I applaud the efforts of researchers published in this issue of Health Care for Women International for studying vulnerable women. Such populations include women with health issues and their health practitioners. Both groups are vulnerable to stigma. I am impressed by the work of Gretchen Ely and colleagues, because their trauma-informed recommendations for practice with women who receive funding for abortions makes a theoretical contribution to the literature. I think readers will agree their theory may also be applied to other vulnerable populations including imprisoned women, sex workers, women whose genitals have been mutilated, and women who have experienced intimate partner violence. After reading all these manuscripts, it is my hope that you will understand why both health care practitioners and their patients are vulnerable. What practitioners and patients have in common is they lack sufficient resources to improve women's health.
Nagore Martinez-Merino and colleagues note in their review of studies of incarcerated women that globally penal institutions are androgenic as most cultures are androcentric. This fact limits both the resources available for health interventions for this population, and research evidence evaluating the few interventions that do exist. It simply is not politically correct, in many countries, to work with women in prison.
Tais Cardoso Vernaglia and co-authors explain that vulnerable populations such as the crack users they studied are rarely researched because potential informants shy away from revelations to avoid greater vulnerability to stigma. The authors should be proud of their large sample of crack users in Brazil, which contained data aggregated by gender. Such data allowed them to conclude female crack users are more vulnerable than men in every area except the likelihood of being addicted to alcohol. Women had less education, were more likely to be unemployed, lacked economic resources to meet basic needs and were separated from their children. That these social conditions exist plus the knowledge that talking to the wrong persons could lead to imprisonment, make it difficult for health practitioners to engage such women in conversation.
Varun Sharma and colleagues write about “predisposing and enabling factors” to predict who gets what health services among female sex workers in Andhra Pradesh, India. They argue that factors such as limited education and living in a rural community explain variation in services received, rather than a medical need for attention. Sex workers either don't know they need medical help or they cannot access help when available. Regardless of predictable factors, it is health practitioners who are tasked with improving health care utilization for this population. Of course, without considering the factors, the practitioners are vulnerable to failure.
From the manuscript by Nazar Shabila, Hamdia Ahmed, and Kolsoom Safari we learn health professionals in Iraqi Kurdistan recognize the vulnerability of young women who may experience female genital mutilation. Health practitioners interviewed claim they do not perform such procedures, although several of those interviewed were circumcised themselves as younger women. I am surprised this population is relatively uninformed of health consequences for circumcised women as the prevalence of FGM in the vicinity averages 40%. They are more likely to be aware the procedure limits sexual arousal because they experienced the consequence themselves. Although the authors believe health practitioners can/should take the lead in implementing change in the region, the practitioners must first speak among themselves to acknowledge personal vulnerability.
Intervening in Japan to help women who have experienced intimate partner violence is rare, according to Maki Umeda and colleagues, most likely due to value of preserving family privacy. The researchers learned the importance of working with clinicians and patients for things to improve, because clinicians struggle with the issue as do their patients. They explain the help of clinicians requires recognition of the autonomy of women regarding initiating change and the importance of meeting with one another about women's recovery as it will encourage them to sustain their work with IPV survivors.
While vulnerability was not the focus of the last two articles in this issue, I read them in the context of vulnerability. I thus read the Evan Perrault and Jill Inderstrodt-Stephens research about how mothers choose health practitioners for their families in the United States, thinking about vulnerability in the context of limited resources. I concluded most mothers in the United States compose a privileged group because they have choices regarding health practitioners. Elsewhere, such choices do not exist.
Hyesun Lee and colleagues' Korean study of the relationship between weight perception and nutrient intake is about how women make decisions about what they eat. As a symbolic interactionist, I assume body self-perception occurs in the context of social interaction with others and misperception of weight involves misperception of how others evaluate bodies. It makes intuitive sense to me that young women who as a group think a lot about mate selection would be vulnerable to how they perceive their bodies being evaluated, and perhaps subsequently choose to eat according to those perceptions, inadequate nutrients.
There is much to learn in this collection, so start reading.