Showing papers in "Health Sociology Review in 2006"

Introduction: taking stock of medical dominance

Abstract: More than 20 years have elapsed since the book that is the subject of this special edition was published. The aim in this scene-setting introductory paper is to undertake a stock-taking of status of doctors, doctoring and professionalism as we head into the 21st century. It considers the various challenges to medical dominance of health systems including neo-liberalism and economic rationalism, a growth in consumerism and associated litigiousness, the change from a cottage industry basis to mass markets as medicine has been industrialised, the rise of complementary and alternative medicine (CAM) and changing roles of other health care professionals.

Visibilising clinical work: Video ethnography in the contemporary hospital

Abstract: This paper discusses the role of video-based research methods in social research. The paper situates these methods in the context of rising levels of visibility of professionals in government-funded organisations. The paper argues that while visual research may appear to play an ambiguous role in these organisations, it can also enable practitioners to confront the encroaching demands of post-bureaucratic work. To ground its argument, the paper presents an account of a video-ethnographic project currently underway in a local metropolitan hospital. This project focuses on negotiating understandings about existing care practices among a team of multi-disciplinary clinicians. Visual data gathered as part of that project are presented to specify issues which have thus far arisen during the project. Against this empirical background, the paper turns to considering the ambiguous potential of video-based research. The argument developed here is that, besides potentially exacerbating the pressure already ...

Collaborative Health Care Teams in Canada and the USA: Confronting the Structural Embeddedness of Medical Dominance

Abstract: There has been a renewed interest in collaborative models of health care delivered by ‘interdisciplinary teams’ of providers across several health care systems. This growing phenomenon raises a host of issues related to the management of professional boundaries and the contemporary state of medical dominance. In this paper, we undertake a critical analysis of the factors both promoting and impeding collaborative care models of primary and mental health care in Canada and the USA. The data our arguments are based upon include a combination of documentary and interview data from key stakeholders influential in various collaborative care initiatives. Based on these data, we develop a conceptual model of the various levels of influence, focusing in particular on the macro (regulatory/funding) and meso (institutional) factors. Our comparative policy and institutional analysis reveals the similarities and differences in the influences of the broader contexts in Canada and the USA, and by extension the d...

Medical dominance then and now: critical reflections

Abstract: The publication of Evan Willis’ notable book coincided with the appearance of similar Anglo-American accounts. Now, there are retrospectives on medical power. Why then and why now? Professional power was central because health care was the focus of political discussion at the time but is now less important vis-a-vis political struggles over neo-liberalism. Freidson played a key role in bringing medical power into focus. Medicine is also less sociologically prominent now because it is in fact less powerful than it was. There is a convergence between the power of the traditional professions and that of numerous other expert occupations. Despite assumptions to the contrary it is noted that neither the linkages of knowledge/expertise/power nor the existence of putatively self-regulatory organizations is sufficient to ensure professional dominance or control. Closure theory, the pre-eminent approach in the area of the professions, cannot adequately explain these changes in medical power. Rather, both c...

Performing birth in a culture of fear: an embodied crisis of late modernity

Abstract: Drawing on recent multidisciplinary work, this paper considers the emerging sense of a crisis around childbirth in late or post-modern western culture. Not only are many health professionals and birth activists expressing concern about rising rates of medical intervention in birth but physiological birth is increasingly defined as difficult and even unattainable. A decline in cultural and individual confidence in women’s birthing capacity seems paradoxical in view of women’s increased social power and achievement in the modern west, along with their improved health and living conditions. Many feminist theorists are ambivalent about childbirth developments though, seeing natural birth advocates’ critiques of technological birthing as essentialist, moralising and patronising towards women’s choices. The paper argues for a theoretical framework that overcomes the tensions between these positions, one which focuses on the interplay between the physiological processes and the internalisation of cultura...

Key Concepts in Medical Sociology

Abstract: (2006). Key Concepts in Medical Sociology. Health Sociology Review: Vol. 15, No. 2, pp. 233-234.

