Labor Care Research Articles

Automating adult social care in the UK: Extracting value from a crisis

The UK appears fixed in perpetual care crisis propelled by austerity-driven funding cuts and the country’s intensifying care labour shortage. Austerity in the UK has generated an operating environment that has accelerated privatisation and incentivized and necessitated private innovation. In this writing, we examine how the infrastructure and delivery of social care in the UK is being radically reimagined through technology. Promising to deliver critical efficiencies and cost savings, new automating technologies are being tested and introduced to reorder how and where care is managed and delivered. Drawing on a series of interviews conducted with local authorities in the UK and the executives of private companies, our task is not to assess the efficacy of new technologies; rather we examine how these public-private partnerships raise difficult questions: Who will deliver caring futures in the UK? Who is absorbing the fiscal risk of technological innovation? Who is profiting? And what are the limits of technology as a response to our care crisis?

Social Issues of the 21st Century in the Preaching to Women at Piekary

Piekary Śląskie is a place usually associated with the Marian sanctuary of Our Lady of Piekary — the Mother of Justice and Social Love. State pilgrimages of women and girls to Piekary Śląskie are events of pastoral and cultural importance that go far beyond the borders of the local Church. Social issues are strongly emphasized during the pilgrimages. A special feature is the welcome speeches delivered by the bishops of Katowice. This paper offers an analysis of speeches by Archbishop Damian Zimoń and Archbishop Wiktor Skworc, delivered during state pilgrimages of women and girls to the Sanctuary of Our Lady of Piekary in 2001–2022. The addresses include description and critical analysis of current complex social problems in Poland. The speakers focused mainly on the issues of life and human dignity, marriage and family, civil rights and duties, respect for the poor and weak, dignity of human labour, social solidarity and natural environmental care.

Effectiveness of Sacral Massage on Labor Pain and Satisfaction Among Antenatal Mothers in Active Phase of Labor

Background: Massage is a powerful old technique & non pharmacological pain control during 1st stage. Satisfaction of mothers during birth is rather important in terms of women's health and positive family relations. Objective of the study is to assess the effectiveness of Sacral Massage on labour pain and satisfaction among antenatal mothers. Methodology: A quantitative research approach and true experimental research design was adopted; 60 antenatal mothers were selected by simple random sampling. Sacral massage was administered for 3 cycles each for 30 minutes at 5-10cm using superficial massage, deep friction & effleurage during active phase of labor and routine care was given to the control group. After intervention post test was conducted. Results: Study showed before Sacral massage the computed ‘t’ value (-0.36) was found to be statistically non-significant at 0.05 level of significance and after Sacral massage it was (-24.7) was statistically significant at <0.01 level of significance, there were significant difference in mean post test score of labor pain in both groups. Majority (86.6%) mothers were moderately satisfied, followed (13.3%) were highly satisfied with Sacral massage. Conclusion: Sacral massage was found effective to reduced pain and increase satisfaction.

Labour Care Guide implementation as a decision-making tool for monitoring labour among healthcare providers in Uganda: protocol for a mixed-methods study

IntroductionThe new WHO Labour Care Guide (LCG), also regarded as the ‘next-generation partograph’, is a core component of 2018 WHO consolidated guidelines on intrapartum care for positive childbirth experience. The...

Quality of analgesic care in labor: A cross-sectional study of the first national register-based benchmarking system.

Unlike other types of acute pain, labor pain is considered physiological. Due to the heterogeneous management during labor, there is a lack of intention to define quality of care of peripartal analgesia. This study presents the first results of the national register for this evaluation. This prospective cross-sectional study, conducted in five different German level-three hospitals, included women after vaginal childbirth between January 2020 and January 2022. A validated questionnaire was completed 24 h postpartum, including information about labor pain, satisfaction, and expectations regarding analgesia. Data were centrally recorded with obstetric records using the database of the QUIPS (Quality Improvement in Postoperative Pain Management) Project. A total of 514 women were included. On an 11-point Numerical Rating Scale, pain intensity during labor was severe (8.68 ± 1.8) while postpartal pain was 3.9 (±2.1). The second stage of labor was considered the most painful period. Only 62.6% of the parturients obtained pharmacological support, with epidural being the most effective (reduction of 3.8 ± 2.8 points). Only epidural (odds ratio [OR] 0.22) and inhalation of nitrous oxide (OR 0.33) were protective for severe pain. In benchmarking, a relation between satisfaction, pain intensity, and the use of epidural was found; 40.7% of the women wished they had received more analgesic support during labor. This study highlights deficiencies in analgesic management in high-level perinatal centers, with more than 40% of parturients considering actual practices as insufficient and wishing they had received more analgesic support, despite the availability of analgesic options. Using patient-reported outcomes can guarantee qualitative tailored analgesic care in women.

