Gender-based discrimination and son preference in Punjabi-Canadian families: a community-based participatory qualitative research study.

OBJECTIVES: To conduct a qualitative study, guided by the principles of community-based participatory research, with the following objectives: (1) to provide a conceptual framework describing the drivers of son preference; (2) to understand experiences of son preference among Punjabi-Canadians and (3) with this understanding, identify and co-design an appropriate educational tool. DESIGN, SETTING, PARTICIPANTS, METHODS: Qualitative study consisting of four bilingual (Punjabi and English) focus group discussions with 11 mothers, 4 fathers and 17 grandmothers in Toronto and Brampton, Canada. Participants were queried about experiences and perspectives related to reproductive decision-making, gender equity and son preference, and for appropriate approaches to reducing inequities. Transcripts were simultaneously translated and written in English and thematic analysis was conducted. An infoposter was identified as a feasible educational tool and was co-designed by researchers and community partners. RESULTS: Participants identified patrilocality (ie, married sons reside with parents, married daughters with in-laws) and patrilineality (ie, sons inherit assets, daughters' husband receives a dowry) as structural precursors to proximal drivers (ie, old-age security) of son preference. Mothers' and grandmothers' value to their families depended strongly on having a son but did not guarantee security. Pressures (ie, internalised discrimination, reproductive coercion) to conceive a son were common after the birth of at least one daughter in the absence of sons. Participants did not know anyone who had a sex selective abortion in Canada; however, traditional sex selection methods (eg, herbal medicines) were mentioned. Our co-designed infoposter entitled 'Truths About Son Preference' addressed three misconceptions identified in discussions. CONCLUSION: This study may be useful to health and social care providers in providing structurally competent and culturally humble counselling and care, particularly after the birth of daughters in the absence of sons. Community engagement is necessary for future intervention development.

Reproductive and Pregnancy Experiences of Diverse Sexual Minority Women: A Descriptive Exploratory Study.

Objectives This study sought to explore how sexual minority women (SMW) and heterosexual women compare in terms of reproductive history, with a particular focus on examining within-group differences among SMW. Methods Women were predominantly recruited through consecutive sampling during presentation for prenatal care in Toronto Canada, and Massachusetts, USA. In total, 96 partnered pregnant women (62 SMW, 34 heterosexual) completed an internet survey during 2013-2015. Results We found few significant differences in reproductive history outcomes when comparing SMW and heterosexual groups. However, when we compared male-partnered SMW to female-partnered SMW, we found potentially important differences in rates of miscarriage and pregnancy complications, indicating that partner gender may be an important contributor to differences in reproductive history among SMW. Conclusions for Practice These findings highlight the need to recognize the unique health risks with which male-partnered SMW may present. Considering that this group is often invisible in clinical practice, the findings from this exploratory study have important implications for providers who treat women during the transition to parenthood. Future research should further examine the differences in social and health access within larger samples of SMW groups, as well as seek to understand the complex relationships between sexual identity and perinatal health for this understudied group of women.

Sex ratios at birth among second-generation mothers of South Asian ethnicity in Ontario, Canada: a retrospective population-based cohort study.

BACKGROUND: Son-biased sex ratios at birth (M:F), an extreme manifestation of son preference, are predominately found in East and South Asia. Studies have examined sex ratios among first-generation migrants from these regions, but few have examined second-generation descendants. Our objective was to determine whether son-biased sex ratios persist among second-generation mothers with South Asian ethnicity in Ontario, Canada. METHODOLOGY: A surname algorithm identified a population-based cohort of mothers with South Asian ethnicity who gave birth in Ontario between 1993 and 2014 (n=59 659). Linking to official immigration data identified births to first-generation mothers (ie, immigrants). Births not to immigrants were designated as being to second-generation mothers (ie, born in Canada) (n=10 273). Sex ratios and 95% CI were stratified by the sex of previous live births and by whether it was preceded by ≥1 abortion for both first-generation and second-generation mothers. RESULTS: Among mothers with two previous daughters and at least one prior abortion since the second birth, both second-generation mothers and first-generation mothers had elevated sex ratios at the third birth (2.80 (95% CI 1.36 to 5.76) and 2.46 (95% CI 1.93 to 3.12), respectively). However, among mothers with no prior abortion, second-generation mothers had a normal sex ratio, while first-generation mothers gave birth to 142 boys for every 100 girls (95% CI 125 to 162 boys for every 100 girls). CONCLUSION: Son preference persists among second-generation mothers of South Asian ethnicity. Culturally sensitive and community-driven gender equity interventions are needed.

Interventions to reduce adverse health outcomes resulting from manifestations of gender bias amongst immigrant populations: a scoping review.

BACKGROUND: Immigrants to Western countries increasingly originate from countries with pervasive gender inequalities, where women experience disproportionately high rates of threats to their well-being. Health and social services in countries of settlement encounter several adverse outcomes linked to gender bias among immigrant groups. Little is known about interventions implemented to address manifestations of gender bias among immigrant populations. METHODS: A scoping review was undertaken to describe the literature on existing interventions and determine knowledge gaps. Nine academic and grey literature databases were searched for literature, with four reviewers screening the results. RESULTS: Of the 29 included reports, most targeted domestic violence amongst the Latino population in the United States, with few interventions focusing on other outcomes, populations, and settings. The majority reported achieving their objective, although 13 interventions were not evaluated. CONCLUSIONS: Future research and practice to address gender bias among immigrants may benefit from expanding on ethnic diversity, designing and reporting evaluations, addressing the context of gender inequities, tailoring to local community needs, and engaging community-based groups.

Characterizing non-monosexual women at risk for poor mental health outcomes: A mixed methods study.

OBJECTIVES: Non-monosexual women - those who report attraction to or sexual relationships with individuals of more than one gender - have elevated risk for poor mental health outcomes. We aimed to examine which elements of non-monosexual experience are associated with this elevated risk. METHODS: We conducted a sequential exploratory mixed methods analysis of qualitative interview and survey data from 39 non-monosexual women recruited consecutively through prenatal care providers. Qualitative analyses identified distinguishing features, and quantitative analyses tested associations between these features and mental health symptoms. RESULTS: Nine qualitative themes were identified to describe distinguishing features of non-monosexual women. Of these, current and past five years partner gender, lack of LGBTQ community connection, and low centrality of sexual minority identity were associated with anxiety symptoms. Latent class analysis revealed significantly higher levels of anxiety symptoms among non-monosexual women partnered with men relative to those partnered with women. CONCLUSION: Sexual minority women who partner with men may be particularly at risk for poor mental health. Considering this group's invisibility in public health research and practice, interventions are needed to address this disparity.