Why are childless women childless? Findings from an exploratory study in Victoria, Australia

Childlessness in Australia is increasing yet there is limited research exploring women’s reasons for childlessness. Previous research has typically examined childlessness within the context of fertility rather than childlessness itself. The limited research that has moved beyond looking at involuntary childlessness has labelled women with a type of childlessness during recruitment rather than exploring women’s reasons for childlessness as a part of the research process. 

Sociodemographic factors associated with healthy eating and food security in socio-economically disadvantaged groups in the UK and Victoria, Australia

Objective
To investigate the associations between sociodemographic factors and both diet indicators and food security among socio-economically disadvantaged populations in two different (national) contextual settings.

Design
Logistic regression was used to determine cross-sectional associations between nationality, marital status, presence of children in the household, education, employment status and household income (four low income categories) with daily fruit and vegetable consumption, low-fat milk consumption and food security.

Setting
Socio-economically disadvantaged neighbourhoods in the UK and Australia.

Subjects
Two samples of low-income women from disadvantaged neighbourhoods: (i) in the UK, the 2003–05 Low Income Diet and Nutrition Survey (LIDNS; n 643); and (ii) in Australia, the 2007–08 Resilience for Eating and Activity Despite Inequality (READI; n 1340).

Results
The influence of nationality, marital status and children in the household on the dietary outcomes varied between the two nations. Obtaining greater education qualifications was the most telling factor associated with healthier dietary behaviours. Being employed was positively associated with low-fat milk consumption in both nations and with fruit consumption in the UK, while income was not associated with dietary behaviours in either nation. In Australia, the likelihood of being food secure was higher among those who were born outside Australia, married, employed or had a greater income, while higher income was the only significant factor in the UK.

Conclusions
The identification of factors that differently influence dietary behaviours and food security in socio-economically disadvantaged populations in the UK and Australia suggests continued efforts need to be made to ensure that interventions and policy responses are informed by the best available local evidence.

Associations between dietary iron and zinc intakes, and between biochemical iron and zinc status in women

Iron and zinc are found in similar foods and absorption of both may be affected by food compounds, thus biochemical iron and zinc status may be related. This cross-sectional study aimed to: (1) describe dietary intakes and biochemical status of iron and zinc; (2) investigate associations between dietary iron and zinc intakes; and (3) investigate associations between biochemical iron and zinc status in a sample of premenopausal women aged 18–50 years who were recruited in Melbourne and Sydney, Australia. Usual dietary intakes were assessed using a 154-item food frequency questionnaire (n = 379). Iron status was assessed using serum ferritin and hemoglobin, zinc status using serum zinc (standardized to 08:00 collection), and presence of infection/inflammation using C-reactive protein (n = 326). Associations were explored using multiple regression and logistic regression. Mean (SD) iron and zinc intakes were 10.5 (3.5) mg/day and 9.3 (3.8) mg/day, respectively. Median (interquartile range) serum ferritin was 22 (12–38) μg/L and mean serum zinc concentrations (SD) were 12.6 (1.7) μmol/L in fasting samples and 11.8 (2.0) μmol/L in nonfasting samples. For each 1 mg/day increase in dietary iron intake, zinc intake increased by 0.4 mg/day. Each 1 μmol/L increase in serum zinc corresponded to a 6% increase in serum ferritin, however women with low serum zinc concentration (AM fasting < 10.7 μmol/L; AM nonfasting < 10.1 μmol/L) were not at increased risk of depleted iron stores (serum ferritin <15 μg/L; p = 0.340). Positive associations were observed between dietary iron and zinc intakes, and between iron and zinc status, however interpreting serum ferritin concentrations was not a useful proxy for estimating the likelihood of low serum zinc concentrations and women with depleted iron stores were not at increased risk of impaired zinc status in this cohort.

