South African abortion attitudes from 2007-2016: the roles of religiosity and attitudes toward sexuality and gender equality.

Abortion is legal in South Africa, but negative abortion attitudes remain common and are poorly understood. We used nationally representative South African Social Attitudes Survey data to analyze abortion attitudes in the case of fetal anomaly and in the case of poverty from 2007 to 2016 (n = 20,711; ages = 16+). We measured correlations between abortion attitudes and these important predictors: religiosity, attitudes about premarital sex, attitudes about preferential hiring and promotion of women, and attitudes toward family gender roles. Abortion acceptability for poverty increased over time (b = 0.05, p < .001), but not for fetal anomaly (b = -0.008, p = .284). Highly religious South Africans reported lower abortion acceptability in both cases (Odds Ratio (OR)anomaly = 0.85, p = .015; ORpoverty = 0.84, p = .02). Premarital sex acceptability strongly and positively predicted abortion acceptability (ORanomaly = 2.63, p < .001; ORpoverty = 2.46, p < .001). Attitudes about preferential hiring and promotion of women were not associated with abortion attitudes, but favorable attitudes about working mothers were positively associated with abortion acceptability for fetal anomaly ((ORanomaly = 1.09, p = .01; ORpoverty = 1.02, p = .641)). Results suggest negative abortion attitudes remain common in South Africa and are closely tied to religiosity, traditional ideologies about sexuality, and gender role expectations about motherhood.

Abortion attitudes among South Africans: findings from the 2013 social attitudes survey.

Abortion is legal in South Africa, but over half of abortions remain unsafe there. Evidence suggests women who are (Black) African, of lower socioeconomic status, living with HIV, or residents of Gauteng, KwaZulu-Natal, or Limpopo provinces are disproportionately vulnerable to morbidity or mortality from unsafe abortion. Negative attitudes toward abortion have been documented in purposively sampled studies, yet it remains unclear what attitudes exist nationally or whether they differ across sociodemographic groups, with implications for inequities in service accessibility and health. In the current study, we analysed nationally representative data from 2013 to estimate the prevalence of negative abortion attitudes in South Africa and to identify racial, socioeconomic and geographic differences. More respondents felt abortion was 'always wrong' in the case of family poverty (75.4%) as compared to foetal anomaly (55%), and over half of respondents felt abortion was 'always wrong' in both cases (52.5%). Using binary logistic regression models, we found significantly higher odds of negative abortion attitudes among non-Xhosa African and Coloured respondents (compared to Xhosa respondents), those with primary education or less, and residents of Gauteng and Limpopo (compared to Western Cape). We contextualise and discuss these findings using a human rights-based approach to health.

Social and cultural factors associated with perinatal grief in Chhattisgarh, India.

Stillbirth is a globally significant public health problem with many medical causes. There are also indirect causal pathways including social and cultural factors which are particularly salient in India's traditional society. The purpose of this study was to explore women's perceptions of stillbirth and to determine how issues of gender and power, social support, coping efforts, and religious beliefs influence perinatal grief outcomes among poor women in rural Chhattisgarh, India. Structured interviews were done face-to-face in 21 randomly selected villages among women of reproductive age (N=355) who had experienced stillbirth (n=178) and compared to those who had not (n=177), in the Christian Hospital, Mungeli catchment area. Perinatal grief was significantly higher among women with a history of stillbirth. Greater perinatal grief was associated with lack of support, maternal agreement with social norms, and younger maternal age. These predictors must be understood in light of an additional finding-distorted sex ratios, which reflect gender discrimination in the context of Indian society. The findings of this study will allow the development of a culturally appropriate health education program which should be designed to increase social support and address social norms, thereby reducing psychological distress to prevent complicated perinatal grief. Perinatal grief is a significant social burden which impacts the health women.

Cortisol activity partially accounts for a relationship between community socioeconomic position and atherosclerosis.

