Chilean women in midlife; aspects on health, sexuality, migration and gender roles : Implications for midwifery

Abstract: Aims: To explore effects of biological and psychosocial factors on climacteric symptoms in Chilean midlife women (I), - to assess the impact of menopause and sociodemographic variables on quality of life (QoL) (II) - to learn about Chilean women s reflection about womanhood, and sexuality during midlife and the possible influence of migration whether they lived in Sweden or in Chile (III) - to explore how Chilean immigrant women living in Sweden perceived and related their life situations and health status during midlife to their migration experiences (IV) and to find out what Chilean midwives and midifery students regard being Chilean women´s health care needs in midlife (V). Material and Methods: Quantitative and qualitative methods were used to collect the data. The inclusion criteria for the studies were healthy Chilean women who accompanied patients to the Primary Health Centres (PHC) in Santiago (I-II), Chilean middle-aged women living in Santiago or who had lived in Stockholm for at least 15-20 years (III and IV). Chilean midwives working in PHC in Santiago and Chilean midwifery students in their last study years (4th and 5th year) (V). The quantitative data were collected in two cross-sectional surveys using face to face structured interviews (I-II); three validated scales and two questionnaires to collect data on biological, psychosocial and climacteric symptoms (I), one quality of life (QoL) questionnaire (II). The qualitative data was collected using Focus Group Discussions (FGDs) (III- V), in depth interviews with key informants (IV) and written narratives (V). Socio demographic data was collected in all the studies. EPI-INFO and STATA softwares were used for analysis of quantitative data (I-II). FGDs, in-depth interviews and written narratives were analysed using manifest and latent content analysis (III-V). Results: Perimenopausal women had a significant increase of stress and climacteric symptoms and perimenopausal state was a risk factor for somatic and vasomotor symptoms (I). Menopausal women had worse quality of life scores than women still menstruating and menopause was the only variable found to cause a significant impairment in QoL (II). A major influential factor in the women´s lives had been the strong influence of a gender imbalanced life since childhood. This was a fact whether the women lived in Stockholm, Sweden or Santiago, Chile. The experienced gender imbalance had made the women socially, economically and biologically more vulnerable to exploitation later in life (III). The Chilean women discussed about their struggle to gain social acceptance and position and they reflected about the discrimination they had met in the Swedish society and within the health care system along with health changes they had had during midlife. They connected some of their health related problems to their hardships of migration. Important for their way of coping with their own health seemed to be a recognition of their level of independence, need for an `own space´, self-acceptance and awareness of power relationships (IV). The midwives considered that women in midlife have special health care service needs; they considered themselves to be the most appropriate health staff to provide health care for women in midlife. Midwives recognized that they lacked communication skills and competences in assisting psychological, social and cultural health care needs of women in midlife such as violence, abuse and sexuality issues. The midwifery students remarked that many midwives focused their attention on fulfilling the biomedical requirements. Some students also questioned disrespectful attitudes by midwives especially towards poor immigrant women and women with psychosocial problems (V). Conclusion: Gender issues, structure of power relationships and empowerment should be incorporated into and critically discussed during midwifery education, training and in clinical settings. More reflections about and attention to the quality of the client provider relationship in clinical practice are needed.