Social reproduction against administrative bordering: Struggles to reproduce legal legibility among temporary student-migrants in Finland

Abstract Migrants in a temporary legal status are subject to heterogeneous techniques of bordering accompanied by assumptions of migratory intention and behaviour. This article analyses migrants’ struggles around administrative bordering among non-EU/EEA migrants who hold one-year student residence permits in Finland. I focus on the ongoing labour of reproducing a ‘legally legible self’ as a perspective for approaching the subjective encounters with the border regime. Rather than merely analysing the impacts of the residence permit on social life, the article centres on the efforts of student permit holders to maintain the right to a continued legally regularized stay in Finland, addressed through a social reproduction lens. The argument is that viewing migrants’ efforts of reproducing a legally legible self through the perspective of social reproduction, and thus analysing the labour of attention and care that goes into reproducing one’s legal status, we can acquire a more nuanced understanding of the everyday struggles around administrative bordering. The article contributes first to the theorization of social reproduction beyond the walls of the home, by demonstrating how bordering processes intimately shape migrants’ opportunities for reproducing their lives, and secondly, by emphasizing life-making as a battlefield, the article adds to the research on administrative border struggles.

‘I try to do something a bit different’: exploring fathers’ integration of care ethics in everyday family lives

This article draws on ethnographic research to explore how an ethic of care is incorporated into fathers’ everyday family lives. Drawing on feminist conceptualisations of the ‘components of care’, this research investigates how fathers recognise and interpret care needs, as well as observing how such needs are practically attended to. Central to this article is an exploration of the extent to which men’s integration of care ethics can be seen to consolidate ideals of hegemonic masculinity or whether newly emerging forms of caring masculinities are challenging traditional gendered inequalities in care work. Analysis of fathers’ recognition of care needs and what they care ‘about’ implies a masculinised coding, in which traditional masculine values are recast to align with an ethic of care. It is argued that such framings stand to reaffirm hegemonic processes, with caring forms of masculinity representing a new hegemon. However, observations of fathers’ embodied caregiving arguably demonstrate how caring ‘for’ children can challenge traditional ideals of care labour, with men’s bodies recast within an ethic of care. Ultimately, this article contributes nuanced understandings of how men interpret and practise components of care, offering distinctions in the gendered trajectories of caring ‘for’ and caring ‘about’.

Meaningfulness experienced in performing domestic labor in Chinese families: a qualitative study from caregivers’ perspectives

The intricately connected interactions among personal choices, traditional cultural ideologies, and modern societal backgrounds have provoked dynamic interpretations and practices in performing domestic labor. The value of domestic labor in terms of macro considerations, such as reproductive value, economic value, and caring value, has been established in scholarly discussions. In China, the emphasis is on the meaningfulness of domestic care for the whole society. However, it remains unclear how family members in contemporary Chinese society understand the meaningfulness of performing domestic labor. This study aims to investigate what kinds of meaning that individuals derive from their day-to-day domestic labor and how the different types of meaningfulness affect their future behaviors in sharing domestic responsibilities. Meaningfulness is a complex notion, but Baumeister’s theory of meaning provides a theoretical framework to understand why humans need meaningfulness in life, the forms that meaningfulness takes, where meaningfulness resides, and how perceptions of meaningfulness are shaped. In total, 48 respondents participated in semi-structured, in-depth interviews concerning their attitudes toward the value of domestic labor. Findings based on in-depth interview data show that the meaningfulness of domestic labor consists of participants realizing their need for belonging, self-efficacy, and a sense of living a good life. These results also suggest that the values of domestic labor illustrated in previous studies, in which domestic labor was conceptualized as reproductive labor, economic activity, and care labor, have little effect on individuals’ lives. Nevertheless, the meaningfulness that individuals experience in daily life continues to motivate their devotion to domestic labor. Finally, the discursive mechanism shaping the meaningfulness of domestic labor is also discussed.

