Experiences Of Low-income Women Research Articles

Reconsidering mobility of care: Learning from the experiences of low-income women during the COVID-19 lockdown in Itagüí, Colombia

In recent years the literature on mobility of care has rapidly expanded, and the concept offers a powerful lens to highlight how everyday mobilities are organised, undertaken, and experienced in gendered ways. The concept can nonetheless benefit from further theoretical development. In this paper we enrich the mobility of care concept by drawing on influential conceptualisations of care from feminist theory and analysis of data collected during the COVID-19 lockdown among a group of 40 low-income women living in peri-urban areas of Itagüí, a municipality in the south of the Medellín metropolitan area, Colombia. Through this approach we first argue that relying on a taxonomy of trip purposes limits the understanding of the role of care in urban mobilities and risks underestimating the prevalence of mobility of care. Second, we suggest that activities of self-care also generate mobility of care and that their consideration allows practices and experiences of receiving care to be considered. Finally, we show how care activities are part of, and generate, intertwined mobilities and immobilities, and argue that rendering visible the full extent of mobilities of care demands that careful consideration be given to immobilities as well.

Hold my Hand

Hold my Hand

"We Were Silent and Now Have Voices": Qualitative Analysis of Low Income Women's Experiences Healing and Thriving Through a Community Arts Group

Marginalized communities without financial power often lack access to psychotherapy, particularly therapeutic arts and somatic psychotherapies, and traditional psychotherapy does not always meet their needs. This study explored the experiences of women living at the intersection of gender- and class-based discrimination in a novel group healing arts psychotherapy model, which was described in a previous issue of this journal. Data included participatory observations and interviews. Six group participants, all low-income women older than age 18 years, were formally interviewed. Qualitative inductive thematic data analysis revealed five overarching domains: (a) psychological realities and life challenges, (b) interpersonal growth processes within the community arts group, (c) art processes facilitating insight, (d) internalized healing and changes, and (e) goals to continue art and take risks. Implications and future directions for expanding the field of group-based healing arts are discussed.

Palliative Care in the Caribbean Through the Lens of Women with Breast Cancer: Challenges and Opportunities

Across the Caribbean, too many women are presenting with advanced breast cancer and dying with little or no access to palliative care. No comprehensive assessment of current capacity to deliver palliative care in the region exists, largely due to limited data. We assess the challenges in delivering palliative care for breast cancer patients in the Caribbean, highlighting the needs and experiences of low-income women through emblematic patient narratives. There is an urgent need to improve access to palliative care and pain relief throughout the region. Challenges include insufficient healthcare infrastructures to support cancer care, tremendous unmet need for palliative care, pervasive opiophobia resulting in limited access to opioids for pain relief, patients’ reluctance to engage with clinical care, and the widespread use of complementary and alternative medicines prior to the acceptance of conventional care. There is an urgent need to improve access to palliative care and pain relief for cancer patients in the Caribbean. Strong regional collaboration, provider and patient education, improved access to opioids, and innovative models for palliative care that reflect the culture and resources available in the region have the potential to measurably improve palliative care delivery.

Exploring the Housing Pathways of Low-Income Women: A Biographical Approach

This research explores the use of a housing pathways framework and a biographical method to improve our understanding of the long-term housing experiences of low-income women. Biographical methods have been employed in the study of vulnerable and special populations outside of the US; however, there has been limited application of the method to examine low-income households within the US. This study draws on interviews of 29 low-income women with children in a large Midwestern metropolitan area to examine the nature of low-income housing pathways. The wages provided in the jobs that were available to the women in this study were insufficient to afford even low-quality, low-rent apartments, suggesting that the ability to achieve stability in modest housing is predicated on achieving much higher levels of household income. Federal rental assistance provided through the Housing Choice Voucher programme, rather than increased job stability or wages, resulted in improved housing conditions and stability for the women in this study. Biographical methods present great potential in providing a nuanced understanding of the housing experiences and life circumstances of low-income households and other vulnerable populations in the United States.