Compared to others, individuals living in communities of socioeconomic disadvantage experience more atherosclerotic cardiovascular disease (CVD) and a greater extent of preclinical atherosclerosis. Although the mechanisms underlying these associations remain unclear, it is widely hypothesized that alterations in normative cortisol release from the Hypothalamic Pituitary Adrenal (HPA) axis may play a role in linking lower community socioeconomic position (C-SEP) to CVD risk. The current study examined this hypothesis in relation to a marker of preclinical atherosclerosis among 488 healthy midlife adults (30-54 years, Mean age= 43, 52% Female, 81% White). All participants were employed and without clinical CVD. C-SEP was estimated from census tract data, and atherosclerosis was measured as intima-medial thickness of the carotid arteries (cIMT) by duplex ultrasonography. Four indicators of HPA activity [cortisol at awakening and the cortisol awakening response (CAR), rate of diurnal decline in cortisol (diurnal slope), and total output expressed as area under the curve (AUC)] were derived from salivary cortisol measurements obtained from 5 samples on each of 3 working days. Path analyses were used to examine associations of C-SEP with cIMT and HPA activity and to test whether individual differences in HPA activity could account for any association of C-SEP with cIMT using bootstrapping (5000 iterations). All models were adjusted for age, sex, race, and composite measures of both individual-level socioeconomic position (income, education, occupation), and cardiometabolic risk (systolic and diastolic blood pressure, waist circumference, fasting lipids and glucose). Lower C-SEP was related to both greater cIMT (b = -0.004, p = .021) and a flatter diurnal slope of cortisol (b = -0.001, p = .039). An indirect effect showed attenuated diurnal slope to partially mediate the relationship between C-SEP and cIMT (95% CI = -0.0018 to -0.0001), and a residual direct effect of C-SEP on cIMT remained significant (95% CI = -0.0097 to -0.004). These results suggest that low C-SEP associations with preclinical atherosclerosis may be due in part to correlated variation in adrenocortical activity.

Attitudes toward abortion, social welfare programs, and gender roles in the U.S. and South Africa.

Public abortion attitudes are important predictors of abortion stigma and accessibility, even in legal settings like the U.S. and South Africa. With data from the U.S. General Social Survey and South African Social Attitudes Survey, we used ordinal logistic regressions to measure whether abortion acceptability (in cases of poverty and fetal anomaly) is related to attitudes about social welfare programs and gender roles, then assessed differences by race/ethnicity and education. Social welfare program attitudes did not correlate with abortion acceptability in the U.S., but in South Africa, greater support for income equalization (OR: 0.59, 95% CI: 0.41-0.85) and increased government spending on the poor (OR: 0.66, 95% CI: 0.49-0.91) correlated with lower abortion acceptability in circumstances of poverty. This was significant for Black African and higher educated South Africans. In the U.S., egalitarian gender role attitudes correlated with higher acceptability of abortion in circumstances of poverty (OR: 1.18, 95% CI: 1.03-1.36) and fetal anomaly (OR: 1.15, 95% CI: 1.01-1.31). This was significant for White and less educated Americans. In South Africa, egalitarian gender role attitudes correlated with higher abortion acceptability for fetal anomaly (OR: 1.12, 95% CI: 1.01-1.25) overall and among Black and less educated respondents, but among non-Black South Africans they correlated with higher abortion acceptability in circumstances of poverty. These results suggest abortion attitudes are distinctly related to socioeconomic and gender ideology depending one's national context, race/ethnicity, and socioeconomic status. Reducing abortion stigma will require community-based approaches rooted in intersectional reproductive justice frameworks.

Palliative care at home: carers and medication management.

OBJECTIVE: The decision to receive palliative care at home brings with it the complexity of managing a medication regime. Effective symptom control is often directly linked to medication management and relies on access to medications at all times. In home-based palliative care practice, polypropylene syringes of medications may be drawn up and left in clients' domestic refrigerators for subcutaneous administration by carers to provide immediate relief for symptoms such as pain and nausea. However, although there has been some discussion in the literature about the need for ready access to medications for symptom control of clients receiving care in the community, the feasibility of this practice has received scant attention. The aim of this article is to present the carers' experiences of administering medications in this manner. METHODS: Semistructured interviews with 14 carers, who were administering medication in a home-based palliative care setting, were analyzed using qualitative methods to develop meaning units and themes. RESULTS: Interviews revealed that this practice was highly valued. The carers willingly assumed the responsibility of medication administration, as it allowed the clients to remain at home where they desired to be. They could provide immediate symptom relief, which was of utmost importance to both the client and carer. The carers were empowered in their caring role, being able to participate in the care provided, rather than standing on the sidelines as helpless observers. Carers acknowledged the security and ethical issues associated with the presence of certain medications in the home and valued the 24-h telephone support that was available to them. After clients had died, the carers reflected on their involvement in care and felt a sense of pride and achievement from administering medications in this way because they had been able to care for their loved ones at home and fulfill their wish to die there. SIGNIFICANCE OF RESULTS: These interviews confirm the feasibility of this practice, which is a component of quality end-of-life care.