Routine vaginal examination to assess labor progress at 8 compared to 4 hours after early amniotomy following Foley balloon ripening in the labor induction of multiparas: a randomized trial

BackgroundVaginal examination to monitor progress in labor is recommended at least every 4 hours but it can cause pain and embarrassment to women. Trial data is limited on the best intensity for vaginal examination. Vaginal examination is not needed for oxytocin dose titration after amniotomy has been performed and oxytocin infusion started. The Foley balloon commonly ripens the cervix without strong contractions; amniotomy and oxytocin infusion is usually required to drive labor. ObjectiveTo evaluate the first vaginal examination at 8 vs 4 hours after amniotomy-oxytocin following Foley ripening in multiparous labor induction. MethodsA randomized controlled trial was conducted from October 2021 to September 2022 in University Malaya Medical Center. Multiparas at term were recruited at admission for labor induction. Participants were randomized to a first routine vaginal examination at 8 or 4 hours after Foley balloon ripening and amniotomy. Titrated oxytocin infusion was routinely commenced after amniotomy to initiate contractions. The two primary outcomes were the time from amniotomy to delivery (non-inferiority hypothesis) and maternal satisfaction (superiority hypothesis). Data were analyzed with the Student t-test, Mann-Whitney U test, Chi square test (or Fisher exact test) as suitable for the data. Results204 women were randomized, 102 to each arm. Amniotomy to birth interval was mean±standard deviation 4.97±2.47 vs 5.79±3.17, mean difference -0.82, 97.5% CI (-1.72 to 0.08) hours p=0.041 (Bonferroni correction), which was non-inferior within the pre-specified 2 hour upper margin and maternal satisfaction score with allocated labor care was median[interquartile range] 9[8-9] vs 8[7-9] p=0.814 (11-point 0-10 NRS) for 8 vs 4 hours arms respectively. Oxytocin infusion to birth interval difference was also non-inferior within the 97.5% CI (-1.59 to 0.23) margin of 2 hours. Of the maternal outcomes, amniotomy to first vaginal examination intervals were 3.9±1.8 vs 3.4±1.3hours p=0.026 and number of vaginal examinations was 2[2-3] vs 3[2-3.25] p<0.001 for 8 vs 4 hours arms respectively. For the 8 hours arm, first vaginal examination was less likely to be as scheduled and more likely to be indicated by sensation to bear down (p<0.001) and epidural analgesia rate was lower 13/102 (12.7%) vs 28/102 (27.5%) RR 0.46 95% CI 0.26–0.84 p=0.009. Other outcomes of mode of delivery, indications for cesarean and delivery blood loss were not different. Neonatal outcomes were not different. ConclusionRoutine first vaginal examination at 8 hours compared to 4 hours is non-inferior for the time to birth but does not improve maternal satisfaction.

After automation: Homelessness prioritization algorithms and the future of care labor

People experiencing homelessness seek support from homeless services systems that increasingly rely on prioritization algorithms to determine who is the most deserving of scarce resources. In this paper, we argue that algorithmic harms in homeless services require a reparative approach that takes the data work of care workers seriously. Building on Davis, Williams, and Yang's concept of algorithmic reparation, we present a qualitative study that examines the intertwining of data work and care labor of 15 care workers. We show how they wrestle with the ethics of algorithmic prioritization and develop workarounds that allow them to advocate for their clients. We contribute an empirical understanding of how care workers provide care under homeless services systems that equate data work with care labor to justify work intensification. Our findings have implications for understanding the future of care labor in datafied conditions and the social and political ramifications of algorithmically mediated care.

Development of a novel labour monitoring tool: Improving labour care quality in the Indian setting.

