The impact of migration and settlement context on Iranian Women's agency in accessing and using reproductive healthcare services in Australia: A qualitative study

This qualitative study aimed to understand how immigration and settlement context shape Iranian immigrants' agency in accessing and using reproductive healthcare services (RHCS). Twenty-one Iranian women of reproductive age (18-49 years) living in Australia were recruited in 2022 through social media platforms. The findings highlighted that although Iranian women's utilisation of RHCS in Australia is highly constrained by established sociocultural beliefs and values of their origin country, they become agents of making changes over their reproductive choices, reformulating beliefs and values, and taking control of reproductive health because of Australian sociocultural norms and context. This suggests a tension between the impacts of sociocultural contexts in their origin country and becoming agents of change after migrating to Australia. These findings need to be included in healthcare policy and practice to support greater consideration of cultural sensitivities and specific needs of immigrant women when accessing Australian RHCS.

Women's participation in microfinance: Effects on Women's agency, exposure to partner violence, and mental health

OBJECTIVES

The health and social effects of women's microfinance participation remain debated.

METHODS

Using propensity-score methods, we assessed effects of microfinance participation on novel measures of agency; intimate partner violence (IPV) exposure; and depressive symptoms in 930 wives in Matlab, Bangladesh interviewed 11/2018-01/2019.

RESULTS

Participants, versus non-participants, were married younger (16.7 vs. 17.4 years), more often Muslim (90.7% vs. 86.2%), less schooled (5.4 vs. 6.8 grades), and more often had husbands (27.0% vs. 19.6%) and mothers (63.2% vs. 50.5%) without schooling. Participants and non-participants had similar unadjusted mean scores for prior-week depressive symptoms, prior-year IPV, and intrinsic attitudinal agency (gender-equitable attitudes; non-justification of wife beating). Participants had higher unadjusted mean scores for intrinsic voice/mobility; instrumental agency (using financial services, voice with husband, voice/mobility outside home); and collective agency. Average adjusted treatment effects were non-significant for depressive symptoms, IPV, and attitudinal intrinsic agency, and significantly favorable for other agency outcomes.

CONCLUSIONS

Microfinance participation had no adverse health effects and favorable empowerment effects in Bangladeshi wives.

POLICY IMPLICATIONS

Microfinance can empower women without adverse health effects. Social-norms programming with men and women may be needed to change gendered expectations about the distribution of unpaid labor and the rights of women.

Conditional cash transfers and gender constructions: A unique dataset on women in Buenaventura, Colombia

This study provides detailed information on socially disadvantaged women and their households in Buenaventura, Colombia. A representative sample for 400 women aged between 18 and 70 was prepared and their living conditions were accessed based on the sociodemographic data and economic and social dynamics of their households. It gives special attention to access to poverty alleviation programs – conditional cash transfers - and forms of agency propelling women towards social change. The data were collected in July 2019 through in-person interviews. The database can greatly contribute toward further comparative research, informing public policy, and more broadly, widening the universe of statistical data on Colombia and other Latin American countries by providing quantitative data on welfare dependence, intragenerational pathways of social mobility, and changes in reproductive strategies and the political culture of women with respect to urban precarity. Fundación WWB Colombia and Universidad Icesi sponsored data collection as part of the project entitled “Analysis of the relationships between gender constructions and welfare programs in southwest Colombia”.

Keeping it together and falling apart: Women's dynamic experience of birth

OBJECTIVE

To explore the complexity of women's birth experiences in the context in which they occur and to describe how these influence women's well-being in labor.

DESIGN

Qualitative method with a phenomenological approach, following the analysis principles of van Manen.

PARTICIPANTS AND SETTING

Eight women from different ethnic and socioeconomic backgrounds in Atlanta, Georgia, United States with a recent, healthy birth were interviewed twice about their experience of the labor journey. The first interview was 3-12 weeks post-partum, with the second interview at 10-22 weeks post-partum.

FINDINGS

The phenomenon of childbirth was a dynamic fluctuating between keeping it together and falling apart. The changes in emotion were created by a sensitive feedback loop between the woman and her environment, the physical space, and interactions with humans present. Four characteristics supported and created this phenomenon: confidence, comfort, agency and connection. Confidence was believing in one's physical ability to birth the baby while at the same time, having the emotional resources to cope with the experience. Comfort was essential to manage pain and difficult emotions. The presence of comfort changed the meaning and experience of pain and increased relaxation. Agency was overtly supported in labor, but compromised by hospital routine and unresponsive caregiver practices, and was diminished by women's vulnerability in labor. When agency was compromised, falling apart increased, and there was a move towards intense negative emotion. In labor, women wanted an authentic human connection, being known as a person. This connection was a mechanism to support the other characteristics of comfort, confidence, and agency.

IMPLICATIONS FOR PRACTICE

Clinicians need to accommodate the complex, dynamic fluctuations of emotion during birth addressing both the physical and non-physical aspects of the person. Birth care practices and childbirth research need to account for the complexity of birth as a holistic experience, specifically regarding the emotional shifts as well as the women's sensitivity to the environment and everything contained in it. There is a need for more research related to the dynamics of emotional changes in labor, how these changes affect labor physiology and influence normal birth and birth outcomes.

Theory and social practice of agency in combining breastfeeding and employment: A qualitative study among health workers in New Delhi, India

BACKGROUND

Women's agency, or intentional actions, in combining breastfeeding and employment is significant for health and labour productivity. Previous research in India showed that mothers use various collaborative strategies to ensure a "good enough" combination of breastfeeding and employment. Bandura's theoretical agency constructs previously applied in various realms could facilitate the exploration of agency in an Indian context.

AIM

To explore manifestations of agency in combining breastfeeding and employment amongst Indian health workers using Bandura's theoretical constructs of agency and women's experiences.

METHODS

Qualitative semi-structured interviews were conducted with ten women employees within the governmental health sector in New Delhi, India. Both deductive and inductive qualitative content analyses were used.

FINDINGS

Bandura's features and modes of agency revealed that intentionality is underpinned by knowledge, forethought means being prepared, self-reactiveness includes collaboration and that self-reflectiveness gives perspective. Women's interviews revealed four approaches to agency entitled: 'All within my stride or the knowledgeable navigator'; 'Much harder than expected, but ok overall'; This is a very lonely job'; and 'Out of my control'.

CONCLUSIONS

Agency features and their elements are complex, dynamic and involve family members. Bandura's theoretical agency constructs are partially useful in this context, but additional social practice constructs of family structure and relationship quality are needed for better correspondence with women's experiences of agency. The variation in individual approaches to agency has implications for supportive health and workplace services.