Crisis management in the Australian tourism industry: Preparedness, personnel and postscript.

Since the pilots' strike of 1989, the Australian tourism industry has experienced a series of 'shocks' or crises which have included the 1991 Gulf War, the Asian economic crisis in 1997, the dotcom crash of 2000, the collapse of the HIH Insurance Company, the World Trade Centre attacks and the demise of Ansett Airlines in 2001, the Bali bombings in 2002 and the Iraq War and the outbreak of the SARS (severe acute respiratory syndrome) epidemic in 2003. In 2002, a research project was carried out in a range of sectors of the Australian tourism industry to investigate the impact of the collapse of the HIH Insurance Company, the World Trade Centre attacks and the demise of Ansett Airlines on these organisations and the range of responses adopted to these events. This paper describes the preparedness of organisations to respond to these events; the personnel or human resource (HR) strategies implemented and the postscript, the organisational learning which had occurred. Interview findings indicate that there was little preparation for such events, a widespread reluctance to retrench staff, and limited organisational learning had taken place.

Trait positive and negative emotionality differentially associate with diurnal cortisol activity.

Inter-individual variability in metrics of hypothalamic-pituitary-adrenocortical (HPA) activity, such as the slope of the diurnal decline in cortisol, cortisol awakening response (CAR), and total cortisol output, have been found to associate inversely with trait ratings of extraversion and positive affect (E/PA) and positively with neuroticism and negative affect (N/NA) in some, but not all, investigations. These inconsistencies may partly reflect varied intensity of cortisol sampling among studies and reliance on self-rated traits, which are subject to reporting biases and limitations of introspection. Here, we further examined dispositional correlates of HPA activity in 490 healthy, employed midlife volunteers (M age=43 years; 54% Female; 86% white). Trait ratings were requested from participants and 2 participant-elected informants using the Positive and Negative Affect Schedule (PANAS) and Extraversion and Neuroticism dimensions of NEO personality inventories. CAR was assessed as percent increase in cortisol levels from awakening to 30min after awakening; and the diurnal slope and total output of cortisol [Area Under the Curve (AUC)] were determined from cortisol measurements taken at awakening, +4 and +9h later, and bedtime, across 3 workdays. Structural equation modeling was used to estimate multi-informant E/PA and N/NA factors. We used 3days of measurement as indicators to model each of the three latent cortisol factors (slope, CAR, and AUC). With the two latent emotionality and three latent cortisol indices included there was good fit to the data (χ(2)(200)=278.38, p=0.0002; RMSEA=0.028, 90% CI=0.02-0.04; CFI/TLI=0.97/0.96; SRMR=0.04). After controlling for covariates (age, sex, race), results showed higher latent E/PA associated with a steeper diurnal slope (Standardized ß=-0.19, p=0.02) and smaller CAR (Standardized ß=-0.26, p=0.004), whereas N/NA did not associate with any cortisol metric (Standardized ß's=-0.12 to 0.13, p's=0.10 to 0.53). These findings suggest that positive emotionality may be more closely associated with indices of diurnal cortisol release than negative emotionality.

Exposure pathway evaluations for sites that processed asbestos-contaminated vermiculite.

The Agency for Toxic Substances and Disease Registry (ATSDR) is currently evaluating the potential public health impacts associated with the processing of asbestos-contaminated vermiculite at various facilities around the country. Vermiculite ore contaminated with significant levels of asbestos was mined and milled in Libby, Montana, from the early 1920s until 1990. The majority of the Libby ore was then shipped to processing facilities for exfoliation. ATSDR initiated the National Asbestos Exposure Review (NAER) to identify and evaluate exposure pathways associated with these processing facilities. This manuscript details ATSDR's phased approach in addressing exposure potential around these sites. As this is an ongoing project, only the results from a selected set of completed site analyses are presented. Historical occupational exposures are the most significant exposure pathway for the site evaluations completed to date. Former workers also probably brought asbestos fibers home on their clothing, shoes, and hair, and their household contacts may have been exposed. Currently, most site-related worker and community exposure pathways have been eliminated. One community exposure pathway of indeterminate significance is the current exposure of individuals through direct contact with waste rock brought home for personal use as fill material, driveway surfacing, or soil amendment. Trace levels of asbestos are present in soil at many of the sites and buried waste rock has been discovered at a few sites; therefore, future worker and community exposure associated with disturbing on-site soil during construction or redevelopment at these sites is also a potential exposure pathway.