Efficient care by labour monitoring tools manages labour, identifies the abnormalities and avoids the fatalities. Various studies are being undertaken by the researchers to understand the limited use of these therapeutic tools. The present study aimed to develop a novel labour monitoring instrument after understanding the barriers and enablers of the currently used tools and using it in the health setting for improving clinical outcomes. Methodological research design was adopted to develop the novel tool. Item pool was generated by literature review, focus group discussions and retrospective observations of the partographs. Developed tool was evaluated by various experts by undergoing three rounds and was found to be reliable in terms of stability and equivalency. After undergoing pilot runs by researcher and nurses, tool was found to be feasible and understandable. The developed novel labour monitoring tool was used on 200 intranatal women. Focus group discussions revealed various barriers in the current labour tools, such as lack of clarity, complexity, staff shortage, workload etc. Retrospective observation of filled partographs revealed the incomplete recording of the components of the partograph. The prepared first draft underwent rigorous review by the experts. The prepared novel tool, after being used on 200 intranatal women resulted in 90% of normal vaginal deliveries. Duration of 1st stage of labour was around 5 hours. A novel labour monitoring tool was developed after methodological approach resulting in adequate monitoring and improved labour outcomes.

European Association of Perinatal Medicine (EAPM), European Board and College of Obstetricians and Gynaecologists (EBCOG), European Midwives Association (EMA). Joint position statement: Substandard and disrespectful care in labour – because words matter

Substandard or disrespectful care during labour should be of serious concern for healthcare professionals, as it can affect one of the most important events in a woman’s life. Substandard care refers to the use of interventions that are not considered best-practice, to the inadequate execution of interventions, to situations where best-practice interventions are withheld from patients, or there is lack of adequate informed consent. Disrespectful care refers to forms of verbal and non-verbal communication that affect patients’ dignity, individuality, privacy, intimacy, or personal beliefs. There are many possible underlying causes for substandard and disrespectful care in labour, including difficulties in modifying behaviours, judgmental or paternalistic attitudes, personal interests and individualism, and a human tendency to make less arduous, less difficult, or less stressful clinical decisions. The term “obstetric violence” is used in some parts of the world to describe various forms of substandard and disrespectful care in labour, but suggests that it is mainly carried out by obstetricians and is a serious form of aggression, carried out with the intent to cause harm. We believe that this term should not be used, as it does not help to identify the underlying problem, its causes, or its correction. In addition, it is generally seen by obstetricians and other healthcare professionals as an unjust and offensive term, generating a defensive and less collaborative mindset. We reach out to all individuals and institutions sharing the common goal of improving women’s experience during labour, to work together to address the underlying causes of substandard and disrespectful care, and to develop common strategies to deal with this problem, based on mutual comprehension, trust and respect

헉슬리의 『멋진 신세계』에 나타난 여성 유토피아 비전과 철인 통치 국가론

This article examines the vision of gender utopia presented in Aldous Huxley’s Brave New World and explores its utopian possibilities in Mustapha’s World State, which is compared to the philosopher-ruled state in Plato’s Republic. The theme of utopia has been approached differently in liberalism and socialism: liberal utopia prioritizes individual freedom, while socialist utopia emphasizes egalitarian community. The World State in The Brave New World abolishes patriarchy with advanced scientific and technological civilization and depicts a gender utopia without female reproductive labor, emotional labor, and care labor, while the actual main woman characters such as Lenina and Linda suffer pain and death. Therefore, Huxley’s World State represents an ideal gender utopia, while the female characters are evaluated based on their appearance and live tragic lives due to excessive national norms enforcing order. On the other hand, Mustapha’s World State embodies some of the ideal state described in Plato’s Republic, and the two polities are similar in that they are class societies based on stability ruled by philosophers. However, the World State places too much emphasis on community stability, suppressing individual freedom, emphasizing sensual pleasure rather than spiritual happiness, Eudaimonia of Plato’s polity. Eventually, Huxley’s utopia has an ideal structure of gender equality, but the women living there are not so happy. Although it is excellent in terms of stability and efficiency as an ideal politeia ruled by a philosopher, it has limitations that its educational method is rather oppressive, only indulges in pleasure, then represents a failed gender utopia in the end.

Unravelling the tensions: exploring the interplay of paid care work, family obligations, and transnational care among Zimbabwean migrant care workers in the UK

ABSTRACT An increasing number of studies have examined the impact of migration on reconciling familial care obligations with demanding paid care work. However, much of this research focuses on women who employ migrant care workers and ignores the experiences of migrant care workers balancing their jobs with their own familial responsibilities. As a result, little is known about how migrant care workers navigate local contexts, form families, and manage work and childcare in destination countries while maintaining commitments at home. This paper explores the family dynamics and transnational lives of Zimbabwean migrant care workers in the UK. It draws on qualitative interviews with 10 participants to elaborate on the additional challenges they face in reconciling paid care work with localized and transnational family care. The analysis highlights that migrant workers must simultaneously respond to the care demands of their families and employers, often causing tensions as gendered care expectations are challenged. To manage these difficulties in balancing work and family, Zimbabwean care workers employ various strategies that sometimes strain familial relationships. This study provides insight into the intersection of migrant care workers’ paid labour and familial care obligations across borders.

