While managerial initiatives to cut costs through increased labour flexibility are widespread, we have limited knowledge of the micro-politics of gender and contemporary restructuring at the local level: of the processes and dynamics through which flexibility and other initiatives reconstitute or transform gendered patterns of work and advantage in specific workplaces. This case study, based upon extensive interviewing, observation, and examination of documentary materials, examines the gender implications of several different types of restructuring initiatives in three types of manual work at two hospitals in an NHS Trust. On the whole, it finds that restructuring created more continuity than change in gendered patterns of work and advantage in the two sites. The case study suggests, first, that employment restructuring incorporates elements of structural, institutional and interactive gendering; managers use women's subordination in the workplace and labour markets to achieve their objectives, and male workers actively resist loss of their advantages. Second, it suggests that competitive tendering exercises have a disproportionately negative impact upon women workers, while functional flexibility initiatives are somewhat more positive. Third, the case study suggests union resistance to restructuring is limited and particularly circumscribed in relation to restructuring of women's jobs.
Introduction
This study aimed to identify how perinatal health workers, especially midwives, explained US Black maternal mortality and morbidity and what ameliorative measures they suggested across categories of primary social determinants, health care access, and provider practices.
Methods
Using a mixed closed‐ended and open‐ended researcher‐designed exploratory survey, 227 perinatal health workers responded to a series of questions probing views of causation and strategies for improvement. The closed‐ended responses were summarized. Open‐ended responses were analyzed using basic categorical and thematic coding.
Results
Perinatal health workers’ responses prominently identified racism as a cause of Black maternal morbidity and mortality, and their recommendations ranged across levels of social determination of health.
Discussion
Results suggest that the views of perinatal health workers, the majority of whom were midwives, are complex and correspond to the problems and solutions identified in the research literature. Midwives and other perinatal health workers are well positioned to help center health equity in perinatal care, through both clinical practice and policy advocacy.
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