China's provisioning of care prior to the outbreak and investigate how the care crisis has further deepened in the pandemic. Drawing on the most recent data available on China's experience, we explore the role and function of community-centered social infrastructure, an assemblage of state, family, and local resources, in effectively combating the virus and providing care. We further provide comparative international evidence to demonstrate the essential role of community care infrastructure in this pandemic. Building social infrastructure to deliver care at the community level presents important policy implication, especially for many developing countries. Therefore, a critical reflection and discussion on pandemics and women is not only more vital than ever, but also sheds light on the endeavour to develop long-term solutions for the care crisis that will almost certainly outlive the current pandemic.

This is a handcraft: valuation, morality, and the social meanings of payments for psychoanalysis

This article examines valuation and payment practices of psychoanalysts in Buenos Aires, Argentina. Psychoanalysts do not use explicit sliding scales but rather reach an agreement about fees in conversation with the patient. This negotiation is conducted with some principles of gift-giving, where parties try to give more, rather than through competitive bargaining (an inverted bazaar). Drawing on the sociology of money, morals and markets, and valuation studies literatures, I distinguish four factors to explain this: 1) Some formally produced prices as well as market mechanisms shape benchmarks for fees, but the peculiar service psychologists offer (which makes quality judgments hard), the way patients and therapists are matched, and the lack of public information about prices allow for high flexibility in price-setting; these are structural factors that remain unsaid in the conversation on fees. 2) A professional narrative that highlights a responsibility towards patients that should not be contaminated by economic interest. 3) Psychoanalysts' elaborations on the meanings of the payment, which should reflect the uniqueness of each patient and the bond analyst-patient and symbolize the patient's commitment to treatment, involving a cost and a loss beyond the economic. 4) The prevalence of cash, face-to-face payment without intermediaries, which helps desacralize the analyst and disentangle the session from the rest of the economic life of the analyst, but impedes evading moralization of the transaction. Payments in psychoanalysis are delicate arrangements, and analysts often stress about valuation and payments. They have to be careful to ensure this flexibility results in morally acceptable transactions.

A qualitative study of what care workers do to provide patient safety at home through telecare

BACKGROUND

In health care, the work of keeping the patient safe and reducing the risk of harm is defined as safety work. In our digitised and technology-rich era, safety work usually involves a relationship between people and technologies. Telecare is one of the fastest-growing technology-domains in western health care systems. In the marketing of telecare, the expectation is that safety is implicit simply by the presence of technology in patients' homes. Whilst both researchers and health authorities are concerned with developing cost-benefit analyses and measuring effects, there is a lack of attention to the daily work needed to ensure that technologies contribute to patient safety. This paper aims to describe how patient safety in home care is addressed through and with telecare. We base our exploration on the social alarm, an established technology that care workers are expected to handle as an integrated part of their ordinary work.

METHODS

The study has a qualitative explorative design where we draw on empirical data from three case studies, involving five Norwegian municipalities that use social alarm systems in home care services. We analyse observations of practice and interviews with the actors involved, following King's outline of template analysis.

RESULTS

We identified three co-existing work processes that contributed to patient safety: "Aligning people and technologies"; "Being alert and staying calm"; and "Coordinating activities based on people and technology". Attention to these work processes exposes safety practices, and how safety is constructed in relational practices involving multiple people and technologies.

CONCLUSIONS

We conclude that the three work processes identified are essential if the safety alarm is to function for the end user's safety. The safety of home-dwelling patients is reliant on the person-technology interface. The efforts of care workers and their interface with technology are a central feature of creating safety in a patient's home, and in doing so, they utilise a repertoire of skills and knowledge.

Liminal space and the negotiation of care work in extra-care housing

This is a qualitative case study of care work in a liminal space, specifically the case of an extra-care housing residence, which is an innovative housing alternative for elderly people in need of care in Sweden. The study is an exploration of social care workers' perceptions about their workplaces and their understandings of themselves, which are shaped by their embeddedness in architectural space. The extra-care housing residence appeared as a liminal space in which two dominant spaces - home care services and residential care - underpinned the staff's perceptions of an unclear workplace and their identity work.

[Changes in well-being and private support for older people: a closer look at the impact of the COVID-19 pandemic in early summer 2020]

Hintergrund

Die Pilotstudie „Gesundheit und Unterstützung in Zeiten von Corona“ (Technische Universität Dortmund) erhob vom Mai bis Juli 2020 Veränderungen von Unterstützung und Wohlbefinden Älterer infolge der COVID-19-Pandemie.