A Qualitative Exploration of Low-Income Women's Experiences Accessing Abortion in Massachusetts

BackgroundAt a time when most states are working to restrict abortion, Massachusetts stands out as one of the few states with multiple state-level policies in place that support abortion access for low-income women. In 2006, Massachusetts passed health care reform, which resulted in almost all residents having insurance. Also, almost all state-level public and subsidized insurance programs cover abortion and there are fewer restrictions on abortion in Massachusetts compared with other states. MethodsWe explored low-income women's experiences accessing abortion in Massachusetts through 27 in-depth telephone interviews with a racially diverse sample of low-income women who obtained abortions. Interviews were digitally recorded, transcribed, coded, and analyzed thematically. ResultsMost women described having access to timely, conveniently located, affordable, and highly acceptable abortion care. However, a sizable minority of women had difficulty enrolling in or staying on insurance, making abortion expensive. A small minority of women said their abortion care could be improved by increasing emotional support and privacy, and decreasing appointment times. Some limited data also suggest that young women and immigrant women face specific barriers to care. ConclusionThis study provides important, novel information about the need for state-level policies that support access to health insurance and comprehensive abortion coverage. Such policies, along with a well-functioning health care environment, help to ensure that low-income women have access to abortion. However, not all abortion access challenges have been resolved in Massachusetts. More work is needed to ensure that all women can access affordable, confidential care that is responsive to their specific needs and preferences.

What do Women Want? Experiences of Low-Income Women with Postpartum Contraception and Contraceptive Counseling.

BackgroundContraceptive counseling can increase postpartum contraception use, yet the optimal method and timing for counseling are unknown. The objective was to investigate preferences of underserved pregnant and postpartum women regarding contraception use and counseling.MethodSurveys regarding contraception experiences and perceptions of contraceptive counseling were conducted with 57 women age 18 and older who were postpartum or antepartum with a previous delivery within 5 years and receiving Medicaid-funded care at an academic medical center. Health literacy was assessed using REALM-7. Responses were analyzed using descriptive statistics.ResultsA majority of women reported unplanned pregnancies (78%). Women using contraception at the time of conception reported “not sure” (30%) and “taken wrong” (30%) as primary reasons for failure. Most subjects had at least a high school level of health literacy (88%), desired to use a postpartum contraceptive method (92%) and had a high self-reported understanding of that method (94%). Most women reported receiving counseling (91%) and stated that the best time for counseling was both before and after childbirth (84%). However, only 60% of subjects intended to use the method they were prescribed at discharge; reasons for changing included side effects (37%), desire for different contraception (23%) and too complicated of a method prescribed (17%).ConclusionWomen perceived the best timing of contraceptive education to be both antepartum and postpartum. Despite a high frequency of prior contraceptive failure, self-reported understanding of the chosen postpartum contraceptive method was high. Contraception counseling should be tailored to a woman’s perceived needs, with such education occurring frequently and within the context of her health literacy.

What Happens to the Women Who Fall Through the Cracks of Health Care Reform? Lessons from Massachusetts

We investigated the impact of Massachusetts health care reform on low-income women's experiences accessing insurance and health services, specifically reproductive health services such as contraception. Our findings suggest that concentrated efforts are needed to make sure that health services are available and accessible to populations who fall through the cracks of health care reform, including immigrants, minors and young adults, and women living outside urban areas. In addition, systems changes are needed to ensure that women going through common life transitions, such as pregnancy, marriage, moving, or graduating from school, have continuous access to insurance, and therefore health services, as their lives change. These groups face barriers enrolling in and maintaining their insurance coverage as well as obtaining timely health care benefits they are eligible for through their insurance benefits or public health programs. Without intervention, many in these groups may delay or avoid seeking health care altogether, which may increase health care disparities in the long term. Family planning providers in Massachusetts have played a critical role in mitigating barriers to insurance and health care. However, recent threats to defund family planning providers call into question the ability of these providers to continue providing much-needed services.

The Experience and Determinants of First-Time Breast-Feeding Duration among Low-Income Women from São Paulo, Brazil

While the ability to breast-feed is virtually universal among women, the experience of breast-feeding is particular to each woman and is influenced by her social, economic, and personal circumstances. This paper explores quantitative and experience-focused ethnographic data on the experiences of low-income women from the eastern periphery of the city of São Paulo, Brazil, who were breast-feeding for the first time. The prospective, longitudinal data collection method involved repeated in-depth interviews with a group of 65 women, from the end of pregnancy through the first 12 weeks postpartum. Multivariate statistical analyses of the quantitative data revealed that older age, lower interpersonal satisfaction, and unplanned pregnancy shortened the period of exclusive breast-feeding and increased women’s likelihood of having begun supplementation by 12 weeks postpartum. Ethnographic data analysis exposed the meanings of breast-feeding and motherhood for women who had experienced unplanned pregnancy and helped to shed light on the dramatic influence of unplanned pregnancy on women’s breast-feeding practice.

