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February 2009 RNR

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Below is the newest installation of Research News Reporter (RNR) Online. Previous editions can be viewed in the Archives.

 

February 2009

IWPR’s Research News Reporter is distributed to highlight informative, innovative, and sometimes controversial research related to women and their families.

Research Making News
1 . “For Privacy’s Sake: Taking Risks to End Pregnancy”
2. “UA Study Faults Treatment of Female Immigration Detainees”
3. “Religion Today”
4. “Study Identifies Gender Bias in Kidney Transplants”

Research Reports
1. Paid Sick Days in Massachusetts: Containing Health Care Costs Through Prevention and Timely Treatment
2. Providing Maternity Care to the Underserved: A Comparative Case Study of Three Maternity Care Models Serving Women in Washington, D.C.
3. Equal Pay for Breadwinners: More Men are Jobless While Women Earn Less for Equal Work

Research Making News

Each selection includes a short excerpt, link to the news article, and link to the research cited:

1. “For Privacy’s Sake, Taking Risks to End Pregnancy”

New York Times
By Jennifer B. Lee and Cara Buckley
January 5, 2009

Citing: An ongoing study by project partners Ibis Reproductive Health and Gynuity Health Projects and a 2000 study titled, “The Knowledge, Acceptability, and Use of Misoprostol for Self-Induced Medical Abortion in an Urban US Population,” by Mark A. Rosing and Cheryl D. Archbald.

[…] Two new studies by reproductive-health providers suggest that improper use of such drugs is one of myriad methods, including questionable homemade potions, frequently employed in attempts to end pregnancies by women from fervently anti-abortion cultures despite the widespread availability of safe, legal and inexpensive abortions in clinics and hospitals.

One study surveyed 1,200 women, mostly Latinas, in New York, Boston and San Francisco and is expected to be released in the spring; the other, by Planned Parenthood, involved a series of focus groups with 32 Dominican women in New York and Santo Domingo. Together, they found reports of women mixing malted beverages with aspirin, salt or nutmeg; throwing themselves down stairs or having people punch them in the stomach; and drinking teas of avocado leaf, pine wood, oak bark and mamon fruit peel.

[…] “Some women prefer to have a more private experience with their abortion, which is certainly understandable,” said Dr. Daniel Grossman, an obstetrician with Ibis Reproductive Health in San Francisco, which joined Gynuity Health Projects in New York in conducting the larger study.

[…] Dr. Carolyn Westhoff, an obstetrician at New York-Presbyterian/Columbia University Medical Center, said the trend fits into a larger context of Dominicans seeking home remedies rather than the care of doctors or hospitals, partly because of a lack of insurance but mostly because of a lack of trust in the health care system. “This is not just a culture of self-inducted abortion,” she said. “This is a culture of going to the pharmacy and getting the medicine you need.”

[…] In a study of 610 women at three New York clinics in largely Dominican neighborhoods conducted eight years ago, 5 percent said they had taken misoprostol themselves, and 37 percent said they knew it was an abortion-inducing drug. Doctors and community leaders say they have not seen any signs of the phenomenon disappearing, which they find worrisome because of concerns about the drug’s effectiveness and potential side effects.

[…] Researchers studying the phenomenon cite several factors that lead Dominican and other immigrant women to experiment with abortifacients: mistrust of the health-care system, fear of surgery, worry about deportation, concern about clinic protesters, cost and shame […].”

To view the full article, click here.

To access a PDF of the 2000 study cited in the article, click here.  To read about the ongoing Ibis Reproductive Health and Gynunity Health Projects study, click here.

2. “UA Study Faults Treatment of Female Immigration Detainees”

Tucson Citizen
By Arthur H. Rotstein
January 14, 2009

Citing: “Unseen Prisoners: A Report on Women in Immigration Detention Facilities in Arizona,” a report issued by the Southwest Institute for Research on Women.

“Women held in three immigration detention facilities in Arizona receive inadequate treatment, ranging from deficient medical care to being mixed in with people serving criminal sentences, University of Arizona researchers said Tuesday.

The report issued by the Southwest Institute for Research on Women criticized Immigration and Customs Enforcement, the federal agency responsible for detaining immigrants facing administrative deportation hearings, for a variety [of] shortcomings.

