women’s health update
“Good” Workers – “Bad” Mothers? August has seen us celebrate another successful World Breastfeeding Week with a record breaking 1521 mothers breastfeeding simultaneously throughout Aotearoa New Zealand in our annual breastfeeding event – The Big Latch On. While this seems to indicate an increase in support and acceptance for our breastfeeding mothers in public, a recent paper by Deborah Payne & David A. Nicholls looks at the challenges that breastfeeding women at work face trying to be both “good mothers” and “good workers”. Women with infants and children under three years of age are the fastest growing segment of today’s labour force which means that workplace support is critical for mothers returning to work who are also breastfeeding. Below is an excerpt from this paper, the full version of which is available from www.bfw.org.nz, Women’s Health Action’s recently launched breastfeeding and work website. Research shows that breastfeeding promotes the short and long term health of both the mother and her infant (Murphy, 1999; Ip et al, 2007; Horta et al, 2007). Increasingly the slogan ‘breast is best’ is being used by governments to encourage mothers to breastfeed. In addition, the World Health Organisation recommends that infants be exclusively fed breastmilk until they are six months old, and continue having breastmilk up until the age of two years. Such drives to increase mothers’ uptake and prolonged engagement in breastfeeding occur within the context of more mothers returning to paid employment. For example, in New Zealand more than one third of mothers return to paid employment within a year of having a baby (Galtry & Annandale, 2003). For mothers who wish to continue breastfeeding on their return to work, particularly if their infant is less than six months old, returning to the workplace may pose particular barriers to breastfeeding, which if they are to be successful breastfeeders they must overcome. In a collaborative qualitative study of 34 mothers who had given birth between 2003 – 2005 (Payne & James, 2008), the presence or absence of space, time, and support emerged as key factors in the mothers’ perception of their ability to continue to breastfeed on their return to paid employment. However, a secondary analysis of the transcripts of the 20 women
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● ● ● who continued to breastfeed on their return to work yielded significant insights into how the women juggled being both a ‘good employee’ and a ‘good mother’ (Payne & Nicholls, 2010). To be a good employee requires the mother to make her work her priority and to be productive in her work time. To be a good mother, women must demonstrate a commitment to her infant’s short term and long term wellbeing and breastfeeding is one means of achieving this. Therefore, to be both a good employee and a good mother can create real tensions for these women. The secondary analysis asked how the mothers who returned to work and continued breastfeeding managed these two positions. How the mothers who were unable to feed their infants during work time managed being a good mother was to ensure that their infant had an adequate supply of breastmilk. They achieved this by creating a stockpile of breastmilk and by maintaining the ability to breastfeed. To do this they had to learn how to use a breastpump and how to hygienically store the breastmilk they expressed during the work day. Being a good employee meant that the mothers tried not to allow their breastfeeding activities to intrude into their work time. The mothers demonstrated to their employers and colleagues that their work was their priority: when work required they would delay their need to express breastmilk; they found breast pump machines that took less time for them to express. The mothers also found ways that kept their breastfeeding discrete from their co-
Support for breastfeeding f r i e nd ly w o r k pl a c e s N Z P u b l i c H e a lth & D i s a b i l i t y A m endment Bill K e e p i n g w o m e n’s h e a l t h o n t h e a ge nd a Contraceptive i mp l a nt s New Health & Disability Co mmi s s i o ne r
workers such as not storing breastmilk in the shared fridge, using quieter breastpumps or washing their equipment in the toilet and not in the work kitchen. These activities, while they permit the mother to be both a good employee and a good mother, show and perpetuate the belief of some that breastfeeding in the workplace is a ‘deviant’ and thus undesirable activity; and that being a good worker is more important than being a good mother. In the context of such beliefs, breastfeeding is only tolerated as long as it does not breach work boundaries. But breastfeeding is presented as a public interest, benefiting society by reducing the incidence of disease both in the mother, and most importantly, her infant. It is also presented as economically beneficial to the mother’s workplace, reducing sick leave and enhancing employer-employee relations. In the absence of legislation and workplace policy that supports breastfeeding workers, the responsibility to meet public health interests falls on solely the mothers. Therefore,
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Women’s Health Update features women’s health news, policy and scientific findings, to enable health care professionals and community-based workers to be at the forefront in women’s health. Women’s Health Update is published by the Women’s Health Action Trust
2 • Women’s Health Update • vol 14 no 3 • September 2010 continued from page 1 if mothers are to meet the demands of health promotion that are currently placed on them, health practitioners, unions and governments need to share the responsibility by lobbying for and enacting polices and law that support breastfeeding workers. Acknowledgement Deborah Payne wishes to thank the women who participated in the study, Sue Berman the past research officer for AUT Centre for Midwifery & Women’s Health Research, Louise James from Women’s Health Action, and Barbara Sturmfel from La Leche League; and the AUT Faculty of Health & Environmental