I Wanted a Fresh Start from Where I Was: Rural Low-Income Women's Experiences of Multiple Partnership Transitions

Rates of union disruption between romantic partners--whether through divorce, separation, or dissolution of cohabitation--are substantially higher in the United States than other Western countries (Cherlin, 2008). It is estimated that approximately 25% of all American marriages end in divorce or separation within five years and more than half of cohabiting relationships are dissolved within five years (Cherlin, 2008). Yet, rates of re-partnering also are high, with more than half of the women who end their partnerships entering new relationships within four years (Andersson & Philipove, 2002). Partnership transition rates or instability, however, vary by social-class. Working or poor families are more likely to experience partnership transitions than their middle-class counterparts (Wells, 2005). Those with less education, particularly women, are the most vulnerable (Cherlin, 2010). Consequently, it is becoming increasingly common for low-income individuals to experience multiple partnership transitions during adulthood in the United States.To date, research examining partnership transition/instability has focused primarily on child outcomes or maternal parenting. In addition, the majority of studies conceptualize partnership instability as a discrete, singular event, such as divorce, separation, and dissolution of cohabitation, rather than a series of multiple transitions over time (Beck, Cooper, McLanahan, & Brooks-Gunn, 2010). Further, most previous studies have investigated urban, low-income populations, even though the greatest increase in cohabiting households with children in the last decade has occurred in rural areas (O'Hare, Manning, Porter, & Lyons, 2009). This study begins to fill in some of these knowledge gaps by focusing on rural, low-income mothers' experiences of and explanations for multiple partnership transitions.The higher rate of family instability among low-income households compared to other social classes has become a national concern as it is associated with a decrease in family finances, increase in welfare dependency, and higher likelihood of negative developmental outcomes for children. A substantial body of literature indicates that as children are exposed to multiple changes in family structure, they experience less positive developmental outcomes (Osborne & McLanahan, 2007; Sun & Yuanzhang, 2008). Negative outcomes include behavioral problems, delinquency, and teenage pregnancy (Cavanagh & Huston, 2006; Fomby & Cherlin, 2008; Wu & Thomson, 2001). Osborne and McLanahan (2007) reported that each partnership transition modestly increased the likelihood of a child exhibiting behavioral problems. Even one partnership transition, such as a separation, introduces multiple stressors into family life, which could include changes in family rules and routines, reassignment of household roles and responsibilities, challenges in meeting the emotional needs of family members, and readjustment of family finances. In the case of partnership dissolution, mothers and children tend to experience substantial declines in their financial and social resources (Bradbury & Katz, 2002). Additionally, mothers often report more psychological distress following, rather than preceding, partnership transitions (Crnic, Gaze, & Hoffman, 2005), and these transitions often lead to high levels of mental distress (Blekesaune, 2008).Despite the negative financial, emotional, and psychological outcomes that follow family transitions, recent evidence reveals that multiple partnership transitions over short periods of time are increasing (Burton, Cherlin, Winn, Estacion, & Holder-Taylor, 2009; Cherlin, 2010; Sassler, 2010). Burton et al. (2009) investigated the role of trust/distrust in low-income mothers' partnership formations and claimed that mothers who rapidly enter romantic relationships are less likely to collect information about their partners' trustworthiness than those who enter relationships gradually. …

Breastfeeding support - the importance of self-efficacy for low-income women.