Associations of diet quality with health-related quality of life in older Australian men and women

This study investigated associations between diet quality measures and quality of life two years later. Adults 55-65 years participating in the Wellbeing, Eating and Exercise for a Long Life (WELL) study in Victoria, Australia (n = 1150 men and n = 1307 women) completed a postal survey including a 111-item food frequency questionnaire in 2010. Diet quality in 2010 was assessed via the dietary guideline index (DGI), recommended food score (RFS) and Mediterranean diet score (MDS). The RAND 36-item survey assessed health-related quality of life in 2012. Associations were assessed using logistic regression adjusted for covariates. In men, DGI and RFS were associated with better reported energy (OR = 1.79, CI: 1.25, 2.55 and OR = 1.56, CI: 1.11, 2.19 respectively), and DGI was additionally associated with better general health (OR = 1.54, 95% CI: 1.08, 2.20), and overall mental component summary scale (OR = 1.51, CI: 1.07, 2.15) in the fully adjusted model. In women, associations between two indices of diet quality (DGI, RFS) physical function (OR = 1.66, CI: 1.19, 2.31 and OR = 1.70, CI: 1.21, 2.37 respectively) and general health (OR = 1.83, CI: 1.32, 2.54 and OR = 1.54, CI: 1.11, 2.14 respectively) were observed. DGI was also associated with overall physical component summary score (OR = 1.56, CI: 1.12, 2.17). Additional associations between emotional wellbeing and DGI (OR = 1.40, CI: 1.01, 1.93) and RFS (OR = 1.44, CI: 1.04, 1.99), and MDS and energy (OR = 1.53, CI: 1.11, 2.10) were observed in the fully adjusted model, in women only. Older adults with better quality diets report better health-related quality of life, with additional associations with emotional wellbeing observed in women.

Abortion and conscientious objection: the new battleground

This paper examines the vexed issue of conscientious objection and abortion. It begins by outlining the increasing claims to conscientious objection invoked by physicians in reproductive health services. After an examination of developments overseas, the paper turns to the acrimonious debate in Victoria concerning the conscience clause and the 'obligation to refer' contained in the Abortion Law Reform Act 2008 (Vic) ('ALRA'). This paper questions the interpretation by the Catholic Church that the clause breaches its right to freedom of conscience and freedom of religion. We argue that the unregulated use of conscientious objection impedes women's rights to access safe lawful medical procedures. As such, we contend that a physician's withdrawal from patient care on the basis of conscience must be limited to certain circumstances. The paper then examines international and national guidelines, international treaties and recommendations of treaty monitoring bodies, laws in other jurisdictions, and trends in case law. The purpose of this examination is to show that the conscientious objection clause and the 'obligation to refer' in ALRA is consistent with international practice and laws in other jurisdictions. Finally, the paper turns to the problematic interpretation of conscience and moral responsibility in the context of abortion. We believe that narrow interpretations of conscience must be challenged, in order to incorporate patients' rights to include the choice of abortion and other lawful treatments according to their conscience. We conclude that the conscientious objection provisions in ALRA have achieved the right balance and that there is no justifiable legal reason upon which opponents can challenge the law.

Small area-level socioeconomic status and all-cause mortality within 10 years in a population-based cohort of women: Data from the Geelong Osteoporosis Study

Background: The social gradient of health and mortality is well-documented. However, data are scarce regarding whether differences in mortality are observed across socio-economic status (SES) measured at the small area-level. We investigated associations between area-level SES and all-cause mortality in Australian women aged ≥. 20. years. Methods: We examined SES, obesity, hypertension, lifestyle behaviors and all-cause mortality within 10. years post-baseline (1994), for 1494 randomly-selected women. Participants' residential addresses were matched to Australian Bureau of Statistics Census data to identify area-level SES, and deaths were ascertained from the Australian National Deaths Index. Logistic regression models were adjusted for age, and subsequent adjustments made for measures of weight status and lifestyle behaviors. Results: We observed 243 (16.3%) deaths within 10. years post-baseline. Females in SES quintiles 2-4 (less disadvantaged) had lower odds of mortality (0.49-0.59) compared to SES quintile 1 (most disadvantaged) under the best model, after adjusting for age, smoking status and low mobility. Conclusions: Compared to the lowest SES quintile (most disadvantaged), females in quintiles 2 to 5 (less disadvantaged) had significantly lower odds ratio of all-cause mortality within 10. years. Associations between extreme social disadvantage and mortality warrant further attention from research, public health and policy arenas.

