B|b||ography Series X ¢ Women and the Health System: Selected Annotated References fleeié—AA/w k4% T - ram RA Aip A|2H4 pus)". Tug -~ U.S. DEPARTMENT OF wer - HEALTH, EDUCATION, AND WELFARE Women and the : Health System: Selected Annotated References Cosponsors: Office of the Administrator Office of Health Resources Opportunities Special Programs and Bureau of Health Planning and Resources Development Division of Planning Methods and Technology National Health Planning Information Center \ U.S. DEPARTMENT OF HEALTH, EDUCATION AND WELFARE Public Health Service Health Resources Administration Center Building 3700 East-West Highway Hyattsville, Maryland 20782 DHEW Publication No. (HRA) 78-629 This bibliography was produced by the Health Resources Administration (HRA) as a further effort to focus attention on the magnitude of contributions of women in the health system. Its preparation was a combined effort of the Bureau of Health Planning and Resources Develop- ment (BHPRD), the Office of Health Resources Opportunity, and the HRA Council for Women and Health. Funding was provided by the National Center for Health Services Research, the National Center for Health Statistics, the Bureau of Health Manpower, and BHPRD as evidence of the total HRA support for efforts made in the area of women and health. For sale by the Superintendent of Documents, U.S. Government Printing Office Washington, D.C. 20402 Stock No. 017-022-00613-8 ii FOREWORD The Health Resources Administration (HRA) recognizes the important contributions of women to the health care system and the multiple roles involved in their interface with the system. Moreover, HRA is aware that there exists an even greater significant potential for women to participate in the improvement of health care in the United States. Thus, HRA has attempted to focus upon the issues and problems of women's participation in and utilization of the health system. One mechanism by which this focus is achieved is through the efforts of the HRA Council for Women and Health. The Council was established in November 1975 to provide advice and assistance to the Special Programs staff of HRA's Office of Health Resources Opportunity in planning and implementing a comprehensive extramural program for women and health. > This bibliography is the result of a joint effort of the Council and the National Health Planning Information Center (NHPIC) of the Bureau of Health Planning and Resources Development, HRA. The purpose of this bibliography is to highlight the findings of significant research thus far undertaken in the area of women and health. These findings may serve as a basis for possible policy directions. It is hoped that other Federal agencies, health care providers and consumers, health planning agencies, women, and other interested organizations will use this bibliography as a source book for becoming acquainted with the literature and will take actions to improve the efficacy of women as health care consumers, paid providers, decision- makers, and extra-market providers. Appreciation is extended to Ms. Jean Doong who, while assigned to NHPIC, conducted the literature searches and compiled and wrote the abstracts not accredited to NTIS or the author. Comments and questions concerning this bibliography are welcome. Please direct them to: Assistant Director for Special Programs Office of Health Resources Opportunity Health Resources Administration Center Building, Room 10-50 3700 East-West Highway Hyattsville, Maryland 20782 Clay impzon, Jy/, Ph.D. Ssociate Administrator for Health Resources Opportunity Programs, HRA iii AVAILABILITY OF DOCUMENTS Copies of articles and publications cited in this bibliography are not available from the Health Resources Administration unless indicated in the availability statement at the end of the abstract. Most journal articles are copyrighted and copies can only be obtained from the author or journal, or by contacting a university or large public library. Copyrighted publications can be obtained directly from the publisher. Other, non-copyrighted documents cited in the bibliography will have an availability statement at the end of the abstract, which will be: 1. Publisher or author at given address 2. National Technical Information Service (NTIS) U.S. Department of Commerce 5285 Port Royal Road Springfield, Virginia 22161 3. Xerox University Microfilms 300 North Zeeb Road Ann Arbor, Michigan 48106 iv RA 410 Women constitute the majority of users and providers of health f? services. They annually average 25 percent more visits to doctors than A12 men, use 50 percent more prescription drugs than men, and are admitted H4 to hospitals more often than men.*+ In addition, most patients over 65 years of age in nursing homes are female. "0.4 PUBL PREFACE Besides being the largest group of health services consumers, women comprise 75 percent of the total labor force in health services occupations. During the 1950-1970 period, the relative number of women employed in health services has increased substantially (from 65 to 75 percent). The proportion of women health workers in hospitals and other health settings has also grown steadily during that same period (from 72 to 77 percent in hospitals, from 54 to 70 percent in other health settings).3 Despite the large number of women in the health work force, the majority are employed in the lower paying health occupations. For example, in the United States in 1970, 97.9 percent of all dental assistants were women, but only 3.4 percent of all dentists were women.* Similarly, the nursing occupations are predominantly female while physicians are predominantly male." These statistics illustrate the disparity between numbers and influence, i.e., women are absent from leadership positions of decision-making, planning, administration, and delivery of health services, and are concentrated in the lower levels of health service occupations (technologists, assistants, aides, etc.). Women also interact with the health care system as providers of extra-market health services, i.e., home nursing care, access to the health care system, and preprimary, preventive, and health promotion services, all of which are mandated by traditional female societal role expectations.6 These issues which directly affect women are not taken into consideration by health policy makers in the United States. lLipman—Blumen, Jean, "Demographic Trends and Issues in Women's Health," in Oleson, Virginia (ed), Women and Their Health: Research Implications for a New Era, DHEW Publication No. (HRA) 77-3138, pp. 17-18. 2Ibid., p. 18. 3APHA,.Women in Health Careers, Chart Book for International Conference on Women in Health, Washington, D.C., June 16-18, 1975, p. 9. 4Ibid., p. 13. Ibid., p. 13. 6Policy Statement on Women and Health, Health Resources Administration, Public Health Service, Department of Health, Education, and Welfare. The statistical references cited illustrate the complexity of the interface between the health care system and women. For the purposes of this bibliography, this interface is identified as that interaction between the health care system and women in the roles of consumers, paid providers, decision-makers, and extra-market providers. The bibliography is limited to those publications in the English language issued between 1970 and March 1977 and is designed in the context of the health system (see Table I). The references are categorized according to the following four roles: Health Care Consumers, Health Care Providers (Paid), Decision-Makers (Paid), and Extra-Market Health Care Providers. In each category an attempt was made to identify literature and research which examine the forces impacting upon the efficacy of women in these roles. Since the health care system is often described by its structure and organization, financing mechanisms, regulatory structure, and policies, these characteristics are descriptive of the forces and issues relative to women and their roles in the health system. A fifth category, Other Bibliographies and Periodicals, is also included. Although there is some overlap of issues, and categories are not mutually exclusive, no cross references are made. An author index is provided after Section V. The computer data banks of the National Health Planning Information Center as well as the National Clearinghouse for Mental Health Information were utilized. Additional resources were the Parklawn Health Library, the National Institute of Mental Health Library, and the National Technical Information Service (NTIS). For those abstracts not written by the compiler, the source of the abstract is indicated in parentheses following the citation. In general, these sources are: Journal abstract, Modified journal abstract, NTIS abstract, Modified NTIS abstract, Author abstract, Modified author abstract. vi ILI. IIl. IV. CONTENTS Foreword Availability of Documents Preface Women as Health Care Consumers Women as Health Care Providers (Paid) Women as Decision-Makers (Paid) Women as Extra-Market Health Care Providers Other Bibliographies and Periodicals Author Index vii Page 111 iv 16 36 39 46 53 II. III. IV. TABLE I. CONTENT AND ORGANIZATION OF BIBLIOGRAPHY Women as: Health Care Consumers Health Care Providers (Paid) Decision-Makers (Paid) Extra-Market Health Care Providers Other Bibliogra-, phies and Periodicals The Health System Financing Policies and Structure & Organization Practices Regulation Health Status National Contraception Health Services Utilization Health Accessibility of Services Insurance Appropriateness of Services Health and Modifying Existing Structure Disability & Organization Insurance Utilization Status Education Salaries Licensure of Occupational Structure Necessary New Profes- Strategies for Change Degree sions (education-, al creden-, tials) Utilization Status Salaries Strategies for Change Educational Credentials Family as a Unit Regulations Motherhood Affecting Health Maintenance Decision-, and Promotion viii Making (e.g., Medicaid Reg- ulations, Use of Medicaid Treatment, etc.} I. WOMEN AS HEALTH CARE CONSUMERS Banks, M. H.; Beresford, S. A.; Morrell, D. €.; Waller, J. J.; and Watkins, C. J., "Factors Influencing Demand for Primary Medical Care in Women Aged 20-44 Years: A Preliminary Report." International Journal of Epidemiology, 4 (3) :189-195, September 1975. A preliminary report of the findings of a study designed to relate social and psychological variables to demand for medical care in a random sample of female patients is presented. The sample of 516 women between the ages of 20 and 44 was drawn from the register of a National Health Service General Practice in England. Women selected for study completed questionnaires on anxiety and social characteristics, and maintained health diaries for four weeks. Demand for general practitioner care among these women was recorded over a 12-month period. Preliminary findings suggest associations between anxiety, perception of symptoms, and demand for primary care. A review of the literature on the subject of utilization behavior is included, as are details of study design and methodology. Supporting tabular data are included. (Modified NTIS abstract) California Commission on the Status of Women, Women and Insurance. February 1975. It has become increasingly clear, through studies conducted by the New York Civil Union and the Pennsylvania State Department of Insurance, as well as through congressional hearings held by the Joint Economic Committee on the economic problems of women, that insurance needs of women are neither being realistically assessed nor satisfactorily met. Since the major areas of concern defined by these reports reflect much of the experience of women across the country, they are used by the California Commission as a basis for examining the California insurance market and the experience of women in the State in attempting to buy insurance. Availibility: California Commission on the Status of Women 926 J Street, Room 1003 Sacramento, California 95814 $3.65 Corea, Gena, The Hidden Malpractice: How American Medicine Treats Women as Patients and Professionals. New York: Morrow, 1977. This book is a polemic about the way male doctors mistreat women physicians, health workers, and patients. The author's accumulation 264-032 O - 78 - 2 of horror stories from the eighteenth and nineteenth centuries adds a dimension that makes it easier to understand why women are angry about health care in the twentieth century. The author also documents a host of medical "offenses against women today, from discrimination against female medical students and the tendency to treat women's illnesses as psychogenic, tn questionable practices in venereal disease control, contraception, sterilization, childbirth, and drug use. Ehrenreich, Barbara, "Gender and Objectivity in Medicine." International Journal of Health Services, 4(4):617-623, Fall 1974. Medicine in the United States has been an overwhelmingly male profession since the emergence of the modern medical profession in the late nineteenth century. Historically, women were excluded from medical training on the grounds that females are innately less capable of scientific objectivity than males. An examination of gynecological theory and practice advanced by male physicians over the last century reveals that medical "science" continues to be permeated with sex prejudices. Thus, nonobjectivity in medical care of women has reinforced the traditional social roles of women in a direct way and has been detrimental to women's health. Alternative health care systems for women must reflect the physiologic and social needs of the recipients rather than the biases of the practitioners. (Modified journal abstract) Ehrenreich, Barbara, and English, Deirdre, Complaints and Disorders: The Sexual Politics of Sickness, Glass Mountain Pamphlet No. 2. Old Westbury, New York: The Feminist Press, 1973. In this delightfully illustrated pamphlet, Ehrenreich and English focus on the social role of medicine and emphasize that changing the medical system is strategic for women's liberation. Their major thesis is that "medicine's prime,contribution to sexist ideology has been to describe women as sick, and as potentially sickening to men'" (p. 5). To substantiate this claim, they describe how nineteenth century middle- and upper-class women were treated as delicate and sick while lower-class women were feared as sickening, potential carriers of dreaded diseases. They also point out how gynecologists' role as definers of female sickness and weakness was taken over by psychiatrists so that today, women's "defectiveness" is more often defined as mental than physical. Overall, the authors marvel 'at the plasticity of medical science which so efficiently fits the need of the dominant male ideology. (From: Ruzek, Sheryl, Women and Health Care, 1973) Ehrenreich, Barbara, and English, Deirdre, Witches, Midwives, and Nurses: A History of Women Healers, Glass Mountain Pamphlet No. 1. Old Westbury, New York: The Feminist Press, 1972. The authors argue that health care is largely in the hands of male professionals, not because of their superior scientific or technological skill, but as a result of an active takeover on their part. From this position, they examine the suppression of witches in medieval Europe and describe the rise of the male medical profession in nineteenth century America. They point out that both of these events involved the ousting of lay female healers by male professionals. They argue that these male takeovers were political struggles--part of the general history of sex struggle and class struggle. For women healers were people's doctors while male professionals have served the interests of the ruling class, both medically and professionally. (From: Ruzek, Sheryl, Women and Health Care, 1973) Ehrenreich, Barbara, and Ehrenreich, John, "Health Care and Social Control." Social Policy, 5(1):26-40, May-June 1974. In this article social control functions of the medical system are viewed as having grown out of the social structure of medical care and the organization of the medical system which have been described by Talcott Parsons and Eliot Freidson. With regard to women there can be no question that medicine operated as a key agency in the social control of women, enforcing passivity and a childlike dependency on men, particularly on physicians and husbands who pay the bills. If the medical system is viewed as a system of social control, both women and men can free themselves from the medical mystification which restricts all of us to seeing medical care as something wholly technological. Then we can start determining what kinds of social relationships we want a medical system to foster and how we can design a system so that the social relationships it engenders promote socialist relationships in society in general. Fee, Elizabeth, Women and Health Care: A Comparison of Theories. Johns Hopkins University, Baltimore, Maryland, School of Health Services, 1975, International Journal of Health Services, 5(3):397-415, 1975. Three distinct approaches are compared for analyzing the position of women in society and their position relative to the health care system. Liberal feminists seek equal opportunity within the societal system, demand equal opportunity and employment for women in health care, and are critical of the patronizing attitudes of physicians. 