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Objectives. The aim of the present study was to provide qualitative insights from urban-based junior doctors (graduation to completion of speciality training) of the effect of rural placements and rotations on career aspirations for work in non-metropolitan practices. Methods. A qualitative study was performed of junior doctors based in Adelaide, Brisbane and Melbourne. Individual face-to-face or telephone semistructured interviews were held between August and October 2014. Thematic analysis focusing on participants' experience of placements and subsequent attitudes to rural practice was undertaken. Results. Most participants undertook rural placements in the first 2 years after graduation. Although experiences varied, positive perceptions of placements were consistently linked with the degree of supervision and professional support provided. These experiences were linked to attitudes about working outside metropolitan areas. Participants expressed concerns about being 'forced' to work in non-metropolitan hospitals in their first postgraduate year; many received little warning of the location or clinical expectations of the placement, causing anxiety and concern. Conclusions. Adequate professional support and supervision in rural placements is essential to encourage junior doctors' interests in rural medicine. Having a degree of choice about placements and a positive and supported learning experience increases the likelihood of a positive experience. Doctors open to working outside a metropolitan area should be preferentially allocated an intern position in a non-metropolitan hospital and rotated to more rural locations. [ABSTRACT FROM AUTHOR]

Background In Australia, maternity care is available through universal coverage and a parallel, competitive private health insurance system. Differences between sectors in antenatal and intrapartum care and associated outcomes are well documented but few studies have investigated differences in postpartum care following hospital discharge and their impact on maternal satisfaction and confidence. Methods Women who birthed in Queensland, Australia from February to May 2010 were mailed a self-report survey 4 months postpartum. Regression analysis was used to determine associations between sector of birth and postpartum care, and whether postpartum care experiences explained sector differences in postpartum well-being (satisfaction, parenting confidence and feeling depressed). Results Women who birthed in the public sector had higher odds of health professional contact in the first 10 days post-discharge and satisfaction with the amount of postpartum care. After adjusting for demographic and postpartum contact variables, sector of birth no longer had an impact on satisfaction (AOR 0.95, 99% CI 0.78-1.31), but any form of health professional contact did. Women who had a care provider's 24 hour contact details had higher odds of being satisfied (AOR 3.64, 95% CI 3.00-4.42) and confident (AOR 1.34, 95% CI 1.08- 1.65). Conclusion Women who birthed in the public sector appeared more satisfied because they had higher odds of receiving contact from a health professional within 10 days post-discharge. All women should have an opportunity to speak to and/or see a doctor, midwife or nurse in the first 10 days at home, and the details of a person they can contact 24 hours a day. [ABSTRACT FROM AUTHOR]

Background: Reduced length of hospital stay following childbirth has placed increasing demands on community-based post-birth care services in Australia. Queensland is one of several states in Australia in which nurses are employed privately by pharmacies to provide maternal and child health care, yet little is known about their prevalence, attributes or role. The aims of this paper are to (1) explore the experiences and perspectives of a sample of pharmacy nurses and GPs who provide maternal and child health services in Queensland, Australia (2) describe the professional qualifications of the sample of pharmacy nurses, and (3) describe and analyze the location of pharmacy nurse clinics in relation to publicly provided services. Methods: As part of a state-wide evaluation of post-birth care in Queensland, Australia, case studies were conducted in six regional and metropolitan areas which included interviews with 47 key informants involved in postnatal care provision. We report on the prevalence of pharmacy nurses in the case study sites, and on the key informant interviews with 19 pharmacy nurses and six General Practitioners (GPs). The interviews were transcribed and analysed thematically. Results: The prevalence of pharmacy nurses appears to be highest where public services are least well integrated, coordinated and/or accessible. Pharmacy nurses report high levels of demand for their services, which they argue fill a number of gaps in the public provision of maternal and child health care including accessibility, continuity of carer, flexibility and convenient location. The concerns of pharmacy nurses include lack of privacy for consultations, limited capacity for client record keeping and follow up, and little opportunity for professional development, while GPs expressed concerns about inadequate public care and about the lack of regulation of pharmacy based care. Conclusions: Pharmacy based clinics are a market-driven response to gaps in the public provision of care. Currently there are no minimum standards or qualifications required of pharmacy nurses, no oversight or regulation of their practice, and no formal mechanisms for communicating with other providers of postnatal care. We discuss the implications and possible mechanisms to enhance best-practice care. [ABSTRACT FROM AUTHOR]

