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With governments reducing funding in health services, the eroding of nursing positions in the community have been severely impacted on, including women's health nurses.

Social determinants of health is a core cross-cutting approach of the World Health Organization to reduce health inequalities, and places an emphasis on aged care planning in rural areas of low- and lower-middle income countries including Bangladesh. The complex correlated health and social factors in Bangladesh interplay to shape the healthcare access of rural people. This impact is significant for rural elderly women in particular who have been shown to access healthcare in ways that are described as ‘socially determined’. This study aimed to explore how this cohort related their healthcare access to their living circumstances and provided insight into how their healthcare access needs can be addressed. This study was a critical social theoretical exploration from conversational interviews held over three months with 25 elderly women in rural Bangladesh. Two critical social constructs, ‘emancipation’ of Habermas and ‘recognition’ of Honneth, were used in the exploration and explanation of the influence of personal circumstances, society and system on rural elderly women’s healthcare access. The concept of ‘social determinants of healthcare access’ is defined from the physical, emotive, symbolic and imaginative experiences of these women. Interviewing the women provided information for exploration of the determinants that characterized their experiences into an overall construct of ‘The World is Not Mine’. This construct represented four themes focusing on the exclusion from healthcare, oppressive socioeconomic condition, marginalization in social relationships and personal characteristics that led the women to avoid or delay access to modern healthcare. This study confirms that the rural elderly women require adequate policy responses from the government, and also need multiple support systems to secure adequate access to healthcare. As healthcare services are often a reflection of community values and human rights concerns for the elderly, there is a need of recognition and respect of their voice by the family members, society and the healthcare system in planning and implementation of a prudent aged care policy for rural elderly women in Bangladesh.

Research into health professional's views of sexual and reproductive health (SRH) issues in rural and remote areas of South Australia was recently conducted by Dr Wendy Abigail from Flinders University School of Nursing and Midwifery.

Women living in rural, regional and remote areas in Australia generally have poorer access to sexual and reproductive healthcare. In my role as a researcher at Flinders University School of Nursing and Midwifery, I am researching the extent of the issue in an ethically approved university funded project.

This paper aims to contextualise ‘healthcare access and utilisation’ within its wider social circumstances, including structural factors that shape primary healthcare for marginalised groups. Mainstream theories often neglect complexities among the broader social, institutional and cultural milieus that shape primary healthcare utilisation in reality. A blended critical social framework is presented to highlight the recognition and emancipatory intents surrounding person, family, healthcare practice and society. Using the theoretical contributions of Habermas and Honneth, the framework focuses on power relationships, misrecognition/recognition strategies, as well as disempowerment/empowerment dynamics. To enable causal and structural analysis, we draw on the depth ontology of critical realism. The framework is then applied to the case of rural elderly women’s primary healthcare use in Bangladesh. Drawing on the literature, this article illustrates how a blended critical social perspective reveals the overlapping and complex determinants that affect primary healthcare utilisation, before concluding with the importance of situating healthcare access in sociocultural structures.

Group B Streptococcus (GBS) is a bacterium identified primarily in the vagina, gastrointestinal tract and urethra (Sheehy et al. 2012). GBS colonisation in the mother is a significant cause of neonatal sepsis, amassing the newborn morbidity and mortality rate in developed countries (Valkenburg-van den Berg et al. 2010).