Sciences Contestable Research Fund. References Horta, B., Bahl, R., Martines, J. C. & Victoria, C. G. (2007) Evidence on the Long Term Effects of Breastfeeding. Systematic Reviews and Metaanalyses. Geneva: World Health Organization. Humenick, S. & Gwayi-Chore, M. (2001) Leader or left behind: National and international policies related to breastfeeding. 30(5), 529–546. Ip, S., Chung, M., Raman, G., Chew. P., Magula, N., DeVine, D., Trikalinos, T. & Lau, J. (2007) Breastfeeding and Maternal Health and Infant Health Outcomes in Developed Countries. Evidence Report / Technology Assessment No 153. Rockville:
Agency for Healthcare Research & Quality Galtry, J., & Annandale, M. (2003) Developing Breastfeeding-Friendly Workplaces in New Zealand. Wellington: Equal Employment Opportunities Trust. Payne, D. & James, L. (2008) Make or break. Mothers’ experiences of returning to work and breastfeeding: A New Zealand study. Breastfeeding Review 16(2), 21–27. Payne, D. & Nicholls, D.A. (2010) Managing breastfeeding and work: a Foucauldian secondary analysis. Journal of Advanced Nursing 66(8), 1810–1818.
Keeping women’s health on the agenda The 6th Australian Women’s Health Network Conference was held in May in Hobart, Tasmania. The conference, only held every 5 years, is an international gathering of over 500 delegates working in women’s health policy, research, women’s health care and women’s not-for-profit organisations. Delegates attended from Australia, New Zealand, Canada, Ireland, the United States and United Kingdom. All areas of women’s health were represented including, but not limited to, government departments, universities, women’s health advocacy groups, women’s health nursing organisations, women’s health physicians, breast and cervical screening organisations, violence prevention organisations, and eating disorders services. With the support of the Lottery Minister’s Discretionary Fund, we were delighted to have our Policy Analyst Christy Parker attend the conference, and present a paper on approaches to cervical cancer prevention in Aotearoa New Zealand. Violence against women was a major theme of the conference with speakers focusing on the need to ensure government strategies and programmes include a gender focus, as well as the importance of supporting communities to identify their own solutions and resourcing them to develop their own initiatives. The importance of keeping women’s health on the agenda in Government health policy more generally was also a strong conference theme. The Australian Government has committed to developing a Women’s Health Strategy that places gender analysis, alongside other social determinants including ethnicity, disability, sexual identity, geographical location, socioeconomic status and access to education, at the centre of health policy development to ensure inequities in women’s enjoyment of health, and access to health services are addressed. The challenge is there for New Zealand to follow suit. Another conference theme focused on developments in women’s health services including abortion law reform, mental health services, indigenous women’s health services, health services for women who are disabled, cancer screening, and health services with a sexual diversity focus to ensure the needs of lesbian, bi-sexual, queer and transgender women are met. A number of Australian
states including Canberra and Victoria have now decriminalised their abortion services and integrated these services into broader women’s health services. Those states that have decriminalised identified benefits including better workforce morale and reduced barriers to service developments such as the introduction of early medical abortion services in the community resulting in improved access and choice for women. Conference discussion focused on how to support the abortion law reform process elsewhere. Indigenous women’s health was also a major conference theme with the need to put indigenous women’s health on the Government’s agenda. Also emphasised was the importance of the need for aboriginal communities to be supported and resourced to identify and provide their own health solutions and services. The conference plenary worked towards a series of recommendations that delegates could use to guide future actions on their return home, and we will be looking for ways that we can integrate these further into our work here at Women’s Health Action. Actions included: • Supporting the establishment of gender equity targets to ensure universal access to sexual and reproductive health services through primary care, including more nurseled services. • Ensuring gender equity in all social policies and working towards a national women’s health policy. • Addressing all of the intersecting factors that influence women’s health and continuing to advocate for a social view of health at every opportunity. • Promoting the prevention of violence against women to become a policy priority. • Reaffirmation of women’s reproductive and
sexual rights, and supporting reproductive and sexual health service developments. • Promoting on-going funding and support for the NGO community sector to ensure women’s health and indigenous health organisations are able to continue to provide community-led services to women. Over the coming months we will profile some of the research and policy developments presented at the conference so watch this space! New research and strategies obtained at the conference will also be available on our website www.womens-health.org.nz.