Background: The postpartum period is a time of increased morbidity for mothers and infants under 12 months, yet is an under-researched area of primary care. Despite a relatively clear framework for involving general practitioners (GPs) in antenatal care, the structure of maternity service provision in some Australian jurisdictions has resulted in highly variable roles of general practice in routine postpartum care. This study aimed to investigate the views and experiences of mothers and GPs about postpartum care in general practice. Methods: This was a qualitative study of mothers and GPs in rural, regional and metropolitan areas of Queensland, Australia. Semi-structured interviews were conducted with 88 mothers and six general practitioners between September 2010 and February 2012. Interviews were recorded and transcribed verbatim. Data were analysed thematically and compared across groups. Results: Three main themes emerged: The relationship between the mother and GP; practice management; and GP visits. This paper focuses on the theme GP visits and its subthemes: recommendations for GP visits; scope of practice; and content of a routine visit. Recommendations about GP visits given to mothers varied by birthing sector, obstetric provider and model of maternity care resulting in confusion amongst mothers about the timing and role of GPs in routine postpartum care. Similarly, GPs voiced concerns about a lack of consistent guidelines for their involvement in routine postpartum care. Although ideally placed to provide primary care to mothers and their infants in the postpartum period, the lack of consistent guidelines for the role of GPs is of concern to both the GPs and early parenting women. Conclusion: General practice is an important source of postpartum care for mothers and provides a basis for ongoing support for the family. More consistent guidelines and better coordination with other care providers would benefit both mothers and GPs. [ABSTRACT FROM AUTHOR]

Abstract: Since the 1970s, governments in many high-income countries have implemented a series of reforms in their health care systems to improve efficiency and effectiveness. Many of these reforms have been of a market-oriented character, involving the deregulation of key services, the creation of competitive markets, and the privatization of health and social care. Some scholars have argued that these “neoliberal” reforms have unseated the historical structural embeddedness of medicine, and in some cases even resulted in the proletarianisation of physicians. Other scholars have challenged this view, maintaining that medical hegemony continues to shape health care provision in most high-income countries. In this paper we examine how policy reforms may have altered medical dominance over maternity care in two comparatively similar countries – Canada and Australia. Our findings indicate that neoliberal reforms in these two countries have not substantially changed the historically hegemonic role medicine has played in maternity care provision. We discuss the implications of this outcome for the increased medicalisation of human reproduction. [Copyright &y& Elsevier]

The proliferation of home health care workers is an increasingly important trend in many contemporary societies, and its impact on the division of labour and the social meaning of care work is complex. In this article, these issues are analysed in relation to a new programme of domiciliary postnatal care in Australia. Coupled with early discharge from hospital, the programme is part of a reconfiguration that disrupts existing logics of care. The insertion of paid carers into the division of labour between 'functionally diffuse', informal care and the 'functional specificity' of professionals' work renders their status liminal, and their spatial location within the home transgresses symbolically important boundaries. Birthing women's responses include unease and a rejection of the workers based on the construction of them as 'strangers'. It is argued that these responses demonstrate the lack of a 'typification' based on contextual and spatialized knowledge of home health care workers [ABSTRACT FROM AUTHOR]

For more than a decade, there has been a strong trend in many Western countries to decrease the length of time that women spend in hospital following childbirth. The research evidence regarding the consequences of early discharge for mothers and babies is mixed. Recent evidence has suggested that early discharge may not be randomly distributed across all sociodemographic groups of birthing women, and that the structures of home care have an important influence on maternal and child outcomes. In the context of decreasing lengths of hospital stay, the aim of the present study was to evaluate a new postnatal home support worker introduced into a geographically defined catchment area of a metropolitan hospital in South Australia. The evaluation included a formative process component to monitor recruitment strategies into the programme, as well as summative evaluation of a number of projected programme outcomes. The research methods used included interviews with antenatal women ( n = 20) about their knowledge of and attitudes to the programme, and interviews with postnatal women ( n = 63) about their transition home experience and assessment of the programme. Secondary analysis of client satisfaction surveys ( n = 163) and aggregate breast-feeding data was also conducted. The results concur with previous research findings regarding the importance of rest and practical, home-based support in the postnatal period to maternal well-being, successful bonding and transition to motherhood. The results demonstrate the importance of well-structured home support services to maternal satisfaction and maternal well-being through the provision of physical, social and emotional care and support in the home. [ABSTRACT FROM AUTHOR]