10. Radical feminists reject the system as one based on the oppression of women and seek to build alternative structures to better fill their needs. They see the division between man and woman as the primary contradiction in society and patriarchy as its fundamental institution. They have initiated self-help groups and women's clinics to extend the base of health care controlled by women in their own interests. Marxist feminists see the particular oppression of women as generated by contradictions within the development of capitalism. They maintain that women's unpaid labor at home and underpaid labor in the work force both serve the interests of the owners of capital. It is suggested that the health care system serves these same interests; it maintains and perpetuates the social class structure while becoming increasingly alienated from health needs of major population segments. Iowa Commission on the Status of Women, A Study of Insurance Practices That Affect Women. February 1, 1975. This study identifies numerous practices within the insurance industry that particularly affect women and to the extent possible documents and evaluates their impact on women. Questionnaires dealing with life, disability, income, health, automobile, and homeowner/property insurance were distributed to insurance companies of varying sizes in Iowa. Completed questionnaires were analyzed by type of insurance and detailed findings are presented in separate chapters. Differences in the availability of health expense insurance to women and men relate primarily to the female role of childbearing. Maternity coverage is not regarded as a normal health expense and is, therefore, not a standard feature of all policies. The coverage is usually available only with a family policy, and is not available to an individual policy holder, whether married or unmarried. Similarly, abortion coverage is usually available only to family policy holders, but not to individuals. Prenatal and postpartum maternity coverage is not usually provided even in family policies. Availability: Iowa Commission on the Status of Women 300 Fourth Street Des Moines, Iowa 50319 $1.50 Jolly, Carol; Held, Berel; Caraway, A. F.; and Prystowsky, Harry, "Research in the Delivery of Female Health Care: The Recipient's Reaction." American Journal of Obstetrics and Gynecology, 110(3): 291-294, June 1, 1971. A random group of women followed during their prenatal course in extramural and intrahospital clinics was questioned regarding the 4 11. services they received. The findings suggest the following: (1) greater positive acceptance of care when rendered in the local community, (2) significant transportation difficulities in attending clinic sessions, especially in the more rural locations, and (3) considerable confusion in the hospital setting. The implications of these observations are discussed relative to strengthening existing services. (Journal abstract) Monteiro, Lois A., and Wessen, Albert, "Monitoring Health Status and Medical Care." Brown University, Providence, Rhode Island, 1976. Data on health status, medical care, and the use of health care services were gathered by the Population Research Laboratory of Brown University in four major surveys of Rhode Island households. The health status analysis is based on three surveys of approximately 1,100 respondents each in 1967, 1968, and 1969, on annual followup interviews through 1971, and on a subsample reinterview in 1973. The report on the findings of these surveys begins with a comparison of locally obtained data on health status and medical care use with the findings of the National Health Survey. Subsequent chapters focus on the following: (1) methodological issues and changes over time in reports of disability by the sample, and problems involved in attempting to monitor health through such surveys, (2) a cross- sectional view of the local population's health in terms of measures of illness and of disability experienced by the sample, and (3) differentials in health between the sexes and the extent to which high female illness levels can be explained with available health survey data. The second part of the report primarily concerns the concept of medical care affiliation and draws upon data from a 1974 survey of 456 households containing 1,329 individuals. Emphasis is given to the way in which the population used private physicians, and to the consequences of affiliation with a particular private physician for utilization. Data are analyzed concerning the patterns of medical care used by the population, the physician specialties used by different population groups, and the extent to which the groups depended on a single care source or on multiple, specialized care sources. The issue of geographic location and ecological factors as barriers to access to care is examined, as are aspects of client satisfaction and their relationship to continuity and changes in medical care affilation. Particular attention is directed to the variable of income and its changing relationship to the utilization of medical care. Methodological details and questions from interview schedules are appended. Supporting data, a list of references, and an index are provided. 12. 13. Availability: Ballinger Publishing Company 17 Dunster Street Harvard Square Cambridge, Massachusetts 02138 Lewis, Deborah A., Women and National Health Insurance: Issues and Solutions. Medical Care, 14 (7):549-558, July 1976. Four issues that could lead to inequitable or inadequate coverage for women under a system of national health insurance are identified and discussed, and related aspects of four national health insurance proposals are examined. The issues are: (1) eligibility provisions that insure women through their husbands' policies, (2) benefit structures that exclude aspects of reproductive health services and/or fail to explicitly recognize women's two central sources of care, i.e., providers of care for both reproductive (gynecological and obstetric) and general medical conditions, (3) provider certification provisions that exclude free-standing ' clinics and/or nonphysician personnel, and (4) incentives for reform of health delivery that force women to choose between their two sources of care. The general concept, eligibility requirements, benefits, cost-sharing, limitations, provider standards and certifi- cation, delivery system reforms, financing, and administrative provisions are summarized for the Nixon Administration Bill (93rd Congress, HR12684, $2970); the Ullman Bill (National Health Care Services Reorganization and Financing Act, HR1l1); the Kennedy Bill (Health Security Act, $3, HR21); and the Long-Ribicoff Bill ($2470). It is concluded that these proposals contain provisions which, if enacted, would lead to inequities for women. Several principles for developing alternative proposals are offered, including the following guarantees: that women have a personal and continuous claim to benefits unaffected by such occurrences as change in marital status, that women can receive both reproductive and general services without added cost stemming from the fact that this care is provided by different physicians, that free-standing clinics receive adequate reimbursement and that the use of nonphysician medical staff is not restricted, and that women do not carry an undue portion of the burden of transition from independent to group practice systems of medical care delivery. Marieskind, Helen I., "Restructuring Ob-Gyn." Social Policy, 6(2):48-49, September-October 1975. In response to Barbara Seaman's article in the same issue of Social Policy, this author urges consideration of another perspective 14. 19. of the field of obstetrics-gynecology: Is the field itself the optimal medium by which women can obtain health care? The author believes that women's health care cannot be left to obstetrician, gynecologists, nor can it be limited to care under the maternal and child health classification. Women need and want a health care model which treats women as whole persons, whose health care needs may, at times, be gynecologically and obstetrically oriented. Instead of pitting men against women as providers or researchers, the argument must be raised against a specialty, a structure, and an underlying conceptual framework which is one ramification of the oppressed position of women in a sexist society. Marieskind, Helen I., and Ehrenreich, Barbara, "Toward Socialist Medicine: The Women's Health Movement." Social Policy, 6(2):34-42, September-October 1975. The authors argue that the health consumer movements of the late 1960's and the early 1970's have made important contributions to a general understanding of the health system and of the socialist alternatives to it. The alternative of the "left" was socialized medicine characterized by public financing of care, government planning and control of resource, and socially rational distribution of services. The Black and Latin community health movements added the demand for direct, democratic control of health facilities at the local level by users and providers of the services. The women's health movement is presently raising the prospect of redefining the services themselves, the social relationships of health care produc- tion, and changing medical technology itself. From the women's health movement's perspective, the ideas of self-help, collective approach to healing, and open-minded approach to unconventional technology are imperative to the social transformation of health. The People's Republic of China is cited as an illustration of a collective victory of all participants in the redefinition of medical technology. Medical College of Pennsylvania, Center for Women in Medicine, Double Dynamics: Women's Roles in Health and Illness, A Report of a Conference held in Philadelphia, Pennsylvania on December 7-9, 1975, and supported by Contract No. HRA 230-76-0073 from OHRO/HRA/DHEW. The conference, Double Dynamics: Women's Roles in Health and Illness was held as a first step in developing a Health Resources Administration (HRA) plan for a women's action program, identifying strategies for improving the efficacy of women in the health system and recommending actions which should be undertaken. The conference addressed the issue of improving the health efficacy of women in four 16. 17. categories: paid providers, consumers, decision-makers, and extra- market providers. In each category the effect of the present structure and organization, the effect of existing health care financing mechanisms, and the effect of existing health system regulations are discussed. In addition, each of the issues was examined from the viewpoints of accessibility of health and medical services, appropriateness and acceptability of health, and health career opportunities. Availability: NTIS HRP-0014453 Moulton, Ruth, "Some Effects of the New Feminism." American Journal of Psychiatry, 134 (1) :1-6, January 1977. The new feminism has opened up new paths for both sexes and loosened up sex role stereotypes. At the same time, it has also created new anxieties and problems in work and sexual and family settings. The author compares the complaints of women she treated in the 1950's, which included frigidity, problems in finding husbands, and difficulties in raising children, with those of women patients in the 1970's, who are in conflict about professional versus personal identity, divorce, and extramarital affairs, and who often avoid marriage as a trap. Since rapid cultural change disturbs the established psychological equilibrium both men and women experience personal anxieties and role strain. A stable equilibrium will be achieved only after the effects of change have been dealt with individually and socially. (Modified journal abstract) Muller, Charlotte, "Methodological Issues in Health Economics Research Relevant to Women." Women and Health, 1(1):3-9, January- February 1976. j Correct specification of a number of definitions and problems is essential for realistic and useful research in health economics. Societal values with regard to women's status and roles are reflected in current concepts, which need review. For example, health status is a concept with many applications. Two areas of health status are discussed: (1) definitions of severity for adult males, children, and adult females all reflect the female role as caretaker, and (2) reproductive efficiency should be incorporated into a life- cycle-oriented concept of health status for women. The evaluation of patient time as an input into health care is conditioned by women's labor force participation and the extent of the earnings differential by sex. Additionally, a concept of a block 18: 19. of time as capital that is available for optimal reproduction or optimal career investment would be useful for several purposes including the tracing of important effects of improved fertility, related health care. Specifications for a health care service and financing system that is responsible to women's health needs must include an appropriate definition of comprehensiveness in relation to fertility control and pregnancy; relative financial burdens for women based on their utilization, need, income, and other characteristics; and compatibility of payment methods with health care objectives. (Journal abstract) Muller, Charlotte et al, "An Index of Insurance Adequacy for Fertility-Related Health Care." Medical Care, 13(1):25-36, January 1975. Health insurance plans are evaluated here in terms of ability to guarantee financial access to a set of basic fertility-related health services. Extent of coverage is determined by the range of service benefits provided, its market cost, and the frequency of its use in a given population in one year. Comprehensive coverage encourages the utilization of preventive care such as well-baby visits, prenatal care, and family planning. In a total population of women of child-bearing age, each woman is likely to need some fertility-related care in a given year. The method of calculating adequacy involves using the best available estimates of deliveries, abortions, etc., per 1,000 women;.and, within each category, a breakdown into components, such as cesarean section. Local or national cost data can be used to derive an average cost per- service and an aggregate for a group. The method of comparing this unit cost with plan benefits depends on the way benefits are expressed. Medical market data from Jacksonville, Florida, were used in a trial of the method on a plan for Federal employees which shows 70 percent coverage of estimated expense. (Journal abstract) Nathanson, Constance A., "Illness and the Feminine Role: A Theoretical Review." Social Science and Medicine, 9(2):57-62, February 1975. Women in the western world live longer than men and have lower mortality rates for most causes of death. There is evidence that these differences are due to women's greater resistance to infections and degenerative diseases. However, women report more physical and mental illness than men and utilize health services at substantially higher rates. The author considers three explanatory models to account for sex differences in illness experience: (1) women report more 264-032 O - 78 - 3 20. 