Fundamentals of Midwifery: A Textbook for Students (25 page)

strict binary of two highly distinct catego- ries, guiding people sometimes gently and sometimes coercively into one or the other
’. This can be related to what are perceived as specific characteristics of femininity and masculinity, which are often seen as opposites, but in practice, can overlap.
Activity 3.6 Sit in a coffee shop or bar and watch the people; think about how you know whether the
people are men or women.How do you think you would feel if you could not identify their gender? 51There is also a debate around the role of fathers and how this can often be marginalised and not fully explored, with the emphasis being on the role of the mother (Bainbridge 2008; Price 2012; Daniel 2005). This is often in terms of inequalities between the focus of care being on the woman rather than the father. The role of fathers has changed over time and is different depend- ing on the family’s culture and community. The changing attitude to fathers being present at the birth of their baby is evidence of how society’s views can change and shape the families’ experiences. It is made clear by the Nursing and Midwifery Council (NMC) (2009) and Depart- ment of Health (2007) that the focus of midwives’ care should be on the whole family, not just the woman and the baby. Hansom et al. (2010) examined how services specifically aimed at young fathers can improve the health and wellbeing of all the family. The Royal College of Midwives (RCM) (2011) sets out guidance on how to help to involve fathers in maternity services and identifies the evidence which states that this will improve the health and wellbeing out- comes of all the family.
Ethnicity and race
There are other factors which can affect a person’s health and wellbeing; these include race andethnicity. It is well-documented that people from certain ethnic backgrounds have poorer health and wellbeing than the general population. This can be related to discrimination and racism which can have an impact on the person’s mental and physical health. Although this does not explain all the differences, there are also genetic influences, with some groups having greater incidences of certain diseases. Practices within different communities can also influence the group’s health in a positive and negative way: for example, having faith can improve a per- son’s psychological wellbeing; female genital mutilation has a detrimental impact on girls and women (WHO 2013); the practice of marrying within a community can have genetic conse- quences with increased rates of infant mortality and congenital abnormalities. There are also health implications related to the age when people marry and start having children. This can vary significantly between cultures, communities and countries (Hepburn and Simon 2006).It is important to be clear about what is meant by terms which are used to define people and groups of people. Bhopal (2004) discusses the difficulties in defining terms such as race and ethnicity and the fact that these terms are not necessarily ‘fixed’ or ‘easily measured’. Bhopal (2004 p. 441) defines ethnicity as:
. . . a multifaceted quality that refers to the group to which people belong, and/or are per- ceived to belong, as a result of certain shared characteristics, including geographical and ancestral origins, but particularly cultural traditions and languages...
Bhopal (2004) also discusses the definition of race and its biological and social determinants, and identifies the difficulties of defining this term, although the study of discrimination of people due to their race is highlighted as being of key importance.
Activity 3.7 What race and what ethnicity would you identify yourself as and why?Race and ethnicity are often seen as in terms of ‘the other’, the dominant race being ‘white’ within the UK. As can be seen with other types of discrimination this is related to difference from the majority and therefore the norm. Racism can be defined as:
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. . . a belief that some races are superior to others, used to devise and justify individual and collective actions that create and sustain inequality among racial and ethnic groups...
(Bhopal 2004, p. 444) Aspinall (2010) discusses how trying to categories people into specific groups can be difficult,with the introduction of the‘mixed’ethnic or racial groups increasing this complexity. As Giddens(2009, p. 671) describes‘
there are no clear cut characteristics by means of which human beings can be allocated to different races
’. Giddens (2009, p. 633) goes on to define ethnicity as ‘
cultural practices and outlooks of a given community of people which sets them apart from others
’. Burnett (2013) explores the sources of racial hatred and how this is shaped over time. He discusses how this hatred can be seen as normal by society, and can be reinforced by the media, giving the examples of asylum seekers and migrants, who are often seen as taking jobs and housing from the rest of the population and living on social benefits. This can tap into the fears of society, which can be around difference and are magnified during times of financial adversity.