It focused on such issues as failing to recognize mental health needs, family separation, inadequate access to telephones and legal materials and severe penal conditions, such as shackling, for women who are not serving criminal sentences.

[…] The study also took ICE to task for aggressive government prosecution and detention of women who pose no security threat or flight risk.

“There is, under the law, mandatory detention for a great number of immigrants. But then there are many immigrants who aren't subject to mandatory detention that they're still insisting on detaining,” said the study's author, Nina Rabin, the institute's director of border research and co-director of the immigration clinic at the university's James E. Rogers College of Law.

[…] But Katrina S. Kane, ICE detention and removal field director in Arizona, noted that the study itself said its information was drawn from a small number of participants not necessarily representative of the entire detainee population, and that researchers relied on anonymous detainees' self-reporting, without independent corroboration.

Those interviewed represent less than 0.0003 percent of more than 72,000 immigrants detained in Arizona before being deported in fiscal 2008, Kane said.

[…] Third-year law students interviewed a total of 42 people, including 21 women who were or had been detainees. Two were detainees' family members and 19 were lawyers or social workers.  Researchers were not allowed to interview ICE personnel or staffers from the detention facilities.  University anthropologist Ted Downing, a former state legislator, said the method used for the study was valid, defensible and common.”

To view the full article, visit the Tucson Citizen online.

To read “Unseen Prisoners: A Report on Women in Immigration Detention Facilities in Arizona,” click here to view the PDF.

3. “Religion Today”

Washington Post
By Rose French, Associated Press
January 21, 2009
Citing:  The United Methodist Lead Women Pastor Project, an on-going eight month study by the United Methodist Church.

“The United Methodist Church, which boasts a history of ordaining women clergy, is seeking to shatter the so-called "stained-glass ceiling" blocking female pastors from its largest pulpits.

The nation's second largest Protestant denomination has launched a new initiative, the Lead Women Pastor Project, to examine barriers to women being appointed pastors to Methodist churches with more than 1,000 members.


The Nashville-based United Methodist Church has a total of 44,842 clergy, and about 10,000 are female—or 23 percent. Yet just 85 women lead those largest churches, compared to 1,082 men in those positions.

The project aims to research leadership styles of women who head these large churches and encourage more female leaders by building a mentoring program for women with potential to serve large congregations.


Church leaders say more women are needed to shepherd the large churches, considering that women make up more than half of those enrolled in master of divinity programs in United Methodist seminaries. Also, nearly 58 percent of the 8 million-member denomination is female.

“Coming from that perspective it's almost natural we pay more attention to the development of women's leadership in the church," said the Rev. HiRho Park, the project's director. "It's breaking the stained-glass ceiling. I think it gives a younger generation of women hope to have a collective vision for the future […].”

To read the full article, click here.

To learn more about the United Methodist Lead Women Pastors Project or to contact one of the project leaders, click here.

4. “Study Identifies Gender Bias in Kidney Transplants”

HealthNews
By Madeline Ellis
January 22, 2009

Citing:  “Outcomes of Transplanting Deceased-Donor Kidneys Between Elderly Donors and Recipients” by Markus Giessing, et al., published in the January issue of the Journal of the American Society of Nephrology.

“Because of a shortage in donor organs, many Americans with chronic kidney disease wait years for a transplant, and some die before ever making it to the first stage of the process. To add insult to injury, a recent study found strong evidence that women over 45 have a significantly less chance of being placed on a kidney transplant list than their male counterparts, even though women who receive a transplant have an equal or slightly better chance of survival.

“This is different from most factors that create access to transplant disparities, such as obesity and race,” said lead researcher Dr. Dorry Segev. “Those disparities continue even once you’ve been listed—for example, blacks are less likely to get listed and, once they’re listed, are also less likely to receive a transplant.”

In order to determine access to transplantation (ATT), either through deceased donor or live-donor transplant, and survival benefits from transplantation, researchers at Johns Hopkins Medical Institutions in Baltimore examined data from the United States Renal Data System on 563,197 patients who developed end-stage kidney disease from 2000 to 2005. They found that women 45 and younger were as likely as men the same age to be placed on a transplant waiting list, but by the time women were 46 to 55, they were 3 percent less likely to be listed. The disparity grew even greater with each decade. At ages 56 to 65, women were 15 percent less likely to be placed on the list; 29 percent less likely at 66 to 75; and 59 percent less likely by the time they were 75 or older. The chance of a woman getting listed was even worse if she had additional diseases such as diabetes or heart disease. “This study suggests that there is no disparity in ATT for women in general but rather a marked disparity in ATT for older women and women with co-morbidities,” the authors concluded.