Only a keystroke away: Support for breastfeeding friendly workplaces Women’s Health Action has recently launched a “Breastfeeding Friendly Workplaces” (BFW) programme. This programme is designed to help employers understand that helping employees balance the demands of work and family results in a happier, more productive workplace. Many workplaces are already taking proactive steps to implement workplace wellness initiatives, and the introduction of the Employment Relations (Breaks, Infant Feeding and Other Matters) Amendment Act certainly reinforces these. However, we still hear from too many women who are facing archaic views from their employers around breastfeeding and working. Our newly launched website offers comprehensive information for employers on becoming breastfeeding friendly including business cases, relevant legislation, common concerns and information about how to implement a BFW programme in your workplace. This site also offers information for employees including how to negotiate support with your employer, real life stories from women about their experiences balancing family and work, and information about expressing at work. Women’s Health Action’s BFW team can offer a range of services to help your workplace achieve a family friendly workplace. For more information see www.bfw.org.nz or call us on 09 5205295
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For better or for worse? Changes underway to our public health and disability services The Health Select Committee has recently heard submissions on the New Zealand Public Health and Disability Amendment Bill. The Bill received a very small number of submissions suggesting many New Zealanders are not aware of the Bill and the impact of proposed changes to our publicly funded health system. Christy Parker, Women’s Health Action Policy Analyst reviews the Bill and discusses how it might shape the health landscape in New Zealand. The New Zealand Public Health and Disability Amendment Bill amends the New Zealand Public Health and Disability Act 2000, a key piece of legislation providing the infrastructure for New Zealand’s publicly funded health and disability support system. The aim of the Bill is to improve the functioning of the health and disability support system in terms of quality and efficiency so that it can continue to provide high quality services in the face of challenges. The Bill identifies these challenges as including a tight funding environment, an ageing population, a competitive international market for health professionals, and an ever expanding and expensive range of health care and disability support technologies. The proposed reforms include amendments to the planning requirements for district health boards (DHBs); amendments to the objectives and functions of district health boards to ensure cooperation and collaboration; increased ministerial powers to enforce collaboration between DHBs; the establishment of the Health Quality and Safety Commission; and enabling the appointment of elected district health board members to the boards of other district health boards. Given the challenges facing the publicly funded health and disability support system, reforms
which aim to support the system to maintain and enhance quality and gain effectiveness are welcome. For example the establishment of an independent quality agency charged with looking at improving system safety has been called for by the sector for some time. It is likely to help improve patient care by reducing the number of adverse events, and is applauded1. Likewise emphasising the need for DHBs to have a national and regional as well as a local focus, and efforts to encourage greater collaboration between DHBs in the sharing of administrative, support, and procurement2 services across the public health system in a time of constrained resources makes good sense. We are but a small player in the global pharmaceuticals and medical devices market after all. For those clinical services that are vulnerable, regional or national approaches to service delivery are likely to be necessary to ensure the ongoing provision of high quality services. However health reforms always come with costs, as well as potential benefits, and it is vital that we are able to put both on the balance sheet in deciding whether we are prepared to pay the price. One of the costs of these current reforms may be the ability of local communities to be consulted on, and be able to influence, service planning and development by their local district health boards. With the goal of ensuring DHB activities are able to be nationally coordinated and influenced by ministerial priorities, the Bill repeals very specific requirements around DHB consultation with communities that are contained in the Principal Act. The ability of DHBs to be responsive to the needs of their local communities’ and specific population