21. illnesses than men because it is culturally more acceptable for them to be ill, (2) the sick role is relatively compatible with women's other role responsibilities and incompatible with men's roles, and (3) women's assigned social roles are more stressful than men's. Based on a review of these alternative explanations, the author concludes that a model that examines illness behavior as a function of the number and character of other role obligations seems to offer the most promise for future research. However, all three models need further testing in studies designed explicitly for the purpose of accounting for women's illness and illness behavior. (Modified journal abstract) Neubardt, Selig B., Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, Bronx, New York, "Women's Liberation and the Male Gynecologist." Medical Aspects of Human Sexuality, 8(10):158-159, 165-166, 174, 179, 182-183, 186, 188-190, 197-199, 1974. Issues raised by the Women's Liberation Movement regarding the attitudes of physicians toward women patients are examined in a round table discussion. Three members of a women's discussion group voiced concern about the attitudes and practices of male gynecologists toward complaints of many women patients. Other topics include: the need for more knowledge regarding female disorders, including those - considered psychosomatic in nature and those causing infertility; office and examination practices of male gynecologists; the advantages and disadvantages of self-help clinics as opposed to seeking professional treatment; the performance of painful and often unnecessary surgical procedures; problems regarding the doctor-patient relationship, including frank discussion of the condition under _ treatment; and the issue of abortion. North, A. Frederick, "National Health Insurance for Mothers and Children (Looking at the Javits and Scheuer Proposals." American Journal of Diseases of Children, 131:17-20, January 1977. The Maternal and Child Health Care Act (HR 12937) and the National Health Insurance for Mothers and Children Act (S 3593), which were introduced to the 94th Congress, are evaluated according to six criteria: universality, promotion of effective services, constraints on unnecessary services and costs, administrative efficiency, equitable financing, and effects on medical practice organization. The author concludes that with modifications the program proposed by the bills could be a major step in the promotion of health of children and reproductive health of women. Because its 10 22. 23. costs are finite, predictable, and relatively inexpensive and its benefits will be larger, national insurance for mothers and children appears to be the next logical step towards national health insurance for all Americans. Pennsylvania Insurance Department, Insurance Commissioner's Advisory Task Force on Women's Insurance Problems. Harrisburg, Pennsylvania, October 1974. The Insurance Commissioner's Advisory Task Force on Women's Insurance Problems undertook the task of identifying the full range of inequitable and inadequate insurance practices which discriminate against women in the State of Pennsylvania. By reviewing insurance policy and application forms, endorsements, riders, insurance company sales manuals, underwriting guides, and rate books; by soliciting women's complaints; and by administering questionnaires to a sample of insurance companies, the Task Force concluded that sex discrimina- tion exists in life insurance, nonprofit medical care plans, disability income insurance, and employment practices of the insurance industry. If sex discrimination exists in property/casualty insurance, it is more subtle and difficult to document than other kinds of insurance. The report includes a detailed list of recommendations encompassing the institutions and persons who influence insurance (i.e., consumers, insurance agents and brokers, regulatory agencies, etc.). Availability: Pennsylvania Insurance Department Harrisburg, Pennsylvania 17120 Free Ziem, Grace, and Marieskind, Helen, "Women in Health," Harvard University, Cambridge, Massachusetts, 1975, 185 pp., Published in International Journal of Health Services, 5(2), 1975. Writings concerned with health and the delivery of health services as related to the needs and demands of women, both as providers and users of services, are compiled in a special issue of a multidisciplinary publication devoted to the subjects of health services policy, planning, administration, and evaluation. Following an introduction to the theme of women and health, original articles are presented on the following topics: women workers in the health service industry, development of the nursing labor force in the United States, the women's health movement, barriers to the nurse practitioner movement, vaginal cancer and diethylstilbestrol, the politics of birth control from 1920 through 1940, and sexual surgery in late nineteenth century America. Review articles are then presented on: steps toward a radical analysis of health care, issues in the radical study of health 11 24. 25. 26. care, a study of medical ideas about women, a book on women's health published by the Boston Women's Health Book Collective, and a discussion of feminist goals for health services. A summary report of the proceedings of the International Conference on Women in Health, held at the Pan American Health Organization in Washington, D.C., June 16-18, 1975, is included. (NTIS abstract) Ris, Hania W., "What Do Women Want." Journal of the American Medical Women's Association, 29(10)446-456, October 1974. The issues discussed in this article focus on what women want as careers in the medical profession, as well as what they want as consumers of medical care and psychotherapy. After briefly describing sex discrimination in medical education, sex roles in drug advertisements, women and gynecologists, and women and psychiatrists, the author concludes that women want a "true partnership" in the doctor-patient relationship with active participation in the decisions on their preventive care and treatment, whenever feasible, as well as equality, mutual understanding and respect in a humanitarian society. Safilios-Rothschild, Constantina, Women and Social Policy. Englewood Cliffs, New Jersey: Prentice-Hall, Inc., 1974. The book delineates a wide range of strategies, social action, policies, and laws necessary to the effective elimination of sexism from all aspects of American life and society. In so doing, available facts, research findings, and experiences in practice of different strategies or social action, and in the implementation of laws and policies in American and other societies are synthesized within the framework of a number of theoretical assumptions derived from sociological theories and the liberation ideology. In the health area, sexism extends into all aspects of health and rehabilitation, including mental health and type of treatment received. Seaman, Barbara, "Pelvic Autonomy: Four Proposals." Social Policy, 6(2):43-47, September-October 1975. During the past decade, many feminists have recognized that the reproductive or "body" issues may be central to the women's revolution. Despite the fact that they have voiced various demands for piecemeal changes, health care policy makers have not been responsive to these feminist demands. If male domination of obstetrics and related areas (which the author believes to be a violation of the civil rights of 12 27 . 28. women) continues, the outlook for reform is pessimistic. The author restates four proposals (originally issued at a Women's Health Conference in Boston on April 7, 1975) to return the obstetrics and gynecology field to women: 1. Admit only women to obstetrics and gynecology residencies; males who are currently in training may remain as may those who are in practice. 2. Deny foundation funds to men for any kind of research into the female reproductive system; instead, such funds will be directed to training qualified women in reproductive biology. 3. Remove from the court and legislative systems the establish- ment and administration of laws concerning female reproduction, abortion, and sterilization. This responsibility shall be given to any agency modeled after the National Labor Relations Board (NLRB), Federal Communications Commission (FCC) , Federal Trade Commission (FTC), or Atomic Energy Commission (AEC) . 4. Encourage the United Nations and the United States to refrain from sponsoring or participating in any international population activity or conference unless women are represented in proportion to their numbers in the population of every participating nation. | Tenebaum, Susan, "Washington Report, Health Care." The Spokeswoman, p. 10, August 15, 1976. Even though the inequitable treatment of health professionals has been recognized, the only effort to revise the overall structure of the American health care system has been through national health insurance proposals which deal more with consumption than delivery. Women as health services consumers face even more inequities than women health professionals. Despite these observations, not one of the national health insurance proposals meet the medical needs of women. This situation raises the question of whether health programs directed towards special groups will detract from the need for comprehensive health insurance for all citizens. Verbrugge, Lois M., "Females and Illness: Recent Trends in Sex Differences in the United States." Journal of Health and Social Behavior, 17(4):387-403, December 1976. Data from the National Health Interview Survey for 1957-1972 indicate that women have higher age-standardized rates of acute conditions , 13 29. 30. chronic conditions, and disability due to acute conditions than men even when reproduction-related events are excluded. More males, however, suffer limitations of activity or mobility due to chronic conditions. The greater incidence of acute conditions among females has persisted with no apparent change since 1957, whereas the severity of chronic conditions among males has increased since 1957. Similar sex differences appear in mortality trends for the same period. Excess morbidity among females may be due to interview behavior, illness behavior, acquired health risk, and inherited health risk. Empirical evidence suggests that the first two factors inflate female rates compared to males; the last two do the opposite. Based on the hypothesis that excess female morbidity is due primarily to social and psychological factors, the author presents a procedure to test this. (Modified journal abstract) Wallace, Helen M., Health Care of Mothers and Children in National Health Services: Implications for the United States. Cambridge, Massachusetts: Ballinger, 1975. In this compendium on the organization and delivery of maternal and child health services in Great Britain and Sweden, the author points out the important distinction between national health insurance and national health service. One is not a substitute for the other and both are necessary to the delivery of comprehensive health care. Both have been subsumed within the British and Swedish systems. The author explores the origin and provision of maternal and child health services within the two selected European health systems and their possible implications for the formulation of a comparable system in the United States. Wilson, J. Robert, "Health Care for Women: Present Deficiencies and Future Needs." Obstetrics and Gynecology, 36 (2) :178-186, August 1970. The deficiencies in the delivery of health care to women are indicated by the fact that over 50 percent of maternal deaths are potentially avoidable; the perinatal mortality rate is inordinately high; premature deliveries and teenage and illegitimate pregnancies are steadily increasing; family planning services are not universally provided; 12,000 or more deaths occur yearly from carcinoma of the cervix; the rate of venereal disease is rising; and a host of other equally important problems face the Nation. Since there is no hope of producing enough obstetrician-gynecologists to provide adequate care within the present system, drastic changes must be made in the 14 31. 32. education and practice of obstetrician-gynecologists. The changes include the use of nonphysician associates, hospital reorganization, and revamping resident education and practice patterns. (Modified author abstract) Olesen, Virginia (Ed.), Women and Their Health: Research Implications for a New Era. Proceedings of a conference held at the University of California, San Francisco, August 1-2, 1975. DHEW, Public Health Service, National Center for Health Services Research, DHEW Publica- tion No. (HRA) 77-3138. Papers presented at this conference, sponsored by the National Center for Health Services Research, Health Resources Administration (HRA), in cooperation with HRA's Federal Women's Program and the School of Nursing at the University of California, San Francisco, cover a variety of issues related to women and health from several disciplinary viewpoints. There was agreement expressed by the discussants that the major issues have not been adequately investigated; that biases are reflected in the selection of issues, in research methods and design, and in the analysis and interpretation of results; and that the exclusion of women from the research process, except as objects of research, has led to a failure to seriously consider certain issues that are relevant to health care for women. Weaver, Jerry L., National Health Policy and the Underserved: Ethnic Minorities, Women, and the Elderly, California University, Los Angeles, 1976. A political view of issues and problems in health care is presented in a book concerned largely with the health needs and behavior of underserved groups. Similarities and differences among ethnic minorities, women, and the elderly as consumers of health services are pointed out in discussions aimed at encouraging researchers to look into the relationships among populations, economic and political institutions, and the formulation, implementation, and consequences of government actions in the provision of personal health services. Another aim of the discussion is to offer information and interpretations relevant to the initiation and execution of reforms in health care. The following topics are covered: class and community, information about health care providers, social patterns and health care problems of Asian Americans, health care behavior in Mexican Americans, poverty and health in blacks and whites, women and the health industry, the elderly as a minority community, and public opinion of national health insurance. The discussion also encompasses health policymaking and common bases of health care problems. 15 33. 34. 35. 36. II. WOMEN AS HEALTH CARE PROVIDERS (PAID) American Public Health Association, Women in Health Careers, Chart Book for International Conference on Women in Health, Washington, D.C., June 16-18, 1975. Washington, D.C.: American Public Health Association, March 1976. The chart book was prepared for use at the International Conference on Women in Health in Washington, D.C., sponsored by DHEW's Health Resources Administration. Data on employment of women in health occupations, status of women health practitioners, and characteristics and education of women health practitioners are presented in tabular and diagrammatic format.. Ashley, Jo Ann, "Nurses in American History-Nursing and Early Feminism." American Journal of Nursing, 75(9):1465-1467, September 1975. As in other professions, the biggest problem facing nurses is inequality. However, in the past nursing leaders were satisfied to accept sexual discrimination and lived with the results. If the nursing profession is to realize all of its potentials, legal constraints and traditional concepts such as the necessity for medical supervision (thereby placing nurses in a subordinate role) need to be eliminated. Their elimination can be fostered by identifying the nursing profession with the feminist movement. Benedek, Elissa P., "Training the Woman Resident To Be a Psychiatrist." American Journal of Psychiatry, 130(10):1131-1135, October 1973. The author focuses on the problems of the woman resident and draws upon her own experience to illustrate how women are not accorded the same consideration as other minorities and how the residency may be a period of loneliness and misunderstanding. Women have as much to learn from men as men from women and where there are enough women staff members to make it possible, the author proposes that each man and woman in a residency program have some personal supervisory experience with a woman staff supervisor. (Modified journal abstract) Brown, Carol A., "Women Workers in the Health Service Industry." International Journal of Health Services, 5(2):173-184, 1975. The health service industry is unusual in that most of the skilled as well as unskilled workers are women, although the industry is largely 16 37. 