Induction of labour care in the UK: A cross-sectional survey of maternity units.

To explore local induction of labour pathways in the UK National Health Service to provide insight into current practice. National survey. Hospital maternity services in all four nations of the UK. Convenience sample of 71 UK maternity units. An online cross-sectional survey was disseminated and completed via a national network of obstetrics and gynaecology specialist trainees (October 2021-March 2022). Results were analysed descriptively, with associations explored using Fisher's Exact and ANOVA. Induction rates, criteria, processes, delays, incidents, safety concerns. 54/71 units responded (76%, 35% of UK units). Induction rate range 19.2%-53.4%, median 36.3%. 72% (39/54) had agreed induction criteria: these varied widely and were not all in national guidance. Multidisciplinary booking decision-making was not reported by 38/54 (70%). Delays reported 'often/always' in hospital admission for induction (19%, 10/54) and Delivery Suite transfer once induction in progress (63%, 34/54). Staffing was frequently reported cause of delay (76%, 41/54 'often/always'). Delays triggered incident reports in 36/54 (67%) and resulted in harm in 3/54 (6%). Induction was an area of concern (44%, 24/54); 61% (33/54) reported induction-focused quality improvement work. There is substantial variation in induction rates, processes and policies across UK maternity services. Delays appear to be common and are a cause of safety concerns. With induction rates likely to increase, improved guidance and pathways are critically needed to improve safety and experience of care.

In search of respect and continuity of care: Hungarian women's experiences with midwifery-led, community birth.

To describe and compare intervention rates and experiences of respectful care when Hungarian women opt to give birth in the community. We conducted a cross-sectional online survey (N = 1257) in 2014. We calculated descriptive statistics comparing obstetric procedure rates, respectful care indicators, and autonomy (MADM scale) across four models of care (public insurance; chosen doctor or chosen midwife in the public system; private midwife-led community birth). We used an intention-to-treat approach. After adjusting for social and clinical covariates, we used logistic regression to estimate the odds of obstetric procedures and disrespectful care and linear regression to estimate the level of autonomy (MADM scale). In the sample, 99 (7.8%) saw a community midwife for prenatal care. Those who planned community births had the lowest rates of cesarean at 9.1% (public: 30.4%; chosen doctor: 45.2%; chosen midwife 16.5%), induced labor at 7.1% (public: 23.1%; chosen doctor: 26.0%; chosen midwife: 19.4%), and episiotomy at 4.44% (public: 62.3%; chosen doctor: 66.2%; chosen midwife: 44.9%). Community birth clients reported the lowest rates of disrespectful care at 25.5% (public: 64.3%; chosen doctor: 44.3%; chosen midwife: 38.7%) and the highest average MADM score at 31.5 (public: 21.2; chosen doctor: 25.5; chosen midwife: 28.6). In regression analysis, community midwifery clients had significantly reduced odds of cesarean (0.35, 95% CI 0.16-0.79), induced labor (0.27, 95% CI 0.11-0.67), episiotomy (0.04, 95% CI 0.01-0.12), and disrespectful care (0.36, 95% CI 0.21-0.61), while also having significantly higher average MADM scores (5.71, 95% CI 4.08-7.36). Hungarian women who plan to give birth in the community have low obstetric procedure rates and report greater respect, in line with international data on the effects of place of birth and model of care on experiences of perinatal care.

Role of intensive care in management of post-partum hemorrhage (PPH)

The management of obstetric emergencies is a challenge and in most hospital setting the management in intensive care is ill-defined. A multidisciplinary approach to the management of obstetric emergency helps to give favorable outcome. In low resource setting, maternal care can be challenging as it faces lack of infrastructure facilities, specialist trained in intensive care, availability of drugs and equipment. Though early intervention is the need of hour there are delays in seeking healthcare due to lack of awareness, financial constraints, culture and beliefs. This article describes the approach to management of PPH in intensive care, defining clear transition from labor care to intensive care should occur.

