Appropriately framing maternal request caesarean section

In their paper, ‘How to reach trustworthy decisions for caesarean sections on maternal request: a call for beneficial power’, Eide and Bærøe present maternal request caesarean sections (MRCS) as a site of conflict in obstetrics because birthing people are seeking access to a treatment ‘without any anticipated medical benefit’. While I agree with the conclusions of their paper -that there is a need to reform the approach to MRCS counselling to ensure that the structural vulnerability of pregnant people making birth decisions is addressed—I disagree with the framing of MRCS as having ‘no anticipated medical benefit’. I argue that MRCS is often inappropriately presented as unduly risky,without supporting empirical evidence,and that MRCS is most often sought by birthing people on the basis of a clinical need. I argue that there needs to be open conversation and frank willingness to acknowledge the values that are currently underpinning the presentation of MRCS as ‘clinically unnecessary’; specifically there needs to be more discussion of where and why the benefits of MRCS that are recognised by individual birthing people are not recognised by clinicians. This is important to ensure access to MRCS for birthing people that need it.

Życie akademickie osób jąkających się w perspektywie społecznego modelu niepełnosprawności i koncepcji structural vulnerability

Stuttering is a speech disorder that affects approximately 50 million people worldwide. It makes everyday life difficult not only for children but also for adults. In psychology and speech therapy the social aspects of stuttering are emphasized, but so far this problem has not been studied in the context of academic life. My research is devoted to this issue in Poland I analyze the academic life of people who stutter through the prism of the social model of disability, the category of structural vulnerability, and exclusion. This study revealed the orality of the universities and a number of academic traditions based on well-established practices and social structures that make stuttering students and academic teachers vulnerable or socially disabled.

Right to health for undocumented migrants in Mexico: from theory to practice in the context of the health system reform

Purpose Undocumented Central American migrants in Mexico are legally eligible for free access to the public health system through the new Instituto para la Salud y el Bienestar (INSABI) health program, but many experience structural vulnerability and stigmatization that prevent them from accessing health-care facilities. The purpose of this study is to investigate the discrepancy between the migrants’ Human Right to health, proclaimed by the Mexican Government and supposedly guaranteed by law, and the reality of the migration process. Design/methodology/approach This study reviewed relevant literature on the health risk factors, social and structural vulnerability, stigmatization and structural violence experienced by undocumented migrants as obstacles to their Human Right to health. It also reviews the current legal framework in Mexico and internationally. Findings This review demonstrates the lack of implementation of the current legal framework in Mexico and identifies a set of complex obstacles to effective access to health for undocumented migrants. Although the migration process itself was not found to be directly associated with major health issues, the social conditions of the migratory journey expose the migrants to serious threats, especially sexually transmitted diseases and tuberculosis. Practical implications This paper makes 10 practical recommendations for interventions collectively involving the state, international and civil organizations and the migrant community. These are especially relevant since the implementation of the INSABI health program in 2020. Social implications The paper lays the basis for influencing Mexican health system stakeholders to improve the health of migrants. Originality/value The sociological barriers to health access for undocumented populations in Mexico have not been fully explored. In addition, this paper provides a unique reflection on opportunities and challenges linked to the 2020 health system reform.

Caring and Grieving in the Context of Social and Structural Inequity: Experiences of Australian Carers With Social Welfare Needs

Caring for and bereavement following the death of someone with a life-limiting illness may precipitate social welfare needs related to income support and housing. Nevertheless, carer experiences of welfare policy and institutions have not received significant attention. This qualitative study explored experiences of carers who navigated social welfare policy while caring for someone with a life-limiting illness, and in bereavement. In-depth interviews were conducted with 12 bereaved carers in an area associated with socioeconomic disadvantage. Carers differentially encountered precariousness, with some experiencing structural vulnerability. These positionalities appeared to be shaped by policy and process-related burdens, perceptions of the welfare state, and degrees of legitimisation or disenfranchisement of forms of capital and coping orientations. Recommendations that may improve carer experience were identified. Implications relate to the need for an expanded conceptualisation of vulnerability in health and welfare practice, policy that authentically validates caring and grieving, and upstream strategies that address inequity.

Care’s Profit

Using a layered, ethnographic approach focusing on four small non-corporate private maternity hospitals, we turn a critical lens on what it means to work within this self-regulated bubble and examine the ‘creation’ of a cadre of healthcare workers. Our analysis addresses how a space of care and business is generated out of the precarious positions of both women and the health workers who depend on employment there. Clinic owners’ staffing strategies centred on hiring unlicensed labour room staff, trained on the job rather than in accredited institutes, who take care of all aspects of patient care, including deliveries. By exploring narratives surrounding training and overtreatment, this chapter highlights the tensions between the value placed on profit, care, and working conditions in the private maternal health sector, and examines the structural vulnerability of unlicensed health providers working there.