This article was downloaded by: [University of Illinois Chicago] On: 24 October 2014, At: 06:14 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
Health Care for Women International Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/uhcw20
Japanese Women's Experiences From Pregnancy Through Early Postpartum Period a
a
a
Rieko Kishi , Beverly J. McElmurry , Susan Vonderheid , Susan b
a
Altfeld , Barbara McFarlin & Junko Tashiro
c
a
College of Nursing , University of Illinois at Chicago , Chicago, Illinois, USA b
School of Public Health , University of Illinois at Chicago , Chicago, Illinois, USA c
St. Luke's College of Nursing , Tokyo, Japan Published online: 10 Dec 2010.
To cite this article: Rieko Kishi , Beverly J. McElmurry , Susan Vonderheid , Susan Altfeld , Barbara McFarlin & Junko Tashiro (2010) Japanese Women's Experiences From Pregnancy Through Early Postpartum Period, Health Care for Women International, 32:1, 57-71, DOI: 10.1080/07399331003728634 To link to this article: http://dx.doi.org/10.1080/07399331003728634
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms &
Downloaded by [University of Illinois Chicago] at 06:14 24 October 2014
Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions
Health Care for Women International, 32:57–71, 2011 Copyright © Taylor & Francis Group, LLC ISSN: 0739-9332 print / 1096-4665 online DOI: 10.1080/07399331003728634
Japanese Women’s Experiences From Pregnancy Through Early Postpartum Period RIEKO KISHI, BEVERLY J. McELMURRY, and SUSAN VONDERHEID Downloaded by [University of Illinois Chicago] at 06:14 24 October 2014
College of Nursing, University of Illinois at Chicago, Chicago, Illinois, USA
SUSAN ALTFELD School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA
BARBARA McFARLIN College of Nursing, University of Illinois at Chicago, Chicago, Illinois, USA
JUNKO TASHIRO St. Luke’s College of Nursing, Tokyo, Japan
Declining availability and accessibility of perinatal health care are emergent social concerns. Based on the Listening to Mothers-II (LTM-II) surveys, we describe a total of 20 Japanese women’s perinatal experiences. Data were qualitatively compared with those of U.S. women, using a theoretical framework for evaluation of primary health care. Japanese women overcame their worries by engaging in healthy behaviors, accepting hardships such as labor pain, and receiving assurance from health professionals and modern technology. We found that while U.S. and Japanese women’s perinatal experiences reflected their unique cultural values and social context, a cross-cultural universality of birthing women’s experiences exists. Declining availability and accessibility of perinatal health care are emergent social concerns in Japan. Many hospitals and clinics are closing, and an
Received 10 May 2009; accepted 19 February 2010. This study was supported by the American Association of University Women International Doctorate Fellowship, the Fumiko Yamaji Trust Academic Nursing Education and Research Grant, and the Sigma Theta Tau Alpha Lambda Chapter. Appreciation is expressed to Dr. Carol Sakala, Ito City Hospital, and Child Research Net. Address correspondence to Rieko Kishi, PhD, College of Nursing, University of Illinois at Chicago, 845 S. Damen Avenue, Chicago, IL 60612, USA. E-mail:
[email protected] 57
Downloaded by [University of Illinois Chicago] at 06:14 24 October 2014
58
R. Kishi et al.
increasing number of perinatal health care providers, particularly obstetricians, are leaving their jobs (Japan Society of Obstetrics and Gynecology [JSOG], 2006; Unno, 2008). The total number of hospitals and clinics that provided labor and delivery care declined by 11.3% from 2002 to 2005 (Ministry of Health, Labour and Welfare [MHLW], 2005). Moreover, according to a recent collaborative survey by the Japan Association of Obstetricians and Gynecologist and MHLW, the number of the hospitals further decreased by 8% in 2008 (Asahi Newspaper, 2008). There were only 2.45 obstetricians per clinic/hospital that provided labor and delivery care, which is fewer than in other developed countries, such as the United States which has 6.7 obstetricians per hospital (JSOG, 2006). A new term “osan-nanmin (childbirth refugees)” has emerged in the society in recent years, referring to women who cannot access necessary prenatal health care. This term illustrates the rapidly declining availability of perinatal health care for women and their families in Japan. The perinatal process, from pregnancy through postpartum, is a phenomenon reflecting the sociocultural context of a particular setting. Comparisons of U.S. and Japanese women’s experiences with the health care system and societal context will contribute to the evaluation of current perinatal care in the two countries. A data set reflecting lay women’s voices provides rich data sources for professionals developing evidence-based practices to improve health care services for their clients, for policymakers developing innovative perinatal health programs, and for women and their families preparing for perinatal events. In this article we report a secondary analysis of findings from an instrument development study in which Japanese women’s perinatal experiences were examined using qualitative and quantitative data. An Englishlanguage questionnaire, LTM-II , was translated and culturally adapted into the Japanese language and pretested with 20 Japanese lay women. Although the sample size of the Japanese version is not yet adequate to generalize the findings to the entire population of Japanese women or make statistical comparisons, evident differences and similarities arose from the qualitative comparisons of women’s perinatal experience in the United States and in Japan. The findings reported in this article need to be considered as first impressions based on a small sample from the earliest stage of a future substantially larger study using the Japanese version of the LTM-II . By publishing this article as the early stage of the project, our intention is to encourage other interdisciplinary researcher readers to translate the LTM-II questionnaire into other languages to enable further cross-national comparisons of women’s perinatal experiences. Multicultural comparisons will facilitate further understanding of the issues for childbearing women and will contribute to improvement of maternal health care worldwide.