38. controlled by men. Women are hired because they constitute an inexpensive, available, and seemingly powerless work force. Women enter health service because they have few alternatives to the low-paying, dead-end jobs found there. Health service occupations are organized like craft unions, with rigid hierarchical separations and control by the top occupation. Conflicts between men and women--between management and workers--are often played out as conflicts between occupations. Challenges to physicians come from various nursing specialties as well as from technical professions. Physicians in turn create lower-level occupations which challenge the nurses' status. Increasing industrialization alters the pattern of conflict, creating opportunities for individual bureaucratic mobility as well as favorable conditions for unionization drives. Unionism is often held back by sex, race, and professional conflicts, which must be overcome if the status of women is to be changed in the industry. (Journal abstract) Bullough, Bonnie, "Barriers to the Nurse Practitioner Movement: Problems of Women in a Woman's Field." International Journal of Health Services, 5(2):225-233, 1975. The author explores the difficulties which nurse practitioners have encountered in gaining wide acceptance from historical and sociological perspectives. Historically, the subordination of women and the sex segregation of nursing and medicine helped create the interaction patterns between the two professions, including informal doctor-nurse games. Nursing schools and State laws which restrict the roles of nurses have reinforced these patterns. Although recent changes in State licensure laws and educational reform in nursing are facilitating the nurse practitioner movement, the stereotyped communication and interaction patterns between doctors and nurses continue to serve as barriers to the full use of the talents of nurses in practitioner roles. (Modified journal abstract) Bullough, Bonnie, and Bullough, Vern L., "Sex Discrimination in Health Care." Nursing Outlook, 231(1) :40-45, January 1975. An examination of sex discrimination in the health field indicates that real equality is absent not only in this particular field but in the society itself. Three aspects of discrimination are evident in the health field. As noted by other authors, sex discrimination results in economic injustice for women in the system. Sex discrimination also affects interdisciplinary relations between members of different health disciplines, often to the detriment of patient care and resulting in negative consequences for medical research. For example, L7 264-032 O - 78 - 4 39. the doctor-nurse game further prolongs the male-female game existing in the American society. The communication barrier between nurse and doctor blocks effective treatment of men and women patients. Sex discrimination also has introduced bias into medical education and physicians' decision-making processes. Physicians, misled by misinformation about the female psyche and physiological processes related to the female reproductive system, inevitably prescribe inadequate or inappropriate treatment regimens. Sex discrimination thus perpetuates female inferiority and as long as it persists in society it will be manifested in the health system. Campbell, Roy, California Nurses' Association, San Francisco. Minority Group Task Force, Minorities in Nursing, January 1973, 95 pp. Goals and results of a Minority Group Task Force study examining the utilization of minorities in nursing in California are presented. The task force set out to determine whether: there is a discrepancy between salary levels of white and nonwhite nurses; most potential minority nurses are educated below the baccalaureate level; and whether minorities are represented in nursing schools, supervisory positions, and nursing associations to the same extent that they are represented in the general population. Surveys were distributed to minority nurses' associations, the California Nurses' Association, schools of nursing, and nursing personnel of various hospitals and agencies. Officers and staff members of the California Nurses'! Association were interviewed directly. Based on data collected, the task force concluded that racism is institutionalized in the nursing profession and that a salary differential exists between white and nonwhite nurses. Minority nurses are not proportionately represented in nursing schools or supervisory positions and are educated at lower levels than their white counterparts. The report recommends that funding be sought for further studies and that nursing schools develop regulations relating to the inclusion of minority group - members. Literature on discrimination is discussed, and an appendix provides samples of survey forms and interview questions used. A bibliography is also included. (Modified NTIS abstract) Availability: California Nurses' Association 185 Post Street San Francisco, California $3.00 18 40. 410 Cannings, Kathleen, and Lazonick, William, "The Development of the Nursing Labor Force in the United States: A Basic Analysis." International Journal of Health Services, 5(2):185-191, 1975. In this article, the authors draw together some basic material on the objective character of the nursing labor force in the United States. First, a statistical and descriptive picture of the nursing labor force as it exists today is presented. The historical development of that labor force up to 1950 is analyzed and its general integration into a hierarchical and concentrated health industry is stressed. Finally, the development of the nursing labor force over the past 25 years is examined in terms of factors such as sex, race, age, educational credentials, labor force participation, place of work, and the hierarchical division of labor. The general implications of the changes in these factors for worker organization in the health industry is discussed. The main conclusion is that the nursing labor force is in a key position to lead a movement for the restructuring of the health industry to serve the health needs of the American people rather than the profit and power requirements of the health employers. The primary, and difficult, task ahead is to build labor organizations which will have the vision and unity to work toward this goal. (Journal abstract) Cleland, Virginia, "Sex Discrimination: Nursing's Most Pervasive Problem." American Journal of Nursing, 71(8):1542-1547, August 1971. The problem of sex discrimination in nursing is discussed with reference to several tenets of the women's rights movement. Nurses often hold the false belief that, because women hold almost all of the positions throughout the nursing hierarchy, nursing has an advantage over other women's occupations. On the contrary, nursing is weaker because of the nearly complete absence of men and because of its isolation from all vestiges of power except those within its own group. A general lack of leadership in nursing is directly derived from the social position of women in society. As members of a woman's occupation in a male-dominated culture, nurses are controlled by male-dominated systems in medicine, hospital administration, and higher education. Further evidence of the problem is found in recruitment efforts that attempt to persuade nurses to accept employment by hinting at opportunities for matrimonial success. If sex discrimination is acknowledged as a problem within nursing, it can be attacked within both the family structure and the professional structure of the nurse's life. A point of departure could be learning to disregard the marital status of a woman when she is functioning in a professional context. Recruitment problems that await the nursing profession are discussed 19 42% 43. 44 . in view of the frequency with which the profession is used to exemplify discrimination against women. The author suggests that nursing will grow as a profession if it becomes less isolated and more attractive to both men and women. (Modified NTIS abstract) Bloom, Barbara I., and Plant, Janet, "Health Manpower. An Annotated Bibliography," American Hospital Association, Chicago, Illinois, April 1976. - Selected references on health manpower are presented to assist persons who are planning health careers, are concerned with the development of health occupations programs, or are involved in attracting and retaining minority members and women in the health care field. The first section includes publications on various aspects of health manpower and the second section pertains to the employment of minorities and women. Availability: American Hospital Association 840 North Lake Shore Drive Chicago, Illinois 60611 Kutner, Nancy G., "Female Medical Student Careers: Health Services Implications (Final Report)." This exploratory study examined factors related to females' (1) choice of medicine as a career, (2) medical school attrition, (3) choice of medical specialties, and (4) preference for certain medical practice patterns as compared to males. This investigation sought to identify some of the potential barriers women encounter in the medical profession as well as to provide current information highlighting some of the relevant factors. Availability: NTIS HRP-O0017630 Dobbins, Margaret Powell, Tulane University. "Feminism, Professionalism, and Unionism Among New Orleans Nurses," (Ph.D. Dissertation), Dissertation Abstracts International, Ann Arbor, Michigan, 688 pp. To determine nurses' attitudes in the New Orleans area toward feminism, professionalism, perception of job shortages, unionism, and advancement limits and competition, questionnaires were sent to 221 randomly selected nurses. The data were factored to yield 26 independent variable scales and 3 dependent variables: (1) unionism; (2) anti-American Nurses Association, prounion, resistant to collective 20 45. 46. bargaining for nurses; and (3) American Nurses Association, not union, should be Collective Bargaining Agent for all health workers. Path coefficients were computed from the 26 attitudinal variables and 17 standard sociological variables to each of the three dependent attitudes toward collective bargaining. Heise's path approach to "Theory Trimming" was used to reduce the attitude variables with direct effect on unionism to the least number in which original path coefficients were reproduced. (Modified journal abstract) Availability: Xerox University Microfilms Ann Arbor, Michigan No. 74-20754 HC $12.50 MF $ 4.00 Ducker, Dalia Golan, The Effects of Two Sources of Role Strain on Women Physicians. (Ph.D. Dissertation). Dissertation Abstracts International. Ann Arbor, Michigan. Beliefs about the suitability of specialties for women physicians were established empirically through questionnaires administered to male physicians on a medical school faculty. Two main sources of strain were studied: believed unsuitability of a field for women, and specialty time demands. Neither of the variables or any other sources of strain had the expected results. An alternative model was suggested, emphasizing the need to take a longitudinal approach since whether or not a woman physician had ever been married or had children was found to be an important factor related to level of professional activity and feeling that personal life suffers. (Modified journal abstract) Availability: Xerox University Microfilms Ann Arbor, Michigan No. 74-29248 HC $13.50 MF $ 5.00 Edelstein, Ruth Greenberg, "Equal Rights for Women: Perspectives." American Journal of Nursing, 71(2):294-298, February 1971. Nursing, perhaps one of the greatest women's professions, has been prevented from developing into a scientific profession because of the erroneous association of subservience and female stereotypes of nurses. Rather than discouraging women from entering the nursing field, feminists should encourage young creative women to enter the field because the status of the pervasively female nursing profession 21 47. 48 . has a major impact on the status of women as a whole. Besides eliminating the myths and prejudices surrounding nursing and the feminine mystique three areas of direct intervention are possible: nursing school curricula, a stratification system in nursing, and the basic structure of the profession. An increase in democratic participation of work, professional solidarity, research, and emphasis on nursing as a science will enhance the rights and status of women in general. Ehrenrich, Barbara, "Health Care Industry: A Theory of Industrial Medicine," Social Policy, 6(3):4-11, November-December 1975. Institutional sexism prevails in the Nation at large and also in the health care field. Women generally occupy a subordinate position within industry. Although approximately 75 percent of health manpower job positions are held by women, they do not play a dominant role as compared to men who serve as physicians and administrators. Women's role in both preindustrial and industrial states of United States medicine is reviewed, along with social forces in the reproduction of sex stratification. Largely because of pressure from the women's liberation movement, medical schools have been admitting more and more women in the past few years. The rising feminist consciousness in the United States has encouraged women health workers to become more militant about their own needs and patient care issues. The author believes that as of 1975, women health workers will discover that the hierarchical divisions among women health workers themselves constitute a greater barrier to change than does sexism. Linn, Erwin L., "Professional Activities of Women Dentists." Journal of the American Dental Association, 81(6):1383-1387, December 1970. The professional activities of women dentists are discussed in terms of activities, types of patients treated, and problems associated with remaining in practice. Questionnaires sent to an estimated 1,588 women dentists who had graduated from United States dental schools were returned by 785. Of this number, 77 percent were actively employed in dentistry, 4 percent had temporarily interrupted their dental activity, 1 percent were employed outside of dentistry, and 18 percent had retired. Since graduating from dental school, 38 percent of the respondents reported some interrup- tion and 26 percent reported some reduction in the amount of time spent in professional dental activities. However, final retirement 22 49. 50. S1. rarely grew out of the interruptions and most respondents returned to the profession. This occurred although 73 percent of those who had ever been married had married professional men and, therefore, most of them were probably not under financial pressure to return to work. It was assumed that satisfaction more than financial need accounted for the women's desire to return to work. Moreover, a majority of all respondents reported great satisfaction from their professional work. It was observed that State licensure is more of a barrier for women than for men dentists because women dentists are more likely to move during their careers. The major reason reported for their moving was marriage or change in location of the husband's job. It is noted that these interruptions of practice could probably be greatly reduced if State dental practice acts provided prompt reciprocity. The study findings implied that women dentists are more inclined than men to teach or participate in dental health programs. Epstein, Cynthia Fuchs, Woman's Place: Options and Limits in Professional Careers, Berkeley, California: University of California Press, 1970, 220 pp. The author contends that the best women--those in which society has invested most heavily--underperform, underachieve, and underproduce. Society has wasted them, and they have wasted themselves. Why this is so and how it occurs is the focus of the book. Sociological analysis is used to identify the social factors that assign women to their place, and also arouse debate over whether this relegation is any longer necessary or desirable. (From: Cromwell, NIMH Bibliography, 1974) Fishbein, Morris, "Women in Medicine: Breaking the Sex Barrier." Medical World News, 15(31):56, 1974. The increasing number of women entering medical school and the characteristics of women students and women physicians has long-range implications such as the imminent curriculum changes with more women medical school teachers. It is hoped that administrators will deal effectively with the change. Fried, Frederick E., "Women in Medicine--The Training Years." Journal of Operational Psychiatry, 5(2):101-102, 1974. This commentary presents the strains imposed on women medical students during the training years. Educational conditions and 23 52. 