Dr. Segev said he believes the gender gap is because older women are perceived to be frailer than they really are, which subconsciously factors into the listing process. Two main steps determine who is placed on the United Network for Organ Sharing kidney transplant list: referral by a nephrologist and how the patient decides to act on that referral. “It appears as though either the nephrologist believes women have a worse chance of survival or some women don’t think they will have a good outcome,” Segev said. “Once they are listed, however, women and men have an equal chance of getting a kidney, regardless of age […].”

To read the full article, click here.

To read more about the study, click here to visit the Journal of the American Society of Nephrology.

Research Reports

Each selection includes a short excerpt from the research and a link to the report:

1. Paid Sick Days in Massachusetts: Containing Health Care Costs Through Prevention and Timely Treatment

Vicky Lovell and Kevin Miller
Institute for Women’s Policy Research
January 2009

“Massachusetts' proposed Paid Sick Days Act is a natural partner to bring cost control to the Commonwealth's expanded health care system. The Massachusetts Health Care Reform Law's universal health care requirement extended health insurance to nearly 440,000 individuals in its first two years (Commonwealth Health Insurance Connector Authority 2008). According to the Massachusetts Department of Revenue, the program has nearly eliminated uninsured status among state taxpayers. However, the program's cost has been much higher than anticipated. Funding for Fiscal Year 2008 was increased by nearly one-third through a supplemental budget request, to $625 million, and the Fiscal Year 2009 budget pegs the program at forty percent more: $869 million.

Rising funding requirements, combined with the law’s original mandate that a new Health Care Quality and Cost Council promulgate information on cost containment, have sparked interest in enhancing preventive care to reduce overall health care spending. This focus may include incentives for healthy living and better management of chronic diseases (Cheney 2008).

Expanded access to paid sick days could help the state meet its cost-containment goals. The proposed Paid Sick Days Act would make it easier for workers to get regular, appropriate care for chronic illnesses and timely treatment for acute medical needs, while reducing the spread of contagious illness.2 Research shows that offering sick days to all Massachusetts workers would yield significant savings to employers, workers, and taxpayers (Lovell 2005). Massachusetts’ Secretary of Health and Human Services Dr. Judy Ann Bigby has noted that, without paid sick days, some workers turn to costly emergency room services rather than scheduling appointments with primary care doctors (Lazar 2008). Since workers who are in poor health are less likely to have paid sick days than their healthier co-workers (Bhatia et al. 2008), improving paid sick days coverage would target precisely the group most at risk of needing health care services, removing a barrier to getting those services in a timely and less costly manner than with a trip to a hospital’s emergency department (Baker and Baker 1994).

Paid sick days are a natural complement to universal health insurance. Together, these policies promote health and reduce health care costs by helping workers access preventive, timely, and lower-cost health services while reducing workplace injuries and the spread of disease […] .”

To download a PDF of the full briefing paper, visit the Institute for Women’s Policy Research website or click here.

2. Providing Maternity Care to the Underserved: A Comparative Case Study of Three Maternity Care Models Serving Women in Washington, D.C.

By Louise Palmer, Allison Cook, and Brigette Courtot
Urban Institute
January 2009

“The District of Columbia is home to some of the worst pregnancy outcomes in the country, including very high rates of infant mortality, preterm birth, low birth weight, and high cesarean section rates (Martin et al. 2006; Mathews et al. 2007). African American women and their babies in particular exhibit worse birth outcomes than white or Latina women in the District (Martin et al. 2006; Mathews et al. 2007). Residents in wards 5, 6 and 7 in the District (situated in the North and East of the city) are predominately African American and low-income. This comparative case study aims to understand how obstetric care provided under three models varies and how it might be improved to better serve this population.