groups within those communities, if they do not consult with them, is doubtful. The publicly funded health service is not just a contract between the Government and individual patients in New Zealand, it is a contract between the Government and the diverse communities and populations that constitute New Zealand with large differences in need and requirements from the publicly funded health and disability support service. It seems further consideration is warranted about how to support moves towards national collaboration that do not compromise the ability to be locally responsive. The Bill also significantly enhances the powers of the Minister of Health to direct activities within and between district health boards. Questions remain about whether such an increase in powers is warranted, justifiable, and what the future implications of such a change might be. New Zealand’s publicly funded health and disability support system is highly valued by most New Zealanders and we are all going to need to be part of the conversation about how it will be sustained and at what cost. Workshop participants called for the establishment of an independent quality agency at Women’s Health Action’s ‘Cartwright Comes of Age? Seminar’ in 2009, see the Seminar Report, pp. 17, http://www.womenshealth.org.nz/index.php?page=cartwright-comes-ofage 2 Procurement is the process whereby DHBs source, negotiate cost and obtain the supply of pharmaceuticals, medical devices and services to support the functioning of the health services in their area. Greater collaboration between DHB’s in procurement means better bargaining power and potentially reduced costs. 1
New publicly funded contraceptive available for New Zealand women PHARMAC has announced that a new contraceptive implant is now fully subsidised for New Zealand women, as of August 1st 2010. This move is strongly endorsed by Family Planning as another important contraceptive resource for supporting women’s sexual and reproductive health. Jadelle, otherwise known as Levonorgestrel, is supplied by Bayer New Zealand and is one of a family of contraceptives called Long Acting Reversible Contraceptive (LARC). LARCs are an appealing contraceptive in that they are effective for up to five years, show very high rates of effectiveness, and can be removed if a woman wishes to become pregnant, with a return to normal fertility soon after removal. The Jadelle implant consists of two small, soft plastic rods each containing 75 mg of progestogen in a reservoir which releases it in tiny doses. The rods are inserted by a doctor
under the skin of the upper arm. The implant can be removed at any time and evidence to date suggests that it is highly effective in preventing pregnancy - with less than one pregnancy expected per 100 women in the first four years of use and the chance of pregnancy in about one in a hundred women in the fifth year. However, like other hormone-based contraceptives, Jadelle is not suitable for all women and some women will experience side effects. The most frequently recorded side effects are irregularity of menstrual bleeding and in some users the altering of blood sugar and lipid (fat) levels. Some women have reported difficultly in the removal of the rods with associated pain, numbness, tingling and scarring in the upper arm. For more information about Jadelle, women should contact their nearest Family Planning clinic or view the Jadelle Consumer
Medicine Information prepared by Bayer New Zealand at the Medsafe website: http://www. medsafe.govt.nz/consumers/cmi/j/jadelle. htm. Women’s Health Action is also preparing an information pack on contraceptive implants which will be available soon.
New Health and Disability Commissioner welcomed A commitment to patient-centred health care was a key message expressed by the new Health and Disability Commissioner, Anthony Hill, at the recent Cartwright anniversary seminar and lunch, held to mark the release of the Cartwright Report in 1988. Mr Hill explained the elements of patient-centred healthcare, including transparency, integration of care services, and respect for and between health professionals and their patients. Mr Hill said that the Health and Disability Commissioner’s part in the Health Quality and Safety Commission will mean that individuals’ stories will be put forward to inform the quality agenda. The audience raised concerns around aged care, including calling for a national conversation about end of life care due to the absence of informed choice in current practice. Jennie Michel from Age Concern pointed out that advance directives and living wills are not always being upheld. With around 80% of residents in aged care facilities afraid of making a complaint, Robyn Northey highlighted the need to look at effective ways of addressing care and safety issues in residential facilities. Sandra Coney, one of the key players in exposing the “Unfortunate Experiment” that led to the Cartwright Inquiry and subsequently, the appointment of a Health and Disability Commissioner, emphasised that the balance needed to be restored between addressing individual health consumers’ complaints and using these to inform improvement in the systems for health care delivery. She pointed out that the Health and Disability Commissioner’s role is to give voice to the consumers in the system, and that the Commissioner is in an ideal position to start national conversations on broader issues of national importance.