53. 54. climate appear to be considerably more humane, intelligent, and flexible outside the United States for the woman medical student or physician with or without children. The National Institute of Mental Health sponsored survey of United States medical schools deans and ministers of health in many foreign countries reflects some negative attitudes toward women in the medical profession. Although there are many ad hoc arrangements in the United States for assistance to individual women during their medical careers, there are only six announced special residency programs. Needed are: innovative programs for women in medicine, and further study of the impact of the residency experience on the personal, as well as the professional, growth of residents and their families during the crisis of residency training. Heide, Wilma Scott, "Nursing and Women's Liberation, A Parallel." American Journal of Nursing, 73(5):824-827, May 1973. A former nurse and president of the National Organization for Women asserts that the problems of nursing are symptoms of the oppression of women. The status of women is reflected in the status of nurses and nursing. Thus, nurses need to identify with the feminist humanist movement and become leaders in bringing about a humanist society as well as in humanizing health care. With heightened consciousness to the feminist analysis, nursing can be in the vanguard in creating a humane health care system. Hesselbart, Susan, "Women Doctors Win and Male Nurses Lose - A Study of Sex Role and Occupational Stereotypes." Sociology of Work and Occupations, 4(1):49-62, February 1977. Impressions of male and female medical and nursing students are compared in a sample of high school students. There are few differences in the ratings of the male and female medical students and both are described as competent and attractive. However, male nursing students are rated as unattractive, unrealistic, and unambitious. These results indicate that men as well as women can be negatively stereotyped when they break customary sex-role expectations and also suggest that men entering a predominantly female profession may be perceived as more deviant than women entering a predominantly male profession. (Modified journal abstract) » Howell, Mary C., "A Women's Health School?" Social Policy, 6(2):50-53, September-October 1975. A modern women's health school, parallel to present-day medical schools in training physician-level providers of health care, is 24 55. 56. proposed. This proposal is based upon the belief that only in an institution organized and served by women can the goals of providing better health care for women and the families for which they are responsible be valued and realistically implemented. Jussim, Judith, and Muller, Charlotte, "Medical Education for Women: How Good an Investment?" Journal of Medical Education, 50(6) : 571-580, June 1975. Reluctance to train women for medical careers has been justified by the failure of some women to use their education. Using data from studies of physician practice patterns and of educational costs, this article presents a preliminary estimate of the "loss" of investment involved in educating women for medicine. Women physicians are estimated to practice an anverage of two-fifths fewer hours over their lifetimes than do men, with a consequent loss of educational investment of about $55,000. Suggestions are made for reducing this loss. The finding of some loss of investment should not be used as an argument for discriminatory treatment of women seeking a medical education, as the rights of women as individuals must be recognized. (Journal abstract) Altenderfer, Marion, "Minorities and Women in the Health Fields; Applicants, Students, and Workers." DHEW - Publication (HRA) 76-22; DHEW, PHS, HRA, BHM, September 1975, 112 pp. The number of racial/ethnic minorities in training in the health fields has increased sharply in recent years, spurred by social change, the enactment of civil rights legislation, provision of financial incentives to schools to increase minority enrollments, and assistance to students from low-income families. Furthermore, because of legislation forbidding sex discrimination together with the changing role of women in recent years, women are also entering the traditionally male fields such as medicine in increasing numbers, while more men are entering nurse training. The report is divided into two parts. The tables in the first part contain information by racial/ethnic category, while the tables in the second part provide data for males and females. In each part, multidiscipline tables covering students and practitioners are followed by similar tables for each health occupation for which data are available. Availability: NTIS _ PB-254 897/2WW - PC $5.50 MF $2.25 25 264-032 O - 78 - 5 37. 58. 59. Navarro, Vicente, "Women in Health Care." New England Journal of Medicine, 292(8):398-402, February 20, 1975. The article describes the situation of women as producers in the health labor force within the context of the overall labor force in the United States and prescribes a strategy for changing this situation. The occupational, class, and sex structure of the United States health labor force (i.e., predominantly female, poorly paid and poorly unionized) is similar to the competitive economy. Upper- middle class men compose the great majority of the medical professionals, whereas lower-middle and working-class women form the greatest proportion of all middle-level, clerical, and service workers. There is a virtual absence of these women in the decision-making bodies of health institutions. The proposed strategy for change is to introduce institutional democracy in the health sector, with control of the institutions by those who work in them (the majority of whom are women) and those who are served by them. (Modified journal abstract) Notman, Malkah T., and Nadelson, Carol C., "Medicine: A Career Conflict for Women." American Journal of Psychiatry, 139 (10) :1123-1127, October 1973. Issues involved in women's choice of a medical career are considered. The woman medical student has few acceptable role models available to illustrate the variety of possible life and family patterns. In addition, she must cope with the anxiety of medical school and also define her identity as a woman in a "man's world." Women respond to these challenges in a variety of ways related to individual styles of character and defense. The authors recommend several approaches to facilitate the participation of more women in medicine. (Modified journal abstract) Participation of Women and Minorities on U.S. Medical School Faculties, Health Manpower References, DHEW Publication No. (HRA) 76-91, DHEW, PHS, HRA, BHM, March 1976. Prepared by the Association of American Medical Colleges (AAMC) under Contract No. NOl-MI-24401. Based on 1975 data from the Faculty Roster System maintained by the Association of American Medical Colleges, this publication reports on all full-time and part-time faculty members of United States medical schools. Distribution of United States medical schools faculty is tabulated by sex, ethnic group, degree and department. 26 60. 61. Proceedings of the International Conference on Women in Health, Held in Washington, D.C. on June 16-18, 1975. MITRE Corporation, McLean, Virginia, June 1975, 223 pp. DHEW Publication No. 76-51, HRA/OC-77-020. The conference was designed to (1) develop improved information on the status of women as health care providers in the United States and selected countries, and (2) present strategies used in other countries which might be adapted for use in the United States. Also covered were approaches to correct the underrepresentation of women in the health professions, improving the utilization of women in health occupations in which they are numerically well represented, organization of nurses and allied health and support personnel, new roles for women in health care delivery, the role of women in health care decision-making, working conditions of both men and women nonprofessional health care workers, and criticism of physicians as the dominant profession in the current (United States) health care system. Availability: NTIS _ PB-261 806/4WW Price Code: PC A10 MF AOL Reverby, Susan, "Health: Women's Work." Health/PAC Bulletin, 40:15-20, April 1972. The predominance of women in the health care system reflects the institutionalization of traditional women's functions such as nurturing, cooking, curing, cleaning and education. Despite the fact that 75 percent of all health workers are women, disparities in salary and status exist. Even women physicians, on the average, have lower yearly incomes than their male counterparts, primarily because instead of establishing private practice they have become affiliated with health care institutions. The high turnover rate of women health workers reflects a number of factors, among which are the dual roles women must play (homemaker and career), narrow job definitions, lack of fulfillment, hierarchy of health careers, and the resulting lack of control over their work. These factors are illustrated in the development of the nursing profession within the United States. Stratification and the internal hierarchy within nursing began with the Nightingale system and persist in the current controversy between professional and technical nursing. The result of expanding nursing roles and creating new health careers is increased rigidity of the hierarchy. In addition, as nurses obtain higher salaries and status they are 27 62. 63. 64. pressured from below by low skilled workers and new technology, and above by men entering the field to take advantage of higher wages and status for which the women have fought. Roeske, Nancy A., "Women in Psychiatry: A Review." Journal of Psychiatry, 133(4):365-372, April 1976. The American The presence and role of women psychiatrists reflect the complex interaction of historical, cultural, religious, economic, educational, political, and legal factors of a country. The role of women psychiatrists must be understood within the context of the role of psychiatry, the role of women, physicians, and the evolving role of all women in a nation. The author presents data on the varying concepts of psychiatry and women psychiatrists in different countries, including the United States, USSR, Japan, and several European nations as well as the factors influencing professional lives of women. In the United States, the woman psychiatrist may find herself expected to fulfill stereotypical feminine roles with and for men colleagues. In addition, women psychiatrists may be objects of envy, anger, competition, and identification by nonpsychiatrist professional women, women patients, and nonprofessional women. Despite these situations, American psychiatry is proving to be a pioneer among medical specialties in equalitarianism. Scher, Maryonda, "Women Psychiatrists in the United States." American Journal of Psychiatry, 130(10):1118-1122, October 1973. The author presents data about the number and percentage of women in medicine, along with an analysis of their motivations for entering this profession. Also presented are data on women in psychiatry: their number, areas of specialization, work settings, hours worked per week, etc. After presenting views of the stereotype of the woman physician-psychiatrist and pointing out some of the myths that have been perpetuated, the author concludes that men and women must work together to correct the mythologic errors and enlighten one another. (Modified journal abstract) Spurlock, Jeanne, "Sexism in Medicine and Psychiatry." Psychiatric Annals, 6(1):7-9, January 1976. Noting that there is a direct relationship between discrimination against women as medical students and women as patients, the author briefly describes a number of sources of sexism in medicine. These sources include: the woman medical student stereotype, sex stereotype 28 65. 66. and clinical judgments, discrimination and bias reflected in medical advertisements, discrimination in professional advancement and limitation of authority of administrators to fulfill the responsi- bilities of their positions. An Exploratory Study of Women in the Health Professions Schools, Executive Summary. Urban and Rural Systems Associates, San Francisco, California, August 1976, 19 pp. The study explores the barriers women face as applicants and students in the health professions schools of medicine, osteopathy, dentistry, veterinary medicine, optometry, podiatry, pharmacy, and public health. The study's central purpose was to develop a set of conceptual models of the recruitment, admissions, and educational systems designed to maximize opportunities for women. The models form the basis of the study's recommendations which are designed to assist DHEW, the health education and professional associations, the schools, and others to eliminate barriers women face and/or to minimize their impact. A series of 11 individually bound volumes constitute the study's final report. The executive summary is a brief overview of the study. (NTIS abstract) Availability: NTIS _ PB-259 224/4WW PC-A0O2/MF A0 An Exploratory Study of Women in the Health Professions Schools, Volume I, Data Analysis, Findings, Conclusions, Recommendations, Urban and Rural Systems Associates, San Francisco, California, August 1976, 430 pp. Contents include: (1) study design and methods; (2) findings and conclusions (women, professions, and schools, seven key resources for successful access, resource barriers faced by women in the professional training sequence); (3) success models--development, presentation, and test strategies (considerations influencing model development, development of the models, success models, strategies for model testing); (4) study implications and recommendations (implications for anti-sex discrimination enforcement and affirmative action, implications and recommendations for health manpower legisla- tion and student financial aid, implications and recommendations for future research, policy, and program efforts); and (5) concluding remarks--some observations on current trends. (NTIS abstract) Availability: NTIS _ PB-259 225/1WW PC-A19/MF AOl 29 67. 68. 69. An Exploratory Study of Women in the Health Professions Schools, Volume II, Medicine. Urban and Rural Systems Associates, San Francisco, California, August 1976, 235 pp. Contents include: (1) overview; (2) the participation of women (a short history of women in American medicine, the current participation of women in medical practice, participation of women in medical education); (3) professional education (some current trends and issues, the training institutions, financing medical education; (4) the training process (application and recruitment, admissions, preclinical training, clinical training, specialty choice, internship and residency); (5) men and women students; (6) summary of findings and conclusions; and (7) recommendations. (NTIS abstract) Availability: NTIS _ PB-259 226/9WW PC-A1l1/MF A01 An Exploratory Study of Women in the Health Professions Schools, Volume III, Osteopathic Medicine. Urban and Rural Systems Associates, San Francisco, California, August 1976, 110 pp. Contents include: (1) overview; (2) brief history of the profession; (3) the profession today (characteristics of the profession, osteopathic hospitals); (4) professional education (current trends and issues, directions, and major changes in professions education, the organizational training network, the schools,; financing osteopathic training, the professional training process); (5) osteopathic medical students (who the students are, attractions and routes to the profession, issues in training, impact of professional training on students, attributes of male/female students); and (6) recommendations (for the association, for the schools). (NTIS abstract) Availability: NTIS PB-259 227/7WW PC-A06/MF AOl An Exploratory Study of Women in the Health Professions Schools, Volume IV, Dentistry. Urban and Rural Systems Associates, San Francisco, California, August 1976, 144 pp. Contents include: (1) overview of dentistry; (2) brief history of the profession; (3) the profession today (characteristics of the profession, current trends and issues); (4) professional education (current trends and issues, the schools, the professional training 30 70. 