Japanese Women’s Perinatal Experiences
59
METHODS
Downloaded by [University of Illinois Chicago] at 06:14 24 October 2014
Theoretical Framework Variables to be measured were classified according to a conceptual framework for evaluation of primary health care (PHC) for perinatal women from pregnancy through the early postpartum period (Kishi, 2009). The “Health for All” philosophy of PHC is an approriate conceptual framework, since the ultimate goal of this study is to ensure that all perinatal women in Japan have necessary health care. The criteria for PHC evaluation follow Alma Ata guidelines: scientific soundness, available, accessible, acceptable, affordable, participatory, collaborative among caregivers, equal, and sustainable (McElmurry & Keeney, 1999). Scientific soundness, equity, and sustainability of perinatal care were not examined at this stage, as they require statistical analyses and longitudinal approaches. This research considered two concepts of the framework time and dimensions of prenatal experience/support. Time includes pregnancy, birth, and early postpartum periods. The dimensions of perinatal experience/support are medical, nonmedical physical, emotional, informational, advocacy, and others such as material and chores.
Study Participants Two groups of Japanese lay women were recruited: a group of 15 early postpartum lay women who had given birth at a rural hospital in the 10 days preceding the interviews; and a group of five lay women who, like the original LTM-II sample, had given birth in an urban city in the 2 years prior to the survey. Inclusion criteria followed the original LTM-II criteria: women between the ages of 18 and 45; birth of a single baby; baby alive at the time of interview; willingness to participate in the study; and ability to read, understand, and communicate in the Japanese language.
Data Collection and Analysis Listening to Mothers (LTM), the first and second national surveys in the United States that examined women’s perinatal experiences, was developed and implemented in 2002 and 2006 as a collaborative endeavor of Childbirth Connection, the LTM national advisory council, and Harris Interactive (Declercq, Sakala, Corry, Applebaum, & Risher, 2002; Declercq, Sakala, Corry, & Applebaum, 2006). The LTM survey examined women’s experiences, along with their beliefs, attitudes, preferences, and knowledge, from planning the pregnancy through the postpartum period. The information and recommendations from the LTM survey findings supported the development of evidence-based maternal health care in the United States (Declercq, Cunningham, Johnson, & Sakala, 2008; Lowe, 2007; Public Advocate for the City of New York, 2006; Sakala, 2006; Sakala & Corry, 2008; Sakala, Declercq,
Downloaded by [University of Illinois Chicago] at 06:14 24 October 2014
60
R. Kishi et al.
& Corry, 2002; Young, 2006). The data for U.S. women were weighted according to the U.S. national population. To collect data from Japanese women, the English-language LTM-II was translated into the Japanese language and was culturally adapted so that Japanese women’s experiences were understood in their cultural context, while maintaining the equivalence between the two instruments as much as possible. Translated LTM-II questionnaires were pretested with 20 lay Japanese women in person in a private room. The interviews were taperecorded. The study protocol was approved by the Institutional Review Board of the University of Illinois at Chicago and the data collection sites in Japan. Data from Japanese women were more detailed than those of U.S. women for a few reasons: the in-person interviews of Japanese women allowed probing and extended conversations; the J-LTM-II had additional questions to address Japanese women’s perinatal experience; and published information about the LTM-II report was limited. Data obtained from Japanese women and information from the LTM-II report on U.S. women were compared qualitatively, based on the theoretical framework for the PHC evaluation. The details of methodology used in the tool development study were reported separately (Kishi, 2009). In this article, we describe major findings based on women’s responses to the Japanese version of LTM questions. A full report on Japanese–U.S. comparisons of women’s perinatal experience is available upon request.
RESULTS Sample Characteristics Overall, the ages, education levels, and income levels of the Japanese participants covered the same ranges as those of the U.S. women. Marital status, parity, and mode of delivery were somewhat skewed: Compared with the U.S. women, Japanese participants were more likely to have been married (95% vs. 70%), primiparous (65% vs. 33%), and had vaginal birth (95% vs. 68%).
Current Availability and Accessibility of Perinatal Care Options Table 1 presents selected comparison data between Japanese and U.S. women using the PHC framework. Japan has had a universal insurance system since 1961, and the system allows all people access to equal health care service in any setting. Reflecting this system, the majority of Japanese women in this study chose their maternity health providers because of geographic convenience, while U.S. women chose providers because of their insurance plans (Declercq et al., 2006). Some Japanese women chose their provider because they felt more secure with a large hospital rather than with a small clinic.
61
Japanese Women’s Perinatal Experiences TABLE 1 Selected Data for Primary Health Care Criteria PHC criteria
Item
Availability
Fetus ultrasound exam
Downloaded by [University of Illinois Chicago] at 06:14 24 October 2014
Electronic fetal monitoring during labor Pain control for labor pain Constraints during labor
Baby’s location
Accessibility Acceptability
Affordability
Participation
Collaboration among caregivers
Distance to prenatal care Internet use for info Exclusive breastfeeding
Japanese women (n = 20)
U.S. women (n = 1,573)
M = 12 times (range: 5–17)
99% of women had > 1 time; 59% > 3 times; 15% > 6 times Throughout labor: 47% Throughout labor: 76% As a baseline: 21% As a baseline: 2% Pain medication use: 0% Nondrug measures: 100% Drank something: 100% Ate something: 37% Walked during labor: 68%