Blood loss monitoring chart, a game changer in postpartum hemorrhage detection and treatment: A direct observation study in 7 E-MOTIVE trial hospitals in Kenya

Background: Every six minutes, a mother dies of postpartum hemorrhage (PPH) in low-resource countries. PPH, defined as blood loss of more than 500 ml, is the leading cause of maternal death worldwide, accounting for 27% of maternal deaths. The WHO published “Recommendations for the Prevention and Treatment of Postpartum Hemorrhage” in 2012 to provide evidence-informed recommendations for managing PPH. However, adherence to these recommendations is currently limited by several challenges, including poor maternal care where despite guideline dissemination, many health care providers (HCPs) do not provide effective care such as proper monitoring of vital signs which is key in hemodynamic assessments that can prompt early intervention. The E-MOTIVE trial supported 14 health facilities in Kenya, 7 intervention and 7 control sites. The trial introduced a blood loss monitoring chart to support HCPs in assessing women after delivery of the placenta and enabling early detection and treatment of PPH. Methods: Blood loss monitoring tool/Trigger chart was developed by the University of Birmingham. This tool was implemented in seven hospitals in Kenya with the capacity for comprehensive emergency obstetric care, including blood transfusion and cesarean delivery. In these hospitals, labor, delivery, and postpartum care are primarily provided by nurse-midwives and students. More senior clinicians, including medical officers and consultant physicians such as obstetrician, gynecologists and pediatricians, make periodic rounds and are available on-call to assist in emergencies. Data were collected from August 2021 to December 2021. Observations were conducted by the trial implementation midwives with the support of the on-site research midwives for two weeks in each of the study hospitals. Observations occurred 24 hours a day. Patients were observed from the second stage up to two hours after placental delivery. All data were collected on paper forms and then entered into a digital database using RedCap. Results: A total of 734 deliveries were observed cumulatively during the study period. All women received four clinical observations within the first hour using the blood loss monitoring chart. The frequency of observing blood loss in the calibrated drapes during monitoring by HCPs was 94%. There was 100% detection of PPH using the blood loss monitoring chart. Conclusion: Efforts to increase the rates of early PPH detection and treatment should emphasize improvements in the quality of care, with a particular focus on PPH blood loss monitoring. The blood loss monitoring chart is easy to use and can be easily adopted and scaled in low-resource settings.

A social reproduction analysis of digital care platform work

ABSTRACT Digital platforms are becoming an important factor in the process of reconfiguration and commodification of social reproduction during the neoliberal phase of capitalism. Developing a theoretical framework merging social reproduction theory and migrant labour regimes, this article argues that the introduction of digital platforms in the care sector is facilitating the expansion of precarised commodification of reproductive activities in a context of social care crisis. Through a mixed-method analysis, combining desk-based research with in-depth interviews of digital care platform work in Spain, the study examines the migrant labour regime of digital care platforms and how they take advantage of the international division of labour and global care chains to further exploit a highly precarious, informalised, feminised and racialised workforce. Our findings reveal that platforms use technology to rapidly access a reserve labour army, thus extracting more surplus value by restricting access to information, controlling the intermediation process and further fragmenting the workforce in reproductive activities.

Predictors of expectant fathers' parental leave-taking intentions before birth: masculinity, fatherhood beliefs, and social support.

Despite continuing progress, men remain underrepresented in childcare, domestic labor, and other care work. Because parental leave is discussed as a gateway to increasing men's childcare engagement, we aimed to gain insights into predictors of men's parental leave-taking intentions during the transition to parenthood. Using outcomes on a continuum from behavioral preferences to more behavior-oriented measures, we examine how masculinity and fatherhood beliefs as well as social support become relevant during men's formation of their leave-taking intentions. Planned analyses of data collected from 143 expectant fathers in Belgium and Germany revealed that the support men perceive from their partners for taking leave predicts their parental leave-taking desire, intention, and planned length of leave. Moreover, men's conception of a prototypical man, especially in terms of agency, was linked to their desire to take leave. Against expectations, father role attitudes and workplace support did not emerge as relevant predictors of men's intended leave-taking. Results of exploratory analyses suggest that care engagement of peers, expected backlash, and self-efficacy beliefs additionally play a role in men's intended leave-taking. We discuss parental leave as a negotiation process within couples and review the role of men's normative environment for their intended leave-taking.