71. sequence); (5) dental students (who the students are, the experience of being a dental student, the experience of being a woman dental student); (6) summary and conclusions--implications for women in dentistry training; and (7) special recommendations. (NTIS abstract) Availability: NTIS _ PB-259 228/5WW PC-A0O7/MF AOl An Exploratory Study of Women in the Health Professions Schools, Volume V, Veterinary Medicine. Urban and Rural Systems Associates, San Francisco, California, August 1976, 118 pp. Contents include: (1) brief history of the profession (the professionalization process, history of women in the profession) ; (2) the profession today (characteristics of the profession, current trends and issues); (3) professional education (current trends and issues, the organizational network, schools, the professional training sequence); (4) students (what the profession is looking for in new members, who the students are); (5) summary and conclusions-- implications for women in veterinary medicine; and (6) special recommendations. (NTIS abstract) Availability: NTIS - PB-259 229/3WW PC-A07/MF A01 An Exploratory Study of Women in the Health Professions Schools Volume VI, Optometry. Urban and Rural Systems Associates, San Francisco, California, August 1976, 130 Pp. f Contents include: (1) overview (work and functions of the profession, size and scope of the profession, scope of professional education effort); (2) brief history of the profession of optometry-- the professionalization process; (3) the profession today (characteristics of the profession, current trends and issues) ; (4) professional education; (5) optometry students; (6) summary and conclusions--implications for women in optometry; and (7) recommenda-, tions (for the professional associations, for the schools). (NTIS abstract) Availability: NTIS - PB-259 230/1WW PC-A07/MF A01 31 72. 73. 74. An Exploratory Study of Women in the Health Professions Schools, Volume VII, Podiatry. Urban and Rural Systems Associates, San Francisco, California, August 1976, 107 pp. Contents include: (1) brief history of the profession (introduction, the early years--out of the barbershop, the middle years--the official expansion, Phoenix rising from the ashes-- chiropody to podiatry, the history of women in podiatry); (2) the profession today (the profession and its social image, the profession and practice options, settings, operations); (3) professional education (current trends, issues, directions, and major changes in professional education, the professional training sequence--main steps, requirements, criteria, and key factors); (4) podiatry students [what the profession is looking for in new members (applicants/students), who the students are]; (5) summary and conclusions--implications for women in podiatry; and (6) special recommendations. (NTIS abstract) Availability: NTIS _ PB-259 231/9WW PC-A06/MF AOl An Exploratory Study of Women in the Health Professions Schools, Volume VIII, Pharmacy. Urban and Rural Systems Associates, San Francisco, California, August 1976, 96 pp. Contents include: (1) history of pharmacy in the United States, including the history of women in the profession (chronology, practice patterns and the experience of women); (2) the profession today (characteristics of the profession, overview, the profession and its social image, the profession and practice options, current trends and issues); (3) professional education (current trends and issues, the professional training sequence); (4) pharmacy students (who the students are, beliefs and expectations of male/female students); (5) summary and conclusions--implications for women in pharmacy; and (6) special recommendations. (NTIS abstract) Availability: NTIS _ PB-259 232/7WW PC-A0O5/MF AOl An Exploratory Study of Women in the Health Professions Schools, Volume IX, Public Health. Urban and Rural Systems Associates, San Francisco, California, August 1976, 94 pp. This study of women in schools of public health focuses on hospital administration and epidemiology. Both disciplines are largely male; both offer a first professional degree without 32 75. 76. requiring any prior professional degree. Hospital administration training includes an off-site residency, and epidemiology is heavily grounded in the physical and natural sciences. The report reflects and is organized around the study's dual focus on women in hospital administration and in epidemiology. In addition, however, it includes a preliminary and general look at the profession of public health as a whole in order to give a better perspective of the two disciplines. (Modified NTIS abstract) Availability: NTIS _ PB-259 233/5WW PC-A0O5/MF A01 Williams, Phoebe A., "Women in Medicine: Some Themes and Variations." Journal of Medical Education, 46(7):584-591, July..197 1. A survey of Radcliffe alumnae who had enrolled in medical school provides insights into the nature, activities, and experiences of medical women across several generations. The study reveals remarkable similarity between generations in major reasons for choosing a medical career and in exhibiting anxiety about the cost of obtaining medical training. All groups, except the earliest, were concerned about satisfactorily combining marriage and a demanding career. The earliest group had to confront a polarized choice in life--either marriage or a medical career. Few women in the later generations, however, were willing to forego marriage and family and thus must combine this part of their life with medicine by creating a variety of arrangements for accommodating their multiple roles. Wilson, Victoria, "Analysis of Femininity in Nursing." American Behavioral Scientist, 213-220, November 1971. Feminist concepts in the field of nursing are examined in relation to the changing role of women in society. A number of studies consider the mother surrogate role of nurses but fail to acknowledge their intellectual capacity. Moreover, the social life within schools of nursing does not foster development of students with talent. In spite of these limitations, nursing education is beginning to examine and revise its programs and encourage nurses to pursue more education, especially through in-service programs and refresher courses. Nevertheless, considerable time and effort will be needed before society and the nursing profession broaden their role expectations of the woman nurse and allow her to achieve full intellectual independence and creativity. Nurses, and women in general, need to develop a sense of self-identity, independent and different from culturally ascribed roles. 33 ya 78. 79. "Women in the Workplace: A Special Section." Monthly Labor Review, 97 (5), May 1974. Data on women in the labor force are summarized narratively and graphically. Statistics cover such characteristics as where women work, sex stereotyping, trends in women's earnings, membership in labor unions, women in professions, professional training, and children of working mothers. Statistics indicate that women find jobs in the fastest growing industries but remain clustered in fewer occupation groups than men. While women have dominated in a few professions--such as nursing, teaching, library science--they have played a small part in others. Women's Work Project of the Union for Radical Political Economics, USA - Women Health Workers. Women and Health, 1(3) :14-23, May-June 1976. Although women represent a clear majority of health workers, they are not a majority in every health occupation. Women are the majority of nurses but not physicians. Women are the majority of housekeepers but not administrators. The occupations where women are a majority have less pay and less prestige than the ones where women are the minority. The authors examine the factors which keep women from being in the higher positions in the health system. In the first part, the present situation of women in health occupations, factors influencing this situation, and factors acting as barriers to change are discussed. In the second part, the authors focus on organizing women to overcome these barriers. Yerxa, Elizabeth J., Rancho Los Amigos Hospital, Downey, California, "On Being a Member of a 'Feminine' Profession." American Journal of Occupational Therapy, 29(10):597-598, 1975. The experiences involved in being a woman and a member of a health profession are examined. Occupational therapists are discriminated against within a largely male-dominated health care system. The authors contend that the women's own attitudes toward themselves as occupational therapists are even more pervasive and defeating than those of men. Suggestions are made for enhancing the development of occupational therapy as a profession, including: (1) increasing sensitivity to sexist attitudes that block personal and professional growth, (2) careful examination of both the content and teaching methods used in educational programs, (3) evaluation of models provided to therapists new to the field, and (4) expansive conceptualization of the future development of the profession and its potential financial, human, and political power base. » 34 80. 81. Heins, Marilyn; Smock, Sue; Martindale, Lois; Jacobs, Jennifer; and Stein, Margaret, "Comparison of the Productivity of Women and Men Physicians." Journal of the American Medical Association, 237, June 6, 1977, 2514-2517. Data obtained from random samples of 87 women and 95 men physicians in the Detroit metropolitan area indicate that, at the time of survey, 84 percent of the women and 96 percent of the men were engaged in medical work. Only seven percent of the women were not working because of reasons related to the traditional female role. Fifty-nine percent of the women and 87 percent of the men had worked full time since medical school graduation. Fifty-one percent of the women, compared to 39 percent of the men, were in primary care specialties. Since medical school graduation, women physicians spent 90 percent as much time in medical work as did the men, despite the fact that most of the women had full responsibil- ity for homes and families. (Author abstract) Haase, Jeannette V.; Wyshak, Grace; Kole, Jean; Whittington, Anne; and Lebowitz, Ann (Editor), A Study of the Participation of Women in the Health Care Industry Labor Force, Executive Summary. Radcliffe Programs in Health Care, Radcliffe College, Cambridge, Massachusetts, supported by Contract No. HRA 106-74-166 from OHRO/HRA/DHEW. Exploratory in design, this research seeks to identify the barriers and facilitators to women interested in health occupations. Using conceptual framework (The Life Patterning Process) as a guide, interrelationships among childhood socioeconomic status, marriage, childbearing, career development and job satisfaction were discussed with 263 women located in six states: Georgia, Massachusetts, Minnesota, Ohio, Texas and Washington. In these states, groups of women representing each of five health occupations were brought together for the discussion process; occupations included registered nurses, licensed practical nurses, dentists, dental hygienists and health administrators. Additionally, employment benefits provided by hospitals, nursing homes and dental group practices were studied. Major conclusions of the study are: existing and future health manpower legislation must be reviewed to determine its impact on women trained but not presently in the health labor market, women currently participating in the health labor market and those planning to enter; initial career choice is a major determinant of future career options (in order to expand options, specific attention must be given to the design and content of continuing education programs for persons trained in specific health occupations); job benefits need to be redesigned to meet the needs of working women and more fully include those employed less than full time. Further research directions are recommended. 35 82. 83. III. WOMEN AS DECISION-MAKERS (PAID) % Appelbaum, Alan L., "Women in Health Care Administration." Hospitals, Journal of the American Hospital Association, 49 (16) :52-59, August 16, 1975. Although university graduate programs in health care administra- tion (or some comparable name) are graduating more females, problems of job placement still remain. Women seem to have equal educational opportunities but encounter difficulty in obtaining top management/health administration positions. One reason cited for the limited progress of women in the top management level of health care institutions is the lack of role models. Because of the small number of women hospital administrators and faculty members, there are few women available to advise women who desire to enter the health profession. Another reason for the dearth of women in management positions is the fact that women who have achieved high administrative levels have not organized themselves nationally to press for change. Attitudes toward women's role in health care management are also resistant to change, thus affirmative action efforts will not succeed until men are convinced that there are talented women with great administrative and management skills. Hooyman, Nancy R., and Kaplan, Judith S., "New Roles for Professional Women: Skills for Change." Public Administration Review, 36 (4) :374-378, July-August 1976. Recognizing that women are concentrated in lower-level positions, the authors suggest changes which will enable women to assume higher- level administrative or planning jobs. Even if full opportunities are provided for women to advance, internal and interpersonal barriers that derive primarily from women's socialization can prevent them from fully utilizing such opportunities. The authors have implemented a training program as one means of removing such barriers to women's participation in upper-echelon decision-making processes. The training model deals with values, skills, and knowledge within internal, interpersonal, and organizational contexts. While it focuses upon women in the human services, the model is relevant to women attempting to increase their power in a variety of professions. 36 84. 85. Nerlinger, Josephine, "Things Looking Up--But Not Too Far--For Women M.H.A.S." Modern Hospital, 120(1):47, January 1973. A survey conducted by a Trinity University student compares the progress of nonmilitary lay women hospital administrators holding the graduate degree in hospital administration with the progress of men of similar educational background. Although salaries have improved for women hospital administrators within the last five years, they have not kept pace with those of male administrators. In addition, more men than women are able to obtain administrative positions in hospitals and more men than women find upward mobility easy in hospitals, with sex discrimination cited as one reason for the difficulty women administrators encounter. Development of Criteria and Certain Related Information for Future Assessment of Minority Representation in HSAs and Associated Agencies, Performance by HSAs and the Impact of HSAs, Orkand Corporation, 1977, supported by Contract No. HRA 230-76-0210, OHRO/HRA/DHEW. A two-part study assessed the representation of minorities and women among Health Systems Agencies (HSAs) and State Health Planning and Development Agency (SHPDA) boards and staff, and in addition developed concepts and criteria that can be used to assess HSA performance and impact relative to the needs of the minority/disadvantaged populations which they serve. On the basis of data gathered from 189 HSAs, women comprise 26.1 percent of board membership, 23.6 percent of the Executive Committee membership, 28.7 percent of the professional staff, but 80 percent of the support staff. For the 49 SHPDAs contacted, a similar pattern emerges: women constitute, on the average, 21.6 percent of the professional staff, and 66.4 percent of the support staff. Thus, women are underrepresented in all agency groups, except for agency support staff where they are overrepresented. Of the minority consumer members of HSA Governing Boards, about two-thirds are men, one-third women. This ratio holds for total minorities, Blacks, and Hispanics, but American Indians and Asians have equal number uf mon and women among their board members. Criteria that can be used to assess HSA performance and impact regarding minority and disadvantaged populations were developed in each of seven functional areas: organization and management, plan development, plan implementation/review activities, plan implementation/health systems, data management and analysis, coordination, and public involvement. 