Social Work and the Third Way: Tough Love as Social Policy

Abstract: and is a fundamental human right. However, despite advances in science, medicine and public health in nearly all countries, a gap exists between the health care services available and health care needs of people. This book provides a critical overview of the social and political context of health and health care systems for beginning health care practitioners. The book is organized into 9 chapters. Chapter 1 consists of an introduction and an overview that provide a critical sociology perspective on health. It addresses the issue of inequality and explains how a range of approaches have been developed to deal with health promotion, primary health care and the New Public Health, and notes the limitations of these approaches. Chapter 2 presents data on the Australian health system to elaborate how social, economic and political factors have fundamental effects on health. Moreover, the author indicates that the steps most likely to create the best health status are reducing the gap between the rich and the poor, and creating employment. Chapter 3 introduces the idea of illness behaviour and the place of the body in society. It emphasizes that both illness behaviour and the body are socially constructed. Chapter 4 summarizes the historical origins of hospitals, and a number of ideological, social and political themes associated with the roles of hospitals in society. Chapter 5 describes the position of doctors in health care systems, outlining several problems associated with the quality of medical services, such as medical dominance and perceptions of patients. Chapter 6 addresses the position of nursing within society and within the health care system, and discusses the issues of gender and medical dominance as well as important sources of occupational power. Chapter 7 describes the nature of technology and examines the problematic issues of the commodification of health care, its costs, its contribution to the medicalisation of life, its dubious relationship to population health and its effect on the work of nurses. Chapter 8 identifies the issues of iatrogensis, the medicalisation of deviance and labeling and social control over the body. Chapter 9 presents the nature and context of health policy, and analyzes the trends in health policy related to privatization and deregulation, and how these trends impact on health care. The book is written more for graduate level students than undergraduates as the concepts tend to be philosophical and abstract. I would suggest a more concrete and practical description, as well as additional examples, would be suitable for undergraduates. Moreover, this book lacks a conclusion to give a clear and integrating standpoint in relation to critical sociology of health care and the health care system. Suggestions for future practice would also have contributed usefully to such a conclusion.

The (im)possibilities of clinical democracy

Abstract: In this article, we argue that homogenising discussions of medical dominance on the meta-level of professions do not fully capture the complexity that characterises current clinical care in multidisciplinary health care teams. We illustrate this through an empirical study of a multidisciplinary team attempting to enact their work in a clinically democratic way. The challenges that arose in putting this into practice highlight the depth and complexity of enculturated medical dominance in Australian hospital practice. Our study shows that effective facilitation of clinician reflexivity has the potential to challenge and change deeply embedded structures and behaviours.

Confining risk: Choice and responsibility in childbirth in a risk society

Abstract: The language of risk in relation to pregnancy practices is available to and invoked by not only women who are contemplating pregnancy, the currently pregnant, and mothers, but also the never to be pregnant. Beyond the dozens of leaflets and posters which warn about all kinds of hazards that women face during their pregnancy and impending birth, there is a multitude of messages within the media where women are told about the inherent faultiness of their bodies. These women are told about invisible killers lurking in their ignorance. Yet, blame is allocated to those who fail to inform themselves about the risks that they face. Risk, according to the works of Beck and Giddens, has become a force of social change. It can be seen to actively shape our concept of health, desire for perfection, and our relationship to technology and responsibility. It is these themes which are noticeably absent from previous research in the area of sociology of childbirth and can capture more adequately the ideological s...

Qualitative Research Methods (2nd edn)