The first of the three models is a city birth center that provides prenatal care, birth services, postpartum follow-up, and infant and child health care. Certified nurse-midwives (CNMs) are the primary maternity care providers. Women meeting established criteria (see Appendix A) can choose to either give birth at the birth center or at a nearby teaching hospital, attended by a birth center CNM regardless of birth location. Women in Wards 5, 6, and 7 might also receive maternity care through one of D.C.’s ten Federally Qualified Health Care Centers (FQHCs). This study focuses on one of these safety net clinics, which provides a variety of primary health care services, as well as prenatal care services. The care model at the safety net clinic uses CNMs and obstetricians to provide prenatal and postnatal care. The safety net clinic collaborates with the teaching hospital to provide easy access to the hospital’s obstetric and gynecological services. Under this arrangement, hospital obstetricians provide prenatal care at the FQHC a few days a week. Most women receiving their prenatal care at the safety net clinic give birth at the teaching hospital. The not-for-profit teaching and research hospital represents a third and different option for women in the city. The hospital provides prenatal and postnatal care through an on-site obstetric clinic where women receive care from either residents or a nurse practitioner. The hospital has a maternity wing for births where residents are the main care providers supervised by attending physicians, and supported by nurses.

This report presents a descriptive overview of each model of maternity care in a case study format, including how maternity services are delivered to women in Wards 5, 6, and 7 under each model, what composes the content of the care, and how the care is perceived by women and providers. A forth-coming paper will provide a comparative analysis of each model which will also discuss the implication of models of maternity care on cost-effectiveness and service delivery efficiency (also see Appendix B for a matrix comparing the key characteristics of care across the three study sites). We hope the results will inform a future impact study of the effects of different models of birth care on birth outcomes, and cost-effectiveness.”

To download a PDF of the full report, click here to visit the Urban Institute’s project page.

3. Equal Pay for Breadwinners: More Men are Jobless While Women Earn Less for Equal Work

Heather Boushey
Center for American Progress
January 2009

“The current recession is entering its second year and looks quite likely to become the worst recession in terms of job losses of any since the Great Depression. Since this recession offi­cially began in December 2007, employers have shed 2.6 million employees—a decline of 1.9 percent—with most of that occurring in the last four months of 2008. Not all groups, however, have been affected equally: Over the first year of this recession, job losses and unemployment have spiked higher for male workers than their female counterparts.

This recession began with the bursting of the housing bubble, which has led to sharp job losses in male-dominated industries, especially construction, through 2008. As a result, the share of men in the United States with a job is at its lowest point ever, 69.7 percent. Over the past year, however, women’s jobs have been sustained by hiring in the govern­ment and health care sectors. As a result, since the recession officially began adult women’s unemployment has risen by 1.6 percentage points, to 5.9 percent in December 2008, from 4.3 percent a year earlier, while adult men’s unemployment has risen by 2.8 percentage points, to 7.2 percent from 4.4 percent over the same period. There has been only one other time since 1949 that men’s unemployment has been this much higher than women’s, in 1983, at the height of the high unemployment of the early 1980s recession.

With so many men out of work, it is clear that more families are relying on women work­ers to make ends meet. As women increasingly take on the role of breadwinner, ensuring that they get a fair wage is taking on more urgency than ever before. Nearly half a century after passage of the Equal Pay Act, women continue to earn less than men, even if they have similar educational levels and work in similar kinds of jobs as their male co-workers. Among full-time, full-year workers, women earn only 78 cents for every dollar a man earns. Earlier this month, the House of Representatives passed the Lilly Ledbetter Fair Pay Act and the Paycheck Fairness Act—legislation that will ensure equal pay for equal work—and is now waiting for action from the Senate. This legislation could not be more timely and more important to the millions of families relying on women’s wages.

There are no signs that the worst of the labor market turmoil is behind us. As of December 2008, the decline in employment as a share of peak employment is larger in the current recession than at this point during all of the recessions in recent memory. To help families make ends meet through this recession, policymakers need to focus on a recovery and reinvestment package that gets people back to work, but they also need to remember that those workers still employed must be paid a fair day’s wage. In the pages that follow, this report will detail the gender trends that underlie the current recession, and then briefly examine the options male and female unemployed workers have to reenter the workforce amid this increasingly brutal economic downturn. Our analysis underscores the impor­tance of equal pay for equal work in this recession.”

To access a PDF of the full report, click here

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