Disability
A person has a disability if: ‘
they have a physical or mental impairment, the impairment has a
substantial and long-term adverse effect on their ability to perform normal day-to-day activities
’ (Equality Act 2010).The key aspect of this definition is around the ability to carry out what are seen as normal day to day activities, this is a theme within the literature. Oliver (1996) identifies ‘three core ele- ments linked to the definition of disability: (a) the presence of impairment; (b) the experience of externally imposed restrictions; and (c) self-identification as a disabled person. This is well- applied to the concept of society affecting the opportunities of the disabled person as seen in the ‘social model of disability’, the presence of an ‘impairment’ linked to the medical model and the importance of how the person feels about being labelled as being disabled. As the term disability tends to be a negative one, people may want to reject this label and want to be viewed as an individual rather than a disability. There is also an ‘affirmation model’ (Swain and French 2000) which challenges society to see disability from a positive perspective; this can be seen in subcultures within disability, for example, the deaf culture (Sparrow 2010). This is interesting as there is controversy within this culture in how treatment for the disability is viewed, in that cochlear implants are seen as a way to wipe out the deaf culture (Sparrow 2010), to meet the medical model of disability within society. The assumption is that deaf people would want to become hearing. Walsh-Gallagher et al. (2012) have identified an affirmation model for pregnant women and mothers who have a disability, the key elements of ‘celebration, achievement, bonding and confidence’ identified from their interviews with women.There is a debate around how society views disability and whether it is the parents’ respon- sibility to ensure they do not have a disabled child requiring additional care and services from society which will be painful for them, the child and their family. As previously identified there are different models of disability (Brandon and Pritchard 2011; Larkin 2009). One of these is the ‘social model of disability’ (McDaniel 2013; Larkin 2009) which links disability to how society treats and views people with a disability, rather than focusing on the disability itself. This theory was developed in contrast and to challenge the medical view of disability, which focused on what was wrong and what could be done to make the person less disabled. The person is
characterised by their disability, lives this experience, and is often not seen as anything else. This is followed by stigma and limitations and expectations of society, about what the disabled person can or cannot do (Barnes and Mercer 2010; Barnes et al. 2010; Burchardt 2010). This view has been challenged by activists from the disabled community, who challenge society toremove barriers which make the person disabled and for their members to have the same
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opportunities as others within society.There has been some discussion around what the impact of the London Paralympics has been in relation to how society views those who are disabled, and how to change negative attitudes, some of which are based around prejudice and ignorance. It is unclear how much impact this will have in the future. Braye et al. (2012, p. 5) highlighted in their study the negative views of some disabled people to the Paralympic Games, with one of the participants stating that:
. . . the focus on elite Paralympians promotes an image of disabled people which is so far removed from the typical experiences of a disabled person that it is damaging to the public understanding of disability . . .
This has an impact on midwives as they are involved in caring for women who have disabilities, women who are having or have had a baby with a disability and their own emotions in relating to these families. This can also be viewed against the idea that the disabled body is one that is failing and has to be measured against the normal functioning body (Hughes 2009). From a childbearing viewpoint women and men who are infertile or have difficulty in conceiving could be viewed as failures; women who are unable to give birth naturally may view themselves as being less of a woman. This has obvious implications for a woman’s self esteem and psychological wellbeing. The language that doctors and midwives use can also facilitate this feeling of failure. Harpur (2012) also discusses how behaviour outside of society’s norms defines the person as disabled.With advances in antenatal screening and diagnostic testing, women and their families are faced with making difficult and challenging decisions about what screening to have and what to do if there is likelihood of abnormality. Some of this is maybe linked to society’s views of disability and the particular condition involved. Williams et al. (2002) discuss how screening for Down syndrome is sometimes explained by midwives, the implication being, that people with this condition have little to contribute to society and their family’s lives.