Ziel der Arbeit

Ziel war es, empirische Erkenntnisse zu den sozialen und mentalen Folgen der Pandemie für in Privathaushalten lebende Personen der Altersgruppe 40+ Jahre zu gewinnen. Betrachtet wurden durch die Pandemie bedingte Änderungen im Erhalt und im Leisten von Unterstützung (u. a. persönliche Pflege, Hilfe im Haushalt) und Betreuungsprobleme sowie Veränderungen des Wohlbefindens.

Material und Methoden

Mithilfe deskriptiver und multivariater Analysen wurde untersucht, wie sich im Zuge der Pandemie Unterstützungsmuster änderten, ob Betreuungsprobleme entstanden, und ob sich in diesem Zuge des Wohlbefinden (Lebenszufriedenheit und Einsamkeit) veränderte.

Ergebnisse

Im Zuge der Pandemie zogen sich insbesondere Ältere und Hochaltrige aus der Unterstützung für andere zurück. Frauen berichteten häufiger von Betreuungsproblemen mit älteren Angehörigen. Das Wohlbefinden verringerte sich insgesamt, am deutlichsten aber bei Frauen und Hochaltrigen. Die multivariaten Analysen verdeutlichen, dass Betreuungsprobleme mit älteren Angehörigen im Zuge der Pandemie mit geringerem Wohlbefinden einhergingen.

Diskussion

Unsere Pilotstudie zeigt deutliche Änderungen in Unterstützungsmustern und im Wohlbefinden der Befragten. Viele berichten von mehr Einsamkeit und geringerer Lebenszufriedenheit als vor der Pandemie – insbesondere Frauen, die Unterstützungsleistungen für andere erbringen. Sorgearbeit wird durch die Pandemie und die Maßnahmen zu ihrer Bekämpfung erschwert. Zukünftige Kontaktbeschränkungen sollten mit Bedacht eingesetzt werden und dies im Blick haben.

[The Nest as Environment. A Historical Epistemology of the Nesting Instinct in Pregnancy]

Today, many pregnancy guides mention a nesting instinct. According to this, pregnant women would be seized by an urge to create the right environment for their child, for example to buy baby equipment or clean the apartment. The concept of the nesting instinct forms a specific configuration of knowledge: While it is widespread in the popular field, it occupies a marginal position in the scientific field. In this paper, I will investigate the historical epistemology of this form of knowledge. In so doing, the following questions are addressed: How did the knowledge about a nesting instinct during pregnancy form? How was the nest as a specific natural-anthropogenic environment constructed? And to what extent do notions of gender and environment interact here? To answer these questions, the study takes the perspective of a history of knowledge in transit, in the longue durée from the nineteenth century to the present. The investigation reveals a gradual feminization of the concept of environment in the knowledge of the nesting instinct. Whereas in the nineteenth century it was often considered a male behavioral pattern and the nest was an analogy to the house, in the first decades of the twentieth century, the instinct transformed into a primarily female characteristic, with the nest representing the interior of the home. A decisive condition for this circulation of knowledge was that the nest became a 'metaphorical thing'. As such, the nest did not simply lead to naturalization, but denoted a natural-social in-between space that increasingly became the goal of female care work.

Gender inequality and the COVID-19 crisis: Evidence from a large national survey during South Africa's lockdown

We analyse the early effects of the COVID-19 crisis and lockdown in South Africa on women's and men's work in the paid and unpaid (care) economies. Because women and men typically have different roles in both spheres, it is likely that they would experience the negative effects of the crisis unevenly, potentially exacerbating existing inequalities. Based on a large national survey conducted during South Africa's lockdown period, we find that women have been affected disproportionately by the crisis. While women comprised less than half of the employed in February, they experienced two-thirds of the net job losses between February and April, with the most vulnerable groups affected more. Among those who remained in employment, there was a larger fall in working hours among women than men. Compounding these disproportionate effects in the labour market, women also took on more of the additional childcare that resulted following school closures. The crisis has therefore increased gender inequality in South Africa, reversing some of the hard-won gains of the previous 25 years.

The health effects of gendered and devalued work: health outcomes of incarcerated women engaging in sex work and care/service work

BACKGROUND

Women with a history of incarceration are often engaged in highly gendered work, either sex work or low-wage care/service work jobs. While employment is an important element of reentry plans, low-wage jobs may not necessarily help women leave illicit activities, including commercial sex work. Incarcerated women often move between care/service work and sex work to supplement income, putting them at greater risk for negative health outcomes.