37 86. Stewart, Debra W., "Women in Top Jobs: An Opportunity for Federal Leadership." Public Administration Review, 36 (4) :357-364, July-August 1976. This article examines the reasons so few women have been able to move into top positions of the labor force. Three theses are considered for analyzing the blockages to female entry into high-, level decisional posts: the political, biological, and sociological explanations. The author contends that the sociological explanation casts the most revealing light on the situation. Specifically, it is argued that the concept of role prejudice (as it resides not merely in attitudes, but more significantly in the structure of contemporary career systems) holds the key to understanding the dearth of women at the top. Since the Federal government has long set the tone for equal employment opportunity in employment practices, it should act to remove existing barriers. Although the author does not specifically address the problems of the lack of women at the top levels of health administration, the forces preventing women from attaining decision-making positions in the general labor force are equally evident in the health care labor force. 38 87. 88. IV. WOMEN AS EXTRA-MARKET HEALTH CARE PROVIDERS Wertz, Dorothy C., "Social Science Attitudes Toward Women Workers," Unpublished Manuscript, 1977, (Research for Social Change, Brookline, Massachusetts.) Social science investigations of controversial subjects tend to be value-laden in their hypotheses and methods. Women's work outside the home has been such a controversial area of research because such work has traditionally been considered to conflict with motherhood. Women workers have therefore become a special and distinct area for research, to be given different considerations from male workers. From its beginnings in about 1870, social science research on women workers has reflected certain dominant values of the middle classes concerning the place of women and women's physical, mental, and moral capacities. The values underlying research have tended to lag behind changes in women's actual behavior. Thus, in spite of an underlying assumption for almost one hundred years that work outside the home was a form of deviant behavior for women (although justified in special circumstances), more and more women entered the labor force. Early values were based on Victorian medical ideas about women's physical and mental weakness to which were added concern for the protection of motherhood -- considered women's primary task. These ideas held strong until the 1960's and most research tended to prove what the investigators already believed. Health research virtually disappeared after the early 1900's and was eventually replaced by mental health research. The outcomes of much of this research reflect prevalent middle-class values, those held by the researchers. This paper describes and catalogues the predominant values underlying such research from 1870 to 1970, and explores some of the reasons for changes in these values. Availability: NTIS Bernard, Jessie, The Future of Motherhood. New York, New York: Penguin Books, Inc., 1974. This book focuses attention upon women in their role as mothers and the changing role of women as mothers. Children and husbands are considered only secondarily. Believing that motherhood is too important for women alone, the author calls for a new balance in bearing the responsibility of child rearing. This balance may be achieved by opening up many of the roles heretofore relegated to mothers to men as women continue to wrestle with the problems of integrating their roles as workers and their diminishing roles as mothers. 39 89. 90. 91. Blumenfeld, Samuel L., The Retreat from Motherhood. New Rochelle, New York: Arlington House, 1975, 222 pp. Recent trends indicating that fewer women are having children and more are choosing to remain single for a longer period of time are examined. Contemporary writing on women's liberation, religion, medicine, and interpersonal dynamics are interpreted and discussed within the context of views about the complex nature of decisions regarding motherhood. Topics include the impact of patriarchal systems on the role of women, sexual and maternal politics as influencing forces within society, the separation of love and sex as influencing factors in new forms of sexuality, and abortion and other medical factors affecting motherhood images and choices. A major target group given considerable attention is the teenager and focus is on the current types of socialization processes which may adversely affect the development of mothers of the future. Availability: Arlington House New Rochelle, New York $7.95 Burton, Linda, The Family Life of Sick Children. London and Boston: Routledge and Kegan Paul Ltd., 1975. This book examines how chronically ill children face up to their illness and the ways parents manage to transcend the problems and difficulties which confront them. In addition to considering the impact of a child's disease on the mother, the author also attempts to describe the responses of the father to the child's illness. It is emphasized that parents do not exist in an emotional vacuum and that many pre-existing factors shape their attitude to illness and the task of rearing a chronically ill child. The attitudes of their children, parents, and extended kin may also be important determinants of their behavior. - Carpenter, Eugenia et al, "Women's Roles in Extra-Market Health Services," Department of Health Planning and Administration, School of Public Health, The University of Michigan, October 1976, supported by Contract No. HRA 230-76-0073, OHRO/HRA/DHEW. This study reviews the current state of knowledge of the role of women (as wives, mothers, or other relatives) in transactions outside of the health care market in determining the health status of their families and themselves. Aspects of women's roles in the provision of health care which have been explored by various researchers include 40 92. consideration of the household as a unit of health production, the relation of household features to the health of family members, the time spent at household tasks, and the value of the housewife's time. In examining earlier research, none was found that focused specifically on women as informal health providers. Rather, previous studies have emphasized the interaction between women and the formal health care system. Moreover, in many studies sex role norms are implicitly subsumed in the research designs, thereby biasing the research itself. Based on these findings, suggestions for further investigation are made as well as recommendations for policy changes in the areas of child health services, health education, utilization control, insurance and income maintenance programs, and reallocation of resources to the development of support systems for familial roles in health promotion, preventive care, and primary care. Availability: HRP-O0015815 Eisenberg, Leon, "Caring for Children and Working: Dilemmas of Contemporary Womanhood." Pediatrics, 56(1):24-28, 1975. Department of Psychiatry, Harvard Medical School, Boston, Massachusetts. = In a discussion of the problems and future of the working mother and her family, the author notes that increasing numbers of women are entering the labor force in response to the pressures of an inflationary economy, higher education costs for their children, opportunities for personal fulfillment, and a growing market for service occupations. Married women, nevertheless, continue to carry 70 to 80 percent of child care and household duties even when both parents work. The development of sex-typed roles is traced in primitive and industrial society, and described as an artificial rather than a natural process. Social innovations in child care are considered necessary if optimal conditions for child development are to be provided; however, the most necessary condition for successful child care and family adjustment in a home where both parents work is considered to be a redistribution of household work- load among husband, wife, and other members of the family such as grandparents and adolescent siblings. It is felt that the physician, as family counselor, has a responsibility to the family and to society to help his clients fulfill parental, occupational, and personal needs in a rapidly changing society. (Modified journal abstract) 41 93. 94 . 95. Hoffman, Lois Wladis, and Nye, F. Ivan, Working Mothers: An Evaluative Review of the Consequences for Wife, Husband, and Child. San Francisco, California: Jossey-Bass, 1974. Department of Psychology, University of Michigan, Ann Arbor, Michigan. Research findings from the fields of sociology, psychology, demography, and social welfare on the consequences of a woman's working for herself, her husband, and her children are reported. The changes in society that have made it increasingly possible for mothers to seek and find work and the changes in the attitudes of mothers toward work are examined. Data show that mothers' commitment to work is related to their aspirations for their children's education, the income of their closest friends, and their race. Maternal employment is discussed as a factor in the control of population growth as well as provisions required for child care. There is evidence that maternal employment does not foster deprivation of the child, and may in fact, lead to greater marital harmony. Maternal employment increases the power of the mother in the family, and working mothers are reported to be in better physical health and have greater self-confidence than nonworking mothers. Jacobs, Ruth Harriet, "A Typology of Older American Women." Social Policy, 7(3):34-39, November-December 1976. Like older men, older women suffer from the faults of society in general and from the particular problems of "ageism." The author delineates 13 roles of older women in the American society in an attempt to increase understanding of the reality of older American women. The roles analyzed are: nurturers, unemployed nurturers, re-engaged nurturers, chum networkers and/or leisurists, careerists, retired careerists, seekers, advocates, faded beauties, "doctorers," escapists, "isolates," and assertive seniors. Litman, Theodore J., "Health Care and the Family: A Three-Generational Analysis." Medical Care, 9(1):67-81, January-February 1971. An intensive two-year exploratory study of the health attitudes, values, beliefs, experiences, and practices of a sample of 70 three- generation families living in Minnesota was undertaken in the autumn of 1966. Study results demonstrate the feasibility of conducting a three-generational family analysis in the health care area. Findings relevant to women include: In all generations the wife required more health care than husband or children although pregnancy does not account for a large number of these cases; any 42 96. 97. prolonged incapacitation of the wife was consistently regarded as a major disruptive influence on family functioning; the younger generation is more financially vulnerable to the demands of illness; grandparents are ill-prepared to adequately cope with the problems of health and illness; and the family generally had a low level of knowledge about health and health practices. The low level of familial knowledge and information about health and health practices may indicate the necessity of reassessing the medical assumption that the family universally understands and is prepared to provide home care. Litman, Theodore J., "The Family as a Basic Unit in Health and Medical Care: A Social Behavioral Overview." Social Science and Medicine, 8:495-519, September 1974. The current state of the art of research concerning the role of the family in health and medical care is summarized. One area of investigation has been the role in which the mother serves as a prominent influence on health and nutrition of the family. In addition to playing a primary function in the family for defining and organizing responses to children's symptoms, the wife-mother is also the family member most likely to take action in response to these symptoms. Because of her pivotal role as an agent of cure and care, the mother exhibits considerable reluctance in assuming the sick role. Other areas which have been explored include the socio-epidemiology of family health; the family in mental health and mental illness; health maintenance and medication behavior; the impact of illness on family functioning; and the family and physical rehabilitation. Luft, Harold S., Hershey, John C., and Morrell, B. S., "Factors Affecting the Use of Physician Services in a Rural Community." American Journal of Public Health, 66(9):865-871, September 1976. This paper adds to the previous utilization research by examining the relative importance of various independent variables for predicting five separate measures of physician utilization in a rural community. The results are comparable to those of national studies which conclude that health status is the primary determinant of utilization. These results lead to the suggestion that supply be explicitly considered in future demand studies. Whereas previous studies demonstrated that females have a utilization rate higher than males, this study indicates that women appear to receive no more care than men, given their symptoms. When the family is used as the unit of analysis, the utilization rate is even lower.' The authors suggest that this may be 43 98. 99. 100. related to the fact that women are often responsible for medical treatment within the family and may serve as alternative providers of medical care for minor illnesses. Thus, family interactions appear to be important in the use of services and need to be examined in future studies. Pratt, Lois, "Child Rearing Methods and Children's Health Behavior." Journal of Health and Social Behavior, 14:61-69, March 1973. This paper examines the relationship between methods of child rearing used by parents and their children's personal health care practices. The study is based on information obtained from detailed interviews with a representative sample of families with children aged nine through thirteen in northern New Jersey. Separate interviews were conducted with the child, mother, and father. Children's and mothers' statements on child rearing methods were consistently related to children's health habits, but fathers' statements were not. One possible reason is that fathers performed so little child rearing activities. Silver, George A., Family Medical Care: A Design for Health Maintenance. Cambridge, Massachusetts: Ballinger Publishing Company, 1974. This is a revision of an earlier volume issued in 1963, and based upon an experiment conducted over a ten-year period. This project demonstrated the importance of an integrated family team approach in the delivery of care and the primacy of the patient in the effectiveness of medical care. The first two chapters summarize the concept of family health and health maintenance and the maternal role influence upon family health behavior. Swigar, Mary E., Quinlan, Donald M., and Wexler, Sherry D., "Abortion Applicants: Characteristics Distinguishing Dropouts Remaining Pregnant and Those Having Abortions." American Journal of Public Health, 67(2):142-146, February 1977. This study compares two groups of women who applied for induced hospital abortion, 100 of whom had the abortion and 100 of whom dropped out to carry to term. The findings suggest some definable differences between women who received abortions and those who decided to drop out and carry to term. Dropout applicants had less education, had partners with less education, tended to be indecisive, and received negative responses toward abortion from their partners. 44 In addition, these women expressed greater concern about the procedure and about moral implications of abortion. The researchers conclude that these findings need replications and lend themselves to the use of the Janis-Mann model of decision-making. In this model, different types of inappropriate decision-making can occur: the decision-maker may avoid recognizing that a threat exists; there may be an abrupt and enthusiastic switch-over to adopting a new course; there may be a defensive avoidance of discrepant information once a preliminary course is taken; or the reaction may be panic-like when it seems as if no adequate solution can be found. (Modified journal abstract) 45 101. 