Abstract: T extbook writers can find themselves in an invidious position; in attempting to offer a kind of introduction to everything, they can end by satisfying no-one. Happily, Liamputtong’s and Ezzy’s efforts avoid this potential impasse. The book is written primarily with novice researchers in mind and has found the right pitch for this audience. Qualitative Research Methods gives would-be practitioners enough practical instruction to allow them to undertake, analyse and report research. Yet it also provides a sufficient introduction to the epistemological and theoretical bases of qualitative research so readers will know what is distinctive and valuable about this research orientation; they will understand why they are doing what they are doing. Not only do Liamputtong and Ezzy provide a useable foundation for the how and why of research, they consistently pay attention to its ethical and political dimensions. One of the book’s most admirable features is the constant elucidation of the ways in which researchers owe an ethical ‘duty of care’ to the people they research. This ethical commitment is, however, complemented by the authors’ emphasis on the richness and enjoyment of doing research. The book begins with an overview of the main theoretical underpinnings of qualitative research. The discussion is lucid and accompanied by examples illustrating the application and value of qualitative research on health. The only exception is postmodernism. The discussion is not always clear and concludes with an example not drawn from health. This could be taken to suggest this notoriously difficult domain has little to offer the field, a conclusion the authors would not support. Liamputtong and Ezzy largely eschew the issues of reliability and validity, arguing they do not adequately reflect the close relationship between the researcher and his or her ‘field’. ‘Rigour’, they suggest, is a more appropriate criterion because it doesn’t assume separation between researcher and researched, while it simultaneously upholds adherence to correct procedures, sound methodology and well-thought out sampling strategies. The practical advice on techniques for conducting rigorous research and on deciding on appropriate sampling strategies is clear and helpful. However, the authors do not subscribe to the ‘technicist’ premise that appropriate techniques will lead, ipso facto, to rigorous research. Rigorous research must also pay due attention, they say, to the ethical and political frameworks of the lives of people being studied, the audience to which the research report will be directed and the researchers themselves. The book has chapters on the staples of qualitative research: in-depth interviews, focus groups, unobtrusive methods, ethnography and participatory action research. It also canvasses some less widely used methods, notably memory work, as well as narrative analysis and life history. In each of the chapters, there is thorough discussion of the practicalities of conducting each of these forms of research. For instance, the chapter on in-depth interviews contains good advice on selecting an appropriate interviewer, how to ask questions and how to interact with interviewees. Useful instruction is offered on how to construct a theme list and how to word questions. There is even a discussion of practical issues associated with tape-recording interviews. This high-quality ‘how-to’ advice is, however, never separated from the theoretical premises shaping the conduct of qualitative research. The QUALITATIVE RESEARCH METHODS (2 ND EDN)

Risky business: contested knowledge over safe birthing services for Aboriginal women

Abstract: Maternity services in Australia are becoming rationalised with contemporary, authoritative knowledge driving the provision of services under the premise that birth in larger regional and tertiary settings is the safest option. There is increasing evidence that families who live in rural and remote areas are not satisfied with having to travel long distances and be absent from their homes for weeks at a time for childbirth. This is particularly problematic for remote dwelling Aboriginal women, with evidence suggesting current maternity services and relocation for birth are culturally, socially and emotionally unsatisfactory and unsafe. The Indigenous knowledge around birthing that still exists in remote communities today, is not being acknowledged or incorporated into health service provision with the current ‘risk equation’ excluding the social, emotional and cultural risks that have been identified by the women themselves. Unlike the Inuit situation in Canada, which could provide leadership and a...

Medical dominance in a changing world: the UK case

Abstract: This paper examines the governance of the medical profession in the U.K. As in many other countries, external and internal pressures have brought a shift in relations between the state and medicine. The context in which doctors practise has undergone radical change. In common with many countries, the U.K. has turned to competitive markets, and state-sponsored regulatory measures to boost performance. As a consequence, state domination of the health policy agenda has increased replacing a corporatist politics and doctors’ individual clinical autonomy has been reduced. Moreover, the existing system of self-governance is in question. It is argued that, nevertheless, there is evidence of different forms of accommodation. The medical profession continues to control a valued knowledge base, retains its social standing and is able to reap economic rewards. A more plural form of medical leadership may emerge better suited to assuring quality in patient care.

The plasticity of professional boundaries: a case study of collaborative care in maternity services

Abstract: A case study of twenty nine midwives and nine obstetricians working in a regional, public sector Australian hospital demonstrates the plasticity of professional boundaries within a post-welfare state. Driven by new discourses of globalisation, marketisation, managerialism and consumerism, professional boundaries in health care are being blurred, reordered and reconstituted. Government policies that call for a new interdisciplinarity between maternity professionals may be seen as responses to the above pressures. However, there remain considerable barriers to achieving collaborative models including conflicting interpretations of risk, of women's bodies and of childbirth; the veto power of decision making retained by obstetricians; questions of professional accountability; and diversity over appropriate styles of micro-interaction. Collaboration demands a new egalitarianism to eclipse the old vertical system of obstetric dominance and this means that midwives need to create a distinctive professional specialty, or new object of knowledge. Midwives' skill in 'emotion management' could provide this speciality in addition to their rational-technical knowledge and thus elevate midwifery to an equivalent professional status with obstetrics but as yet neither obstetrics nor midwifery have realised its professionalising potential. (author abstract)

Emerging from the shadow of medicine: Allied health as a ‘profession community’ subculture.