RESULTS

Using survey data from 400 women detained in a large urban jail, we examined how incarcerated women's experience with sex work and low-wage care/service work affects four health-related outcomes: overall health concerns, clinical depression, regular drug use, and self-esteem. Of the survey participants, 24% engaged exclusively in sex work and 34% in care/service work. However, 41% of women held both sex work and care/service work jobs, prior to incarceration. Compared to women engaged in care/service work, a greater proportion of women engaged in sex work reported overall health concerns, clinical depression, and regular drug use. On the other hand, women in care/service work jobs exclusively reported lower levels of self-esteem than women engaging in sex work.

CONCLUSIONS

Many reentry programs emphasize the importance of employment for former inmates, and yet, job options for women detained in jail are often limited to low-wage care/service jobs, which do not necessarily provide adequate security to lift women's economic burdens. Consequently, many women with a history of incarceration may supplement their income with sex work to meet their basic economic needs. However, both of these highly gendered and devalued jobs may negatively affect health and wellbeing of women.

Racism, racialization, and health equity in Canadian residential long term care: A case study in Toronto

To date, most of the interdisciplinary scholarly literature pertaining to care work and labor studies of marginalized groups, such as women, visible minorities, and immigrants, has focused on emotional labor as well as concerns about high stress and high turnover. However, few mention racism and racialization. Using a single-case study research design of a long term care ("LTC") home in Toronto, Ontario, Canada, this paper contributes to our understanding of racism and racialization by analyzing participants' experiences of work. It documents how particular social determinants of health ("SDoH"), such as race and racialization, can manifest themselves in the lives of workers. Drawing on critical race theory and feminist political economy, this study examines the ways in which the participants discuss their experiences of care work, with closer attention to racism and racialization.

Changes in work and care trajectories during the transition to motherhood

In most mid- and high-income countries, there have been significant demographic, structural, and cultural changes in the past decades. However, we know little about how these changes have shaped women's work patterns during a key life stage: the transition to motherhood. Using longitudinal data from Chile, covering over 30 years of employment histories and three periods of first births (1980-2010), I conduct sequence analysis to identify women's work-care trajectories during an eight-year period of the transition to motherhood. Over time, I find that continuous care work at home has declined, for which education plays a key role, while the chances of working continuously have not changed over time. Instead, I find an increasing trend of unsteady paths that combine paid work with either caretaking or unemployment. I discuss how these changes, as well as their association with education, have important implications for both gender and social inequality.

A relational ethic of rural home support on two Gulf Island communities, 1978-2018

Since their widespread establishment in the 1970s, home support services across Canada have been subject to shifting state logics, policies, and funding models. The impacts and responses of local actors differ across historical, socio-cultural, and geographical settings. This paper traces the development and evolution of a small home support society on two rural islands off the coast of British Columbia, Canada. Using historical and current data sources, we demonstrate that local actors have consistently engaged a relational ethic that challenges neo-liberal discourses and practices. Our central thesis is that the islands' distinct social, cultural, and rural features set the context for particular constructions of relational care. We identify three themes central to a relational ethic of home support on two rural islands: the strength of intergenerational connections, community-embedded relationships, and care as compassionate civic engagement. Within each theme, we consider how shifting policy structures inform changes over time in the nature and delivery of home support. To conclude, we elaborate on the conditions that allow for relational care to flourish in a particular rural context, and on the potential relevance to other settings.

Time to care? Temporal variations of agency of the Finnish adult foster carers

This article analyses a hybrid form of housing and care service for older people called adult foster care. In Finnish adult foster care model, an older person moves to a foster care home and is cared for by a semi-professional foster carer who is not related to them. A foster care home is thus simultaneously a personal dwelling and a site of intensive care work which also changes the rhythms and routines of both the foster carer and older person. In the article I ask, how do foster carers express their temporal agency and its variations (identity, pragmatic, life course) through time work? By temporal agency I mean individuals' ability to impact on their experience of time, which is done through time work. The article is based on 12 thematic interviews that were analysed using thematic content analysis. The analysis shows that as a resource, time itself was the most valued aspect of foster care work. Being a foster carer was in fact a way of resisting clock-driven, institutional-like care work. The foster carers were able to exercise their professional identity agency, that is, act like 'a good carer' should act, but they found it difficult to allocate time for themselves and to their families. This can. endanger their well-being and the continuity of foster care relationship. In order to develop the adult foster care scheme to a real housing and care option for older people and a tenable work option for potential foster carers, several issues should be carefully considered. To ensure foster carers' well-being, their statutory right to days-off should be increased, and the support and substitute system should be enhanced so that foster carers can allocate more time for themselves and their families, even when this would mean more costs to the municipalities. Also, older people in need of care should be placed to foster care much earlier.