There have been significant changes in the way that maternity services have been organised in recent years. One of the most dramatic has been the significant reduction of time women spend in hospital following childbirth. Yet despite this there has been little debate about whether additional home and community-based support services might be needed for mothers and their newborn infants. At the same time, though, there has been a seemingly parallel occurrence - growing emphasis on the importance of 'early intervention' (including the antenatal as well as the postnatal period) to maximise the health and wellbeing of infants and their mothers. This involves the identification of 'at risk' families and children, and service provision or surveillance that is home or community-based. Two recently implemented strategies in South Australia target maternal and child health in the postnatal period. One is a local program which provides home-based support (the 'Mothercarer' program). The other is a South Australian government sponsored Universal Home Visiting Program called Every Chance for Every Child. While there are variations in the emphases of the programs, it is suggested that an important trend in policy regarding the postnatal period involves an elision between two kinds of objectives: maternal support in the home, and 'early intervention' to minimise the risk of health and social problems. Furthermore, it could be argued that risk assessment through surveillance is being seen as at least as important, if not even more important, than the provision of support. Finally, the trend to early discharge, going hand in hand with the emphasis on surveillance of these programs, suggests a loosening of the medicalised appropriation of the postnatal period in favour of a wider social panopticon. [ABSTRACT FROM AUTHOR]

Water scarcity in urban environments is an issue of increasing concern in Australia and many other parts of the world. Technological solutions include recycling municipal effluent, which can be treated to a standard suitable for nonpotable uses such as garden watering and toilet flushing. Successful operation of such solutions requires institutional arrangements for long-term management, as well as public awareness and cooperation to establish safe practices. This article reports on research undertaken at four case study sites in Australia and the United States and identifies the social and management issues important to the success of water reuse projects. The cross-national findings demonstrate that best practice in residential water reuse technology should be coupled with institutional and structural arrangements that inform and involve the public and provide transparent governance. It is suggested that this combination of technical and social structural elements will facilitate a sustained trust in, and acceptance of, water reuse. [ABSTRACT FROM AUTHOR]

This paper analyses the birthing narratives of 50 Australian women to explore their representations of their birthing experiences. Through the analysis, issues of power, identity and control in childbirth are explored, particularly with respect to the major discursive categories framing childbirth. The birthing narratives of the women in this study revealed significant differences in orientation to first birth according to women's social class, but also revealed significant shifts in identity and empowerment with subsequent births. These findings differ significantly from existing accounts of power relations in childbirth, which have tended either to universalise women, or, in more recent post-structuralist accounts, to abandon the notion of socially structured differences between women altogether. The findings of this research indicate that social class has a strong effect in the shaping of identity, but that these differences can be transcended by the experience of childbirth itself, which is a critical reflexive moment in many women's lives. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To examine the effects of timing of return to work, number of hours worked, and their interaction, on the likelihood of breastfeeding at 6 months and predominant breastfeeding at 16 weeks. METHODS: A nationally representative sample of Australian mothers in paid employment in the 13 months before giving birth [n = 2300} were surveyed by telephone. Four multivariate logistic regression models were used to analyze the effects of timing of return to work and work hours, independently and in interaction, on any breastfeeding at 6 months and on predominant breastfeeding at 16 weeks, controlling for maternal sociodemographics, employment patterns, and health measures. RESULTS: Mothers who returned to work within 6 months and who worked for >20 hours per week were significantly less likely than mothers who had not returned to work to be breastfeeding at 6 months. However, returning to work for ≤19 hours per week had no significant impact on the likelihood of breastfeeding regardless of when mothers returned to work. Older maternal age, higher educational attainment, better physical or mental health, managerial or professional maternal occupation, and being self-employed all significantly contributed to the increased likelihood of any breastfeeding at 6 months. Similar patterns exist for predominant breastfeeding at 16 weeks. CONCLUSIONS: The effects of timing of return to work are secondary to the hours of employment. Working ≤19 hours per week is associated with higher likelihood of maintaining breastfeeding, regardless of timing of return to work. [ABSTRACT FROM AUTHOR]

Background: Reduced length of hospital stay following childbirth has placed increasing demands on community-based post-birth care services in Australia. Queensland is one of several states in Australia in which nurses are employed privately by pharmacies to provide maternal and child health care, yet little is known about their prevalence, attributes or role. The aims of this paper are to (1) explore the experiences and perspectives of a sample of pharmacy nurses and GPs who provide maternal and child health services in Queensland, Australia (2) describe the professional qualifications of the sample of pharmacy nurses, and (3) describe and analyze the location of pharmacy nurse clinics in relation to publicly provided services.Methods: As part of a state-wide evaluation of post-birth care in Queensland, Australia, case studies were conducted in six regional and metropolitan areas which included interviews with 47 key informants involved in postnatal care provision. We report on the prevalence of pharmacy nurses in the case study sites, and on the key informant interviews with 19 pharmacy nurses and six General Practitioners (GPs). The interviews were transcribed and analysed thematically.Results: The prevalence of pharmacy nurses appears to be highest where public services are least well integrated, coordinated and/or accessible. Pharmacy nurses report high levels of demand for their services, which they argue fill a number of gaps in the public provision of maternal and child health care including accessibility, continuity of carer, flexibility and convenient location. The concerns of pharmacy nurses include lack of privacy for consultations, limited capacity for client record keeping and follow up, and little opportunity for professional development, while GPs expressed concerns about inadequate public care and about the lack of regulation of pharmacy based care.Conclusions: Pharmacy based clinics are a market-driven response to gaps in the public provision of care. Currently there are no minimum standards or qualifications required of pharmacy nurses, no oversight or regulation of their practice, and no formal mechanisms for communicating with other providers of postnatal care. We discuss the implications and possible mechanisms to enhance best-practice care. [ABSTRACT FROM AUTHOR]