Breastfeeding is a key determinant in promoting public health and reducing health inequality. Low-income women have a significantly lower level of breastfeeding. Midwives in the UK have been encouraged to implement the World Health Organization/United Nations Children's Fund's Ten Steps to Successful Breastfeeding, but to date, there has been no evaluation of the impact of the training initiative on the breastfeeding behaviours of low-income women. As part of a wider study, this qualitative component was designed to answer the question - what are the views and experiences of low-income women (defined by Jarman scores) in relation to their breastfeeding support received in the post-natal period? A sample of seven women was interviewed. The in-depth interviews were analysed using a qualitative, thematic approach based on the self-efficacy theory. The four themes that emerged from the data were the following: breastfeeding related to the woman's self-confidence, the social environment in which the woman lived, knowledge of breastfeeding and the influence of maternity services on breastfeeding outcomes. These themes were interpreted in relation to the self-efficacy theory. The findings suggest that the components that inform self-efficacy are consistent with the themes from the data, suggesting that midwives and other health professionals should take the psychosocial aspects of breastfeeding support into account. As this important feature of breastfeeding support is not explicitly part of the current Ten Steps to Successful Breastfeeding, we suggest that further research and debate could inform expansion of these minimum standards to include the psychosocial aspects.

Beyond Routine HIV Testing: Beliefs, Perceptions, and Experiences of Low-Income Women of Color

In this qualitative study, a social constructivist lens is used to examine the themes and meanings of HIV testing and prevention that emerge for 56 heterosexual African American and Latina women as shaped by their beliefs, perceptions, and experiences. The findings suggests a community and government multisystemic approach that increases gender equality to talk about sexual health; information, education, and prevention programs with a gendered approach for their children; environmental safety—protection from drugs, crime, and violence; and taking action by macro-level interventions that decrease the likelihood of the spread of HIV in communities of color.

Altered Perceptions of Personal Control About Retained Weight and Depressive Symptoms in Low-Income Postpartum Women

Postpartum weight retention and depressive symptoms have a high prevalence among low income women. This qualitative study describes low-income women's experiences of weight changes and depressive symptoms during the late postpartum period. Women (n = 25) who were either overweight or had depressive symptoms, or both, at 12 months postpartum participated in an ethnically-congruent focus group. Women's experiences indicated altered personal control related to retained postpartum weight and depressive feelings. Retained weight negatively affected self-esteem and family functioning. Depression left women feeling isolated yet reluctant to seek help. These findings could provide the basis for health promotion interventions relevant to this population.

Conducting focus groups with women with severe psychiatric disabilities: a methodological overview.

This article presents information on the methodology used in conducting focus groups with women with severe psychiatric disabilities. The purpose of the focus groups was to understand the experiences of low-income women with severe psychiatric disabilities in accessing and using primary health care services. Discussed are the design decisions researchers should reflect on when constructing and conducting focus groups with women with severe psychiatric disabilities. Information on how guidelines from the literature on conducting focus groups were adapted for these women as well as lessons learned from this experience are presented.

The Family Planning Attitudes and Experiences of Low-Income Women

A 1995 telephone survey of 1,852 low-income women aged 18-34 who were sexually active and at risk of unintended pregnancy found that 83% were currently practicing contraception. They were more likely to do so if they held positive attitudes toward contraceptive use, if they talked frequently about intimate matters with their partners and girlfriends and if they were very satisfied with the services they received at their last gynecologic visit. Seventy percent of current users said they were very satisfied with their method. Women whose last visit was to a clinic, who were very satisfied with the care they received and who used the pill or a long-acting method were more likely than others to report being very satisfied with their contraceptive. Women very satisfied with their gynecologic care were more likely to use oral contraceptives and to take them consistently, but were less likely to report that their partner used condoms or, if they did, used them consistently. Most women had made a medical visit for gynecologic or contraceptive care in the past year (86%), and 80% were very satisfied overall with their care at their last visit. Women were more likely to be very satisfied if the staff was courteous, helpful and respectful and made an effort to find out their needs, if their clinician's gender matched their own preference and if the facility was clean and services were organized.

Economic Self-Sufficiency: It's Not Just Money

Definitions of economic self-sufficiency that are used by public programs fail to recognize the reality and experiences of low-income women. An analysis of data on economic self-sufficiency, gathered from 244 low-income women at the Women's Employment Network in Kansas City, Missouri, resulted in the discovery of four factors underlying this concept: (1) autonomy and self-determination, (2) financial security and responsibility, (3) family and self well-being, and (4) basic assets for living in the community. The policy and practice implications of these findings are explored.