Health information work and the enactment of care in couples and families affected by Multiple Sclerosis

Given the considerable emphasis placed on informed choice, the management of health information has become an increasingly important part of living with chronic illness. This paper explores the intra-familial dynamics of managing health information in the context of chronic illness. Drawing on 77 interviews with people affected by Multiple Sclerosis in the UK (patients, partners, family members and close friends), we show how families develop their own idiosyncratic information practices, including the careful, at times strategic, seeking, sharing and withholding of information. We describe how one individual, most commonly either the patient or their partner, often takes primary responsibility for managing growing quantities of health information. Doing this is a complex task, yet its dynamics within the family unit remain invisible and unacknowledged. In this paper we: (a) stress the importance of understanding information management in chronic illness as a collective process across all those affected, patients as well as carers; (b) conceptualise the process of managing health information in this context as 'health information work'; and (c) analyse it as part of the wider care practices families engage in and as a form of care in its own right.

Social and organizational practices that influence hospice utilization in nursing homes

Hospice has grown considerably but the likelihood that someone gets hospice depends on social and organizational practices. This article shows how staff beliefs and work routines influenced hospice utilization in two nursing homes. In one, 76% of residents died on hospice and in the other 24% did. Staff identified barriers to hospice including families who saw hospice as giving up and gaps in the reimbursement system. At the high-hospice nursing home, staff said hospice care extended beyond what they provided on their own. At the low-hospice nursing home, an influential group said hospice was essentially the same as their own end-of-life care and therefore needlessly duplicative. Staff at the high-hospice nursing home proactively approached families about hospice, whereas staff at the low-hospice nursing home took a reactive approach, getting hospice when families asked for it. Findings demonstrate how staff beliefs and practices regarding hospice shape end-of-life care in nursing homes.

"That's Kind of One of Our Jobs": Sexual Activity as a Form of Care Work Among Women with Sexual Difficulties

Willing engagement in unwanted or undesired sexual activity, often associated with fulfilling a partner's needs or sustaining intimate relationships, is common. Acquiescence with undesired sexual activity can be conceptualized as sexual care work, that is, domestic "labor" that women undertake with the goal of caring for their partners' well-being. Drawing on interviews with 53 women with dyspareunia (pain experienced during intercourse) and low desire, the aim of this study was to examine how women with sexual difficulties engage in sexual care work, the implications of the inability to perform such work for gender identity, and the ways in which sexual care work may blur the lines between women's perceptions of coercion and consent. The women in this study engaged in sexual activity for a number of reasons, including the pursuit of intimacy, to care for their partner, and to fulfill their perceived sexual obligations. Sexual compliance was conceptualized as a form of work, similar to other forms of unpaid care work such as housework or childcare, which negatively affected women's gender identities when it could not be performed. For many women, sex was simultaneously wanted and unwanted, contributing to women's ambivalence regarding the meaning of consent. Further exploration of these issues may lead to a better understanding of how gender is achieved through normative sexuality.

Domesticating dialysis: A feminist political economy analysis of informal renal care in rural British Columbia

Drawing from a case study in rural British Columbia, this article examines the experiences of individuals providing unpaid care for family members on hemodialysis and how these experiences fit within larger political and socio-economic policy contexts. We suggest that the current shift towards home-based renal care, the "domestication of dialysis," reflects a broader trend toward a reduction of public health services, assumptions about the feasibility of unpaid care work in rural settings, and an increasing reliance on individuals-rather than the state-to support dependency and produce healthy citizens. This article confirms the challenges that come with providing daily care to a family member with a chronic disease and the gendered nature of unpaid care work. It also extends discussions of unpaid care to include how these challenges can be applied to renal care and complicated by rural residence.

Who bears the cost of 'informal mhealth'? Health-workers' mobile phone practices and associated political-moral economies of care in Ghana and Malawi

Africa's recent communications 'revolution' has generated optimism that using mobile phones for health (mhealth) can help bridge healthcare gaps, particularly for rural, hard-to-reach populations. However, while scale-up of mhealth pilots remains limited, health-workers across the continent possess mobile phones. This article draws on interviews from Ghana and Malawi to ask whether/how health-workers are using their phones informally and with what consequences. Health-workers were found to use personal mobile phones for a wide range of purposes: obtaining help in emergencies; communicating with patients/colleagues; facilitating community-based care, patient monitoring and medication adherence; obtaining clinical advice/information and managing logistics. However, the costs were being borne by the health-workers themselves, particularly by those at the lower echelons, in rural communities, often on minimal stipends/salaries, who are required to 'care' even at substantial personal cost. Although there is significant potential for 'informal mhealth' to improve (rural) healthcare, there is a risk that the associated moral and political economies of care will reinforce existing socioeconomic and geographic inequalities.