Introduction: This scoping literature review explored the characteristics and behaviours of a subset of Australia’s older population: ‘grey nomads’, many who live and travel with type 1 or 2 diabetes mellitus. Grey nomads are people aged more than 55 years, who travel in caravans or motorhomes for extended periods of time around rural and remote areas of Australia. Grey nomads are challenging the established view of ageing in Australia by their lifestyle choices, which include social and economic contribution, independence and furthering of personal fulfilment. However, some evidence suggests that grey nomads experience health issues while in rural locations, which exerts a significant burden on already under-resourced Australian rural health services. This review seeks knowledge on grey nomads’ self-management of diabetes while travelling, with the aim of understanding their experiences and identifying support services and strategies that would facilitate improved self-management. Furthermore, this review seeks knowledge of how Australia’s rural and remote health services support the nomads with diabetes and the influence of this burgeoning population on such services. Methods: A scoping review methodology provided the methods to map the current evidence concerned with this broad and complex topic. A systematic six-step framework was adopted: identifying the research question; identifying relevant literature; selecting studies; charting the findings; collating, summarising and reporting results; and a final consultation. Results: The grey nomads in this review travelled long distances through the often-harsh Australian countryside where they sought, privacy, isolation, self-sufficiency and a closeness with nature. Although their motivations included life- and health-enhancing experiences, most grey nomads travelled with at least one chronic health condition, which they did not consider as a barrier to adopting a grey nomad lifestyle. However, many were under-prepared for their health needs when in rural or remote Australia. Specific literature concerning grey nomads and self-management of diabetes was not found but salient aspects of diabetes self-management were identified and included a well-developed relationship with their diabetes healthcare provider; a relationship that relied on ongoing communication and support. When travelling, the ability to form or sustain supportive relationships with local health care providers was limited due to sparseness of rural services and the perceived transient nature of the relationship. Increasingly, grey nomads utilised digital technology via telemedicine or social media sites for information and advice on health issues. The local pharmacies in rural and remote locations were also identified as sources of support and services. Conclusion: The literature showed that the grey nomad population had a similar distribution of chronic illness, including diabetes, to that of the general Australian population, but very little was published about how they self-manage conditions when in remote locations where healthcare services were limited. The emerging roles of digital technology and development opportunities for pharmacists offer new and innovative avenues to support grey nomads with diabetes while travelling in rural and remote Australia.

Objective. This research aimed to investigate the fertility management of women aged over 30 years prior to a termination of pregnancy (TOP) to inform primary health care service delivery providers and policy makers. Design. An ethically approved, two-phase sequential explanatory mixed methods design was used. This paper reports on part of that study. Setting. The study was conducted in five South Australian TOP clinics. Patients. Women aged over 30 years attending for a TOP in 2009 were invited to participate. Interventions. The Contraception Sexual Attitude Questionnaire (modified version) of women attending termination of pregnancy services was used. Main Outcomes Measures. Quantitative data analysis utilized SPSS V16 where simple descriptive statistics were described. Results. There were 101 questionnaire respondents where 70.5% were Australian women, predominantly married and with children. Women used contraception but experienced method failure, were beginning a new method, or were afraid of side effects. Risk-taking behaviours were reported such as putting the possibility of pregnancy out of their mind, getting carried away and not thinking of pregnancy risk, or frequently having unprotected intercourse. Conclusion. Service delivery needs to include age specific programs, and policy makers need to include policies which are adequately funded and evaluated. Further research is required to provide greater depth of knowledge in this area.

Morbidity, mortality and quality of life are impacted on by healthcare-associated infections (HAI) which are preventable. According to the World Health Organization 2016), in developing countries, around 10% of patients will contract HAI.

Senior women’s access to medical care in rural Bangladesh is a major public health concern. This study aims to explore the system determinants that impact on rural senior women’s utilization of healthcare. Following a qualitative critical social research design, healthcare staff and senior women living in three rural villages of Bangladesh were approached to participate in face-to-face audio-recorded interviews. A total of 11 staff and 25 senior women were interviewed with questions about health policy, healthcare services and management of aged care. Data was analyzed using a blend of critical discourse and thematic analysis methods. Several healthcare system determinants were identified that were complex and cross-sectional. Three major themes emerged from the system determinants: legal framework of aged care; inadequate healthcare support; and professional knowledge and skills of healthcare staff that led the rural senior women to avoid or delay access to hospitals and clinics. The findings revealed that a lack of health focus and professional skills among healthcare staff can be considered as critical. This study recommends that policy and organizational changes are made to improve the women’s access to rural hospitals and clinics in Bangladesh.