Identifying intimate partner violence at entry to prenatal care: clustering routine clinical information.

Intimate partner violence (IPV) is the greatest trauma-related risk to American women. Pregnant women are no exception, and escalation of IPV frequently occurs during pregnancy. Many studies have linked IPV during pregnancy to adverse maternal and fetal outcomes. This study examined IPV at the beginning of prenatal care to identify correlates of routine entry-to-care information with responses on a validated IPV screening tool, the Abuse Assessment Screen. The purpose of the study was to identify specific data from routine, standard intake information, which could alert clinicians to the potential of violence even in the presence of a negative IPV score or no formally administered screening tool. The point prevalence of abuse, as measured by the Abuse Assessment Screen at entry to care, was slightly in excess of the national mean, reinforcing the need for continual assessment throughout pregnancy. Abused women in this study were more likely to be young, single, and without family or partner support. These women relied on friends for support, admitted to depression, and desired their pregnancies. The findings are consistent with previous studies. Further research needs to be conducted to determine if this cluster of findings at entry to care, with or without a positive score on an IPV screening tool, are consistent markers for an increased risk of IPV.

Pathways of decision making among Yucatan Mayan traditional birth attendants.

In rural, developing world communities, women are often isolated from biomedical services. Frequently, traditional birth attendants (TBAs) are the only caregivers during childbirth, both normal and complicated. Women trust their TBAs to manage their births. Globally, government and non-governmental organizations (NGOs) have sought to upgrade TBAs' skills and to encourage them to refer complications. However, most training programs have failed to change TBAs' practice substantially. Logistical barriers in reaching biomedical services in a timely manner are a key issue. Another is the difference between biomedical and traditional practitioners in the cognitive frameworks that shape decision making and management behaviors. The purpose of this study, conducted in Quintana Roo State, Mexico, was to listen to the voices of practicing Yucatec Maya TBAs (parteras) as they described decision making and management of complicated births. In-depth interviews with six practicing parteras in rural, isolated communities revealed that the parteras used traditional Maya ethnomedicine while valuing biomedical approaches. We isolated themes in decision making and mapped management of birth complications. Integrating TBAs' traditional knowledge into biomedical training programs is one way to honor their knowledge and make training relevant.

Grief and Women: Stillbirth in the Social Context of India.

INTRODUCTION: Few in Western society would argue the potentially devastating impact of stillbirth related grief; but in many developing countries where stillbirth remains the highest in the world, perinatal grief is barely recognized as an issue. The purpose of this study was to explore how poor, rural central Indian women perceive and cope with stillbirths. METHODS: Seventeen key informant interviews and two focus groups (N = 33) with local health care providers, family members, and women who experienced stillbirth were conducted over a 1-month period in 2011 and then systematically coded for emerging themes using grounded theory methods to explore how women experienced stillbirth. RESULTS: Although usually never talked about and not recognized as an issue, perinatal grief emerged as a significant shared experience by all. The perceptions of stillbirth-related grief emerged in three major themes and bear evidence of gender and power issues and indicate that local social norms negatively factor heavily into their perinatal grief experiences. DISCUSSION: The findings in this richly textured study add to the limited literature regarding rural, central Indian women's experiences with stillbirth and factors influencing their resulting perinatal grief. In light of the void of recognition of this phenomenon in Indian society, a better understanding of the context in which poor Indian women experience perinatal grief will be a first step toward developing much needed culturally rooted interventions to positively impact the women's abilities to better cope with stillbirth in the context of their realities.

Simply not there: the impact of international migration of nurses and midwives--perspectives from Guyana.

The shortage of nurses and midwives across the world and the migratory trends of these scarce professionals--primarily from low-income countries to fill staffing needs in high-income countries--are critical international health care issues. This article reviews some of the demographic, educational, and socioeconomic factors driving this global trend, the impact on health care delivery in low-income countries, and the effect on the implementation of global public health initiatives. Nurses and midwives migrate from low-income nations while concurrently qualified applicants are rejected from educational programs in high-income countries. The impact of migration on the viability of the health care delivery system in Guyana, South America, is presented as an exemplar nation within the broader global context of ethical dilemmas, pressures on educational systems, and the anti- and pro-migration arguments.