Ensuring adequate water supplies in urban Australia is a problem of considerable concern to State and federal governments. A variety of technical solutions are available, including water recycling. While there has been policy support for water recycling, public perceptions are seen by industry stakeholders as a significant impediment to the implementation of recycled water schemes. This article reports baseline data on attitudes to water recycling and its uses in a representative sample of Australians from major urban areas. Sociological frameworks for interpreting the results focus on understanding how people assess the risks associated with recycled water. Three perspectives are outlined, and their consistency with the survey results is analysed. The epistemologically realist view, often the fallback of water professionals and policy makers, is shown to have limited applicability. An interpretation focused on the cultural meanings associated with different forms and uses of water is found to be consistent with many aspects of Australians' expressed views about water recycling, as is a view focused on the `risk society' thesis. The article considers the implications of these findings. [ABSTRACT FROM AUTHOR]

The article discusses various reports published within the issue, including one on the changing articulation between state policies and family character and forms and an article about the growth of sole parenthood which has been a feature of the demographic change characterizing household and family forms for some decades.

Governments are increasingly implementing policies that encourage early father-infant bonding. However, to date, research has not systematically examined fathers’ perspectives and experiences of early bonding. Using a social constructionist embodiment perspective we argue that paternal bonding is best conceived as a process of repeated, embodied performances that are shaped by gendered parenting discourses. Drawing on 100 semi-structured interviews with a diverse group of Australian fathers of young infants, we argue that most men believe they are capable of developing early strong bonds. They assume that bonding is a product of spending sufficient time with a child, irrespective of the parent's gender. In contrast, a sizable minority of fathers assert that physiology means fathers are ‘largely useless’ to very young infants, and tend to remain distant in the early months. We conclude that social policies promoting early paternal bonding must engage with and challenge gendered/physiological discourses. [ABSTRACT FROM AUTHOR]

Retrenchment of government services has occurred across a wide range of sectors and regions. Care services, in particular, have been clawed away in the wake of fiscal policies of cost containment and neoliberal policies centred on individual responsibility and market autonomy. Such policies have included the deinstitutionalisation of care from hospitals and clinics, and early discharge from hospital, both of which are predicated on the notion that care can be provided informally within families and communities. In this paper we examine the post-birth "care crisis" that new mothers face in one region of Canada. Method: The data are drawn from a larger study of social determinants of pregnant and new mothers' health in Victoria, Canada. Mixed methods interviews were conducted among a purposive sample of women at three points in time. This paper reports data on sample characteristics, length of stay in hospital and health service gaps. This data is contextualised via a more in-depth analysis of qualitative responses from Wave 2 (4-6 weeks postpartum). Results: Out results show a significant portion of participants desired services that were not publically available to them during the post-birth period. Among those who reported a gap in care, the two most common barriers were: cost and unavailability of home care supports. Participants' open-ended responses revealed many positive features of the public health care system but also gaps in services, and economic barriers to receiving the care they wanted. The implications of these findings are discussed in relation to recent neoliberal reforms. Discussion & conclusions: While Canada may be praised for its public provision of maternity care, mothers' reports of gaps in care during the early postpartum period and increasing use of private doulas is a worrying trend. To the extent that individual mothers or families rely on the market for care provision, issues of equity and quality of care are pivotal. This paper concludes with suggestions for further research on the impact of recent changes in post-birth care on new fathers and on inequities in pre and post-birth care in less-resourced regions of the world. [ABSTRACT FROM AUTHOR]

Despite heightened concerns about levels of obesity and overweight in Western societies, there is a relative absence of sociological research into the subjective experience of dieting, especially for men. This paper focuses on findings related to the male participants from a qualitative study of fourteen volunteers (six female and eight male) drawn from a larger clinical trial comparing two diet conditions. Semi-structured interviews were conducted in two stages to gain an in-depth understanding of the experience of dieting, and found that these men understood and practiced their dieting in different ways from the women, but also from each other, depending on their notions of masculinity. Some were eager to reframe their dieting in 'more manly' terms. The social support or sabotage received from friends and family is significant to these experiences of dieting. This paper discusses how men understand and practice dieting within the framework of gendered discourses and gendered relations that can make healthy eating hard to sustain. [ABSTRACT FROM AUTHOR]