Changes in gait performance over several years are associated with recurrent falls status in community-dwelling older women at high risk of fracture

Background: gait analysis is a recommended geriatric assessment for falls risk and sarcopenia; however, previous research utilises measurements at a single time point only. It is presently unclear how changes in gait over several years influence risk of recurrent falls in older adults.Methods: we investigated 135 female volunteers (mean age ± SD: 76.7 ± 5.0 years; range: 70-92 years) at high risk of fracture. Gait parameters (speed, cadence, step length, step width, swing time and double support phase) were assessed using the GAITRite Electronic Walkway System at four annual clinics over ?3.7 ± 0.5 years. Participants reported incident falls monthly for 3.7 ± 1.2 years.Results: increasing gait speed (odds ratio: 0.96; 95% confidence interval 0.93, 0.99) and step length (0.87; 0.77, 0.98) from baseline to final follow-up was associated with reduced likelihood of being a recurrent faller over the study period. No significant associations were observed for baseline gait parameters (all P ≥ 0.05). At the second follow-up (2.8 ± 0.6 years), an increase in swing time (0.65; 0.43, 0.98) was associated with reduced likelihood, while an increase in double support phase (1.31; 1.04, 1.66) was associated with increased likelihood, for being a recurrent faller in the subsequent 1.3 years following this time point.Conclusion: changes in gait parameters over several years are significantly associated with the likelihood of being a recurrent faller among community-dwelling older women at high risk of fracture. Further research is required to develop gait monitoring guidelines and gait parameter decline cut points that may be utilised by clinicians to identify older adults at risk of incident falls and sarcopenia.

Shifts in media images of women appearance and social status from 1960 to 2010: a content analysis of beauty advertisements in two Australian magazines

Ageing well and successful ageing have become important themes to describe how older individuals should keep ageing at bay. Products and services aimed at controlling ageing have become associated with ageing well. In this study we aimed to analyse the representation of older women in advertisements specific to appearance and ageing. In particular, we sought to explore how ageing for women was presented in the media over a period 50 years and when advertisements began to use the term 'anti-ageing'. A content analysis of 710 advertisements from two prominent Australian women's magazines, from 1960 to 2010, was conducted. Analyses showed that advertisements provided a narrow range of images representing women's physical appearance. The underlying messages were that ageing is problematic and that it had become unforgivable to show any signs of ageing. Text contained in advertisements for beauty products from the two chosen Australian magazines often gave specific and prescriptive advice to women on ways to avoid losing their youthful appearance. It was concluded that media relay powerful messages to spread and modify cultural beliefs informing individuals of a range of options that propose liberation from the problem of ageing.

Receiving care for intimate partner violence in primary care: barriers and enablers for women participating in the weave randomised controlled trial

BACKGROUND: Interventions in health settings for intimate partner violence (IPV) are being increasingly recognised as part of a response to addressing this global public health problem. However, interventions targeting this sensitive social phenomenon are complex and highly susceptible to context. This study aimed to elucidate factors involved in women's uptake of a counselling intervention delivered by family doctors in the weave primary care trial (Victoria, Australia).

METHODS: We analysed associations between women's and doctors' baseline characteristics and uptake of the intervention. We interviewed a random selection of 20 women from an intervention group women to explore cognitions relating to intervention uptake. Interviews were audio-recorded, transcribed, coded in NVivo 10 and analysed using the theory of planned behaviour (TPB).

RESULTS: Abuse severity and socio-demographic characteristics (apart from current relationship status) were unrelated to uptake of counselling (67/137 attended sessions). Favourable doctor communication was strongly associated with attendance. Eight themes emerged, including four sets of beliefs that influenced attitudes to uptake: (i) awareness of the abuse and readiness for help; (ii) weave as an avenue to help; (iii) doctor's communication; and (iv) role in providing care for IPV; and four sets of beliefs regarding women's control over uptake: (v) emotional health, (vi) doctors' time, (vii) managing the disclosure process and (viii) viewing primary care as a safe option.

CONCLUSIONS: This study has identified factors that can promote the implementation and evaluation of primary care-based IPV interventions, which are relevant across health research settings, for example, ensuring fit between implementation strategies and characteristics of the target group (such as range in readiness for intervention). On practice implications, providers' communication remains a key issue for engaging women. A key message arising from this work concerns the critical role of primary care and health services more broadly in reaching victims of domestic violence, and providing immediate and ongoing support (depending on the healthcare context).