Uneasy allies: pro-choice physicians, feminist health activists and the struggle for abortion rights.

Abortion represents a particularly interesting subject for a social movements analysis of healthcare issues because of the involvement of both feminist pro-choice activists and a segment of the medical profession. Although both groups have long shared the same general goal of legal abortion, the alliance has over time been an uneasy one, and in many ways a contradictory one. This paper traces points of convergence as well as points of contention between the two groups, specifically: highlighting the tensions between the feminist view of abortion as a women-centred service, with a limited, 'technical' role for the physicians, and the abortion-providing physicians' logic of further medicalization/professional upgrading of abortion services as a response to the longstanding marginality and stigmatisation of abortion providers. Only by noting the evolving relationships between these two crucial sets of actors can one fully understand the contemporary abortion rights movement. We conclude by speculating about similar patterns in medical/lay relationships in other health social movements where 'dissident doctors' and lay activists are similarly seeking recognition for medical services that are controversial.

Identifying and caring for underserved populations: experience of the National Centers of Excellence in Women's Health.

From 1996 through 1998, 18 National Centers of Excellence in Women's Health (CoEs) were designated by the Office on Women's Health (OWH) of the U.S. Department of Health and Human Services (DHHS). These CoEs were charged with developing standards for comprehensive, multidisciplinary, and culturally competent approaches to women's health. One specific mandate to the CoEs was to address the needs of underserved women. This paper presents the efforts of the CoE Racial and Ethnic Minority and Underserved Women Working Group to describe the work done within the CoEs to meet this mandate. One method of defining underserved populations is the seven-point definition used in the current "Index for Primary Care Shortage," which categorizes underserved populations based on characteristics including race, ethnicity, geography, and health outcomes. The definition allows the local identification of underserved communities based on this group of variables. The analysis included in this paper focuses specifically on the CoEs' efforts to operationalize this definition in order to meet the clinical care needs of women who are of low socioeconomic status (SES), racial or ethnic minorities, or non-English speaking. A brief review of the literature linking these characteristics to being underserved is provided, followed by examples of ongoing activities at the 15 currently funded CoEs, to understand the needs of diverse women, to improve the quality of care provided to women, and to address healthcare needs of underserved women who meet this definition. Efforts to serve three additional underserved populations defined by age, sexual orientation, and disability status are also presented.

Challenges of recruitment: focus groups with research study recruiters.

To rectify the historic lack of research on women's health and the exclusion of women from many significant clinical trials, regulations have been promulgated requiring the inclusion of women and minorities in research studies. Acknowledging that the National Institutes of Health (NIH) mandate has resulted in more inclusive research, the unintended consequences associated with implementation of these regulations must also be explored. While the requirements preclude the use of cost as a reason for excluding women and/or minorities, the additional funding necessary to recruit adequate numbers of study participants has not been provided. Consequently, study recruiters often face unacknowledged expectations and job pressures as they attempt to meet recruitment goals. While it is important to support the NIH mandate, the additional stress imposed upon research study recruiters must also be recognized. Focus groups with study recruiters from various backgrounds and types of research provide an understanding of the challenges recruiters face when attempting to recruit diverse populations of women into research, and provide an understanding of the impact of recruitment goals on study recruiters' job satisfaction.