Noticeboard ●
Cervical Screening Awareness Month (Nationwide)
September Take care of your body. Have a smear test every 3 years. It could save your life! Contact your doctor, nurse or health worker for an appointment. Or call 0800 729 729 for more information. http://www.cervicalscreening.govt.nz/
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Women’s Health Postgraduate Paper
Massey University Albany is offering a Women’s Health postgraduate paper in the first semester of next year. The paper, only offered bi-annually, provides students with critical gender and feminist perspectives on women’s health issues and is relevant to those working in all areas of women’s health including practice, research and policy. For more information contact Professor Jenny Carryer J.B.Carryer@massey.ac.nz
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Welfare Justice - the Alternative Welfare Working Group’s public meetings on welfare reform (Nationwide)
Wellington 24 August; Auckland 9 September; Northland 15 September; South Auckland 20 September; Invercargill 23 September; Christchurch 24 September; Rotorua 29 September. For more details see http://welfarejustice.org.nz/?sid=5
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North Shore Women’s Centre art exhibition (Auckland)
Thursday 2nd – Wednesday 29th September “Inner Strength – Celebrating and Strengthening Women” – this exhibition brings together 33 very, talented NZ female artists. http://nzartguild.blogspot.com
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Women’s Suffrage Breakfast (Auckland)
Friday 17th September 7am – 9am Join us for breakfast at the Ellerslie Racecourse to celebrate Women’s Suffrage and hear Judy McGregor, EEO Commissioner with the Human Rights Commission, speak on “Sex and Power”. See http://www.womens-health.org.nz for more information or call 09 5205295
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2010 Waikato Health & Disability Expo (Hamilton) Friday 17th – Saturday 18th September http://www.healthanddisability.org.nz
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Opening Doors – Hereditary Breast and Ovarian Cancer, the New Zealand Perspective (Christchurch)
Friday 1st – Saturday 2nd October New Zealand’s first conference dedicated to hereditary breast and ovarian cancer aims to answer a growing thirst for knowledge on this important issue. http://www.giftofknowledge.co.nz/
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Youth and Sexual Violence Workshop (Auckland)
Wednesday 6th October One-day, interactive workshop for youth workers For more information see http://www.rapecrisis.org.nz/
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Breastfeeding Update and Ethics in Lactation Practice (Auckland and Dunedin)
Thursday 7th – Friday 8th October, Auckland Saturday 9th – Sunday 10th October, Dunedin For more information or to register, email office@ capersbookstore.com au or see http://www.capersbookstore. com.au
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Thursday 28th – Saturday 30th October Mercure Hotel, 355 Willis Street, Wellington Becoming a New Parent & Perinatal Distress – What You Might Not Know & Who Can Help? http://www.pnd.org.nz/
Family Planning Conference 2010 (Wellington) Friday 15th – Sunday 17th October http://www.familyplanning.org.nz/News/Events/ Conference2010.aspx
ASG Parent and Child Show (Auckland)
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Friday 29th – Sunday 31st October ASB Showgrounds Women’s Health Action will once again have a stall at the Parent and Child Show. Come along to receive breastfeeding information and resources. A comfortable feeding area with water is also available. See http://www.parentandchildshow.co.nz/ for more information
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INVOLVE 2010 Connect: Together We Are Stronger (Auckland)
Wednesday 17th – Friday 19th November Aotea Centre, Auckland A biennial conference for people working with young people http://www.involve.org.nz/
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La Leche League Conference 2010 (Wellington)
Friday 8th – Saturday 9th October “Breastfeeding – Weaving lifelong connections”. Speakers include Alison Barrett, Pinky McKay, Ruth DeSouza and more. See http://www.lalecheleague.org.nz/ for more information and to register
Post Natal Distress Conference 2010
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Women’s Studies Association (NZ) Conference – Connecting Women: Respecting Differences (Hamilton) Friday 19th – Sunday 21st November University of Waikato http://www.wsanz.org.nz/
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White Ribbon Day (Nationwide)
Thursday 25th November White Ribbon is a campaign led by men who condemn violence against women and take action. We are part of a global campaign committed to ending violence against women. http://whiteribbon.org.nz/
Women’s Health Update is produced by Women’s Health Action Trust • Edited by Jo Fitzpatrick To receive copies of Women’s Health Update, make suggestions about future contents or send items for publication please contact: Women’s Health Action Trust • PO Box 9947, Newmarket, Auckland, NZ 2nd Floor, 27 Gillies Avenue • Ph (09) 520 5295 • Fax (09) 520 5731 • email: info@womens-health.org.nz Internet address: http://www.womens-health.org.nz • Women’s Health Update is published with the assistance of the Ministry of Health
Women's Health Action Trust celebrating 20 years 1989-2009