Health issues among Afghan women in California.

Afghan refugee women are part of the largest refugee population in the world. In the United States, they deal with loss of family members, property, and status and cultural, familial, religious, role, and generational conflict in making the transition from a traditional patriarchal society to a more egalitarian postindustrial society. Findings from a San Francisco Bay Area Afghan community health assessment conducted from 1992 to 1993 are presented. The assessment included 38 telephone interviews, seven community meetings, and a survey of 196 Afghan families. Six years of ethnographic study with more than 200 Afghans and their health providers provide contextual data. We describe cultural characteristics that influence women's access to health care, women's approach toward preventive care, control of information regarding sexuality, and spouse abuse.

Racial/ethnic differences in the likelihood of cesarean delivery, California.

OBJECTIVES: The purpose of this study was to determine whether women's sociodemographic characteristics are independently associated with cesarean delivery. METHODS: A retrospective review was conducted of hospital discharge data for singleton first births in California in 1991. RESULTS: After insurance and personal, community, medical, and hospital characteristics had been controlled, Blacks were 24% more likely to undergo cesarean delivery than Whites; only among low-birthweight and county hospital births were Blacks not at a significantly elevated risk. Among women who resided in substantially non-English-speaking communities, who delivered high-birthweight babies, or who gave birth at for-profit hospitals, cesarean delivery appeared to be more likely among non-Whites and was over 40% more likely among Blacks than among Whites. CONCLUSIONS: The findings cannot establish causation, but the significant racial/ethnic disparities in delivery mode, despite adjustment for social, economic, medical, and hospital factors, suggest inappropriate influences on clinical decision making that would not be addressed by changes in reimbursement. If practice variations among providers are involved, de facto racial differences in access to optimal care may be indicated. The role of provider and patient attitudes and expectations in the observed racial/ethnic differentials should also be explored.