102. 103. V. OTHER BIBLIOGRAPHIES AND PERIODICALS Bibliographies Chaff, Sandra, Haimbach, Ruth, Fenichel, Carol, and Woodside, Nina (eds.), Women in Medicine: An Annotated Bibliography of the Literature on Women thsiciahs, (2 vols.), Metuchen, New Jersey: Scarecrow Press, 1978. Medical College of Pennsylvania, Center for Women in Medicine. This comprehensive bibliography, in preparation, includes identifiable books, periodicals, reports, and scholarly works on all aspects of women physicians. Topics covered include: education of women physicians, their practice patterns, and roles as women. Cisler, Lucinda, Women: A Bibliography, 1968, 1969, 1970. This continuously updated bibliography draws from the literature of the women's movement. Although not specifically focused on women and the health system, many entries are relevant to women and mental health issues. Availability: Lucinda Cisler P. O0. Box 240 Planetarium Station New York, New York 10024 $. 60 May, Jean T., Health Career Databank for Minorities/Women: _ An Annotated Selected Bibliography. American Institutes for Research, Pittsburgh, Pennsylvania, May 1976. Literature from the disciplines of public health, economics, psychology, education, and sociology has been selected to provide both general and specific background material about health careers for minorities, women, and other disadvantaged groups. Citations to journal articles, Government publications, monographs, books, papers presented at meetings and workshops, reports of research, directories, program materials, and other bibliographies are included in this compilation of material published between 1960 and 1975. Seventy-nine annotated entries are classified into the following broad topics: developing potential career resources; decision-making, counseling, guidance; education for professional health occupations; employment in professional health occupations; allied health occupations; characteristics of occupations, careers; and health 46 104. services labor market analysis. Unannotated references are grouped as follows: other bibliographies, selected publications of the Department of Labor, selected publications of the Census Bureau, and selected additional references. Most of the citations are presented in the latter section, which is organized alphabetically by author. Slightly more than one-half of all the citations contain information specific to minorities and/or women, and these listings are identified. - The selection and acquisition process of the literature search is described. May, Jean T., Rudow, Melvin H., and Kerr, Joyce L., Health Career Databank for Minorities/Women: Longitudinal Study of Health Careers from Project Talent. American Institute for Research, Pittsburgh, Pennsylvania, May 1976. The longitudinal data base developed by Project TALENT for a sample of American high school students is used to investigate factors associated with successful participation in health careers by minorities and women. The analysis attempts to identify the correlates of high school interests, aptitudes, abilities, and student activities with motivation and entry into health careers and success in those careers; to trace students' post-high school training and health career paths; and to develop methods for predicting health career group membership and success. Subsets of all high school students, females, and minority respondents who were in the eleventh and twelfth grades in 1960 and who had a job in a health-related field eleven years later are analyzed. The analysis included a total sample of 54,546 persons. The results of the study show that predictability of job success and career satisfaction is poor for people in general, for all people in health careers, and for women in health careers, but relative substantial for minorities in health careers. Statistically significant predictors that explained variance in job success and satisfaction for minorities in health occupations were sex, high math composite scores, and family type. Statistically significant predictors explaining variance in job success and satisfaction for females in health occupations were higher I.Q. composite scores, minority status, and higher levels of training required for a job. Supporting data and details of the analysis are provided. Implications of the findings are discussed. Supporting materials and a list of methodological references are appended. 47 105. 106. May, Jean T., and Rudow, Melvin H., Health Career Databank for Minorities/Women: Design and Feasibility Study. American Institute for Research, Pittsburgh, Pennsylvania, May 1976. A design is presented for a six-part program intended to meet the information needs of programs aimed at enhancing health career opportunities for minority groups and women. ° Information gleaned from an analysis of personal characteristics associated with job success and satisfaction, from a review of literature, and from interviews with the staff of 28 health career programs was used in designing the DATABANK program. The core of DATABANK consists of the participant component, which gathers information about people participating in various career programs (including longitudinal information about their success in occupational training programs and in their health occupations), and the program component, which contains information about the characteristics of health career programs for minorities and women. Four add-on components include a research component, initially composed of the database developed by the Center for Health Systems Studies' Project TALENT; two computer-searchable information systems containing bibliographic and technical resource materials relevant to health career programs for minorities and women; and a technical support service component, including such things as training and consultation services, newsletters, and workshops. A management plan for the proposed DATABANK program is outlined, including the personnel, equipment, and facility resources necessary to implement the program. The proposed budget calls for $177,650 for the core components and an additional $69,176 to cover all four add-on components. A schedule for implementing all components over a three-year period is included. Ruzek, Sheryl K., Women and Health Care, A Bibliography With Selected Annotation. Program on Women, Northwestern University, Occasional Papers No. 1, June 1975. This comprehensive bibliography includes literature dealing with women's concerns in health from various perspectives: women's health care issues from a feminist perspective, sexuality and mental health, women's clinics and health projects, the social content of women's health care, illness behavior, comparative studies (health care in a broader perspective), and source materials on women's health issues. Availibility: The Program on Women, Northwestern University 619 Emerson Street Evanston, Illinois 60201 $3.00 + $.50 postage 48 107. Sprague, Jane B., "Women and Health Bookshelf." American Journal of Public Health, 65(7):741-746, July 1975. The author provides a list of books, articles, and other resources which represent an extensive view of topical boundaries of women and health. Both traditional views of women in the health system and literature reflecting the ideas and observations of members of the women's health movement are included. 49 108. 109. 110. 111. Periodicals An Exploratory Study of Women in the Health Professions Schools, Volume X, Annotated Bibliography. Urban and Rural Systems Associates, San Francisco, California, August 1976, 114 pp. Contents include: MODVOPPP general; women and careers; women in medicine; women in osteopathic medicine; women in dentistry; women in veterinary medicine; women in optometry; women in podiatry; women in pharmacy; women in public health; women in general; women, higher education, and the law; and bibliographies and information sources. (NTIS abstract) Availability: NTIS PB-259 234/3WW Congressional Clearinghouse on Women's Rights, Newsletter, Editor: Ms. Carol Forbes, Washington, D.C. 'A weekly newsletter which cites all relevant Federal activities, especially legislation which has an impact on women. The major areas covered are: abortion, administration-Federal, children, civil rights, consumerism, crime, divorce, economics, education, employment, ERA, family planning, health, historical, international reports, labor, military, social issues, social security, sports, and welfare. Availability: Contact your local Congressman to be put on the mailing list. There is no charge. Boston Women's Health Book Collective, Our Bodies, Ourselves: A Book By and For Women. New York: Simon and Schuster, 1973, 276 pp. A collection of readings on women and their bodies, written by women for women, is presented. Chapter topics include: Our Changing Sense of Self; The Anatomy and Physiology of Reproduction and Sexuality; Sexuality; Living with Ourselves and Others; Female Homosexuality; Nutrition; Exercise; Rape and Self-Defense; Venereal Disease; Birth Control; Abortion; Deciding When to Have Children; Childbearing; Menopause; and Women and Health Care. HealthRight. HealthRight, Inc., 175 Fifth Avenue, New York, New York 10010. This is a newsletter on issues and activities of the women's health movement that is directed primarily to women as health services consumers. 50 112. 113. 114. 115. Availability: HealthRight, Inc. 175 Fifth Avenue New York, New York 10010 Subscription: $5.00/year for individuals; $10.00/year for institutions Keeping Abreast Journal, Box 6459 Cherry Creek Station, Denver, Colorado 80206. For further information, contact: Ms. Jimmie Lynne Avery, Editor, (303) 623-7209. This quarterly journal is devoted exclusively to supporting the nursing mother and infant. It was created to serve all professional and lay specialists concerned with maternal and child health, human development, and the family-physicians, nurses, researchers, medical educators, and parent educators. (From Women and Health, 1(2):16, March-April 1976) Signs - Journal of Women in Culture and Society, Catherine R. Stimpson, Editor. Published by the University of Chicago Press, 5801 Ellis Avenue, Chicago, Illinois 60637. Published quarterly, this journal includes essays, reviews, and other materials which contribute to the study of women. Women and Health--Issues in Women's Health Care, Helen I. Marieskind, Editor. SUNY/College at Old Westbury, Old Westbury, New York 11568, 1976. This journal was founded to serve as a forum for indepth exploration of the range of issues in women's health care. The approach is multidisciplinary but emphasis is placed on publishing articles which illustrate the potential of social change through research. (From an Editorial, Women and Health, 1(1):2, January- February 1976) "Women and the Health System," Health/PAC Bulletin, No. 40, April 1972. This issue includes articles on women as patients and as health workers which discuss women's role in the health hierarchy and the emerging new allied health professions. Also included are articles on politics of control, experimentation, medical advertising and community action for health care. 51 116. 117. 118. "Women in Action," Health/PAC Bulletin, March 1970. "The Male, Feasance of Health," (Editorial), pp. 1-2. The entire editorial is devoted to examining the issues which have motivated women into action against the male-dominated health system. The Bulletin includes articles authored by two guest writers and an introductory editorial which notes that health is only one issue which women must face in the struggle for equality and self-determination. In the health area, however, women may have a revolutionary impact because of the strategic positions in which they are employed and the alliance between women health providers and consumers (i.e., both groups have similar attitudes of oppression and can be unified accordingly). Women's Washington Representative, A Women's Legislative Service, Ms. Susan Tenenbaum, Editor. This is an independent, non-partisan newsletter published every three weeks while Congress is in session. It provides current information on legislation that affects women and covers issues such as: education and training, health, taxes, homemaking, child care, aging, and the labor force. Availability: Women's Washington Representative 324 C Street, S.E. Washington, D.C. 20003 Subscription: $25.00/year for individuals; $37.00/year for institutions Women's Equity Action League Educational and Legal Defense Fund (WEAL Fund), Washington, D.C. A non-profit organization which helps support legal cases involving women's rights and sex discrimination in many kinds of employment discrimination; it also monitors the formulation and enforcement of Federal policy, laws and regulations which affect women. The Fund publishes information and kits on such issues as "women and fellowships," women's legal rights within marriage, sexism in elementary and secondary schools, sex discrimination in higher educational institutions, and international efforts on behalf of efforts to establish an international women's network. Publication list and prices available from: WEAL Fund, 733 15th Street, N.W., Suite 200, Washington, D.C. 20006. 52 _ AUTHOR INDEX Author |>> Altenderfer, M. American Institute for Research American Public Health Association Appelbaum, A. L. Ashley, J. A. Association of American Medical Colleges B. Banks, M. H. Benedek, E. P. Beresford, S. A. Bernard, J. Bloom, B. I. Blumenfeld, S. L. Boston Medical Committee for Human Rights Boston Women's Health Book Collective Brown, C. A. Bullough, B. Bullough, V. L. Burton, L. C California Commission on the Status of Women Campbell, R. Cannings, K. Caraway, A. F. Carpenter, E. Chaff, S. Cleland, V. Cisler, L. Congressional Clearinghouse on Women's Rights Corea, G. |9 Dobbins, M. P. Ducker, D. G. 53 Entry Number 56 x03, 105 33 82 34 59 35 88 42 89 110 110 36 37, 38 38 90 39 40 10 91 101 41 101 109 44 45 Author Edelstein, R. G. Ehrenreich, B. Ehrenreich, J. Eisenberg, L. English, D. Epstein, C. F. Fee, E. Fenichel, C. Fishbein, Morris Forbes, C. Fried, F. E. Haase, J. Heide, W. S. Heimbach, R. Heins, M. Held, B. Hershey, J. C. Hesselbart, S. Hoffman, L. W. Hooyman, N. R. Howell, M. C. Towa Commission on the Status of Jacobs, J. Jacobs, R. H. Jolly, C. Jussim, J. |td | =d |d |H Women [t- 54 Entry Number 46 5, 6, 37, 14, 47 7 92 5, 6 49 101 50 109 51 81 52 99 80 10 97 53 93 83 54 80 94 10 55 Author Kaplan, J. S. Kerr, J. L. Kole, J. Kutner, N. G. Lazonick, W. Lewis, D. A. Linn, E. L. Lipman-Blumen, J. Litman, T.: J. Luft, H. S. Marieskind, H. I. Martindale, L. May, J. T. Medical College of Pennsylvania, Center for Women in Medicine MITRE Corporation Monteiro, L. A. Morrell, B.-S. Morrell, D. C. Moulton, R. Muller, C. Nadelson, C. C. Nathanson, C. A. Navarro, V. Nerlinger, J. Neubardt, S. B. North, A. F. Notman, M. T. Nye, F. I. |R t |= 55 Entry Number 81 104 81 43 40 12 48 Preface 95, 96 97 13, 14, 23, 114 80 103, 104, 105 15, 101 60 11 97 1 16 18, 55 58 19 57. 84 20 21 58 93 Author Olesen, V. Orkand Corporation o P. Pennsylvania Insurance Department Insurance Commissioner's Advisory Task Force on Women's Insurance Problems Plant, J. Pratt, L. Prystowsky, H. Quinlan, D. M. Radcliffe College Reverby, S. Ris, H. W. Roeske, N. A. Rudov, M. H. Ruzek, S. K. Safilios-Rothschild, Scher, M. Seaman, B. Silver, G. A. Smock, S. Sprague, J. B. Spurlock, J. Stein, M. Stewart, D. W. Stimpson, C. R. Swigar, M. E. \x \n 56 Entry Number Preface, 31 85 22 42 98 10 100 81 61 24 62 103, 104, 105 106 25 63 26 99 80 107 64 80 86 113 100 Author I Tenebaum, S. U Urban and Rural Systems Associates V. Verbrugge, L. M. W Wallace, H. M. Waller, J. J. Watkins, C. J. Weaver, J. L. Wertz, D. Wesson, A. Wexler, S. D. Whittington, A. Williams, P. A. Wilson, J. R. Wilson, V. Women's Equity Action League Educational and Legal Defense Fund (WEAL) Women's Work Project of the Union for Radical Political Economics Woodside, Nina Wyshak, G. |-4 Yerxa, E. J. [N Ziem, G. 57 Entry Number 27, 117 65-74, 108 28 29 32 87 11 100 81 75 30 76 118 78 101 81 79 23 J.S. GOVERNMENT PRINTING OFFICE : 1978 O-264-032 POSTAGE AND FEES PAID U.S. DEPARTMENT OF HEW HEW 390 = U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Public Health Service Health Resources Administration National Center for Health Services Research Center Building 3700 East-West Highway o MAL Hyattsville, Maryland 20782 OFFICIAL BUSINESS PENALTY FOR PRIVATE USE, $300 BHPRD@® DHEW Publication No. (HRA) 78-629