Abstract: The authority relationship between medicine and the allied health professions has been conceptualised as one of subordination. The research that underpinned the subordination thesis was largely based on pre-1980 studies of interprofessional interaction and struggle. This article presents data from a comparative longitudinal case study analysis of Australian allied health professions employed in three distinct organisational models in urban acute care general hospitals during the 1990s. The article discusses the emergence of a distinct allied health ‘profession community’ subculture associated with the emergence of new organisational structures in Australia. A model to account for subculture development under different organisational conditions is proposed. A key concern is the way in which a ‘profession community’ is created, structured and maintained in the complex organisational settings of the acutecare hospital. The findings challenge the notion that subordination is an inevitable consequence ...

A neoliberal quickstep: contradictions in Australian maternity policy

Abstract: Current Australian maternity policy, while fragmented and uneven, is moving in new directions. Alliances between consumers, sympathetic health professionals and bureaucrats have placed the objectives of improving women's choices, increasing their control over decision making and providing continuity of care firmly on the agenda. The state arena is a central space for articulating such demands and policy support has been critical to implementing changes in service delivery. Along with steps forward, though, steps sideways and backwards indicate the contingent character of the late modern state as it responds to social changes at the same time as advancing particular political goals. This paper argues that impediments towards making services more 'women-friendly' lie not only in the historical location of childbirth management in the medically-driven acute sector but in contemporary neoliberal political and economic pressures that both promote and yet constrain change. Research in selected Victorian hospitals suggests that desirable goals are compromised by working realities in contemporary public hospitals. Political mobilisation in the community and around the state remain necessary to encourage further change in childbirth management, but continuing critical assessment of the structural context and human challenges of maternity reform is also essential. (author abstract)

Beyond Decline: Consumerism, Managerialism and the Need for a New Medical Professionalism

Abstract: In the health care occupational sector powerful social changes have been involved in challenging two of its core features: the centrality of professionalism and medical dominance. This article proposes that factors internal to the health care system, such as health care reforms, can be explained by factors associated with large scale social developments such as neoliberalism and postmodernity. The most significant of these have been consumerism and managerialism. The impact of both is assessed by relying on theoretical insights and empirical evidence from recent studies in several countries. Finally, the need for a new medical professionalism will be considered as an adaptive response to the challenges coming from social change. (author abstract)

Suicide prevention and social capital: A Samoan perspective

Abstract: This paper draws on the example of Samoa to argue that Western models of health promotion and suicide prevention, especially those which draw on conventional understandings of social capital, are not appropriate for non-Western communities, for they are generally not sensitive to cultural beliefs, values and rituals. As such, the value of homogenously promoting social capital as an adjunct to suicide prevention strategies needs to be questioned. Suicide prevention and resilience strategies must be culturally relevant and developed 'by the people for the people', to address the nature of the suicide problem in Samoa. (author abstract)

‘The best friend Medicare ever had’? Policy narratives and changes in Coalition health policy

Abstract: As Leader of the Opposition in 1987, the current Prime Minister of Australia John Howard, stated unequivocally that he would dismantle Medicare at his first opportunity. By April 2000, the Health Minister in a Howard-led government proudly proclaimed to the Australian Parliament the Coalition was ‘the best friend Medicare ever had’. Such a shift in ideology and policy position appears remarkable, overturning more than 60 years of conservative opposition to a universal, publicly funded, health care system. This paper traces the shift from the lead-up to the 1996 election until 2000, interrogating official policy texts to map how the Coalition reconfigured its own policy narrative about the Australian health care system. This paper argues that in order to understand contemporary reforms to the health care system, we must consider the way in which those reforms provide solutions to discursively, rather than objectively constructed, policy problems.

Reflections on the centrality of power in medical sociology: An empirical test and theoretical elaboration

Abstract: This paper explores the contemporary relevance of sociological theorisations centred on medical power, including the medical dominance and deprofessionalisation theses. To achieve this it examines two issues that have been tentatively linked to the relative decline of the power and autonomy of biomedicine - complementary and alternative medicine (CAM) and the Internet-informed patient. Drawing on these two different but interconnected social phenomena, this paper reflects on the potential limitations of power-based theorisations of the medical profession and its relationship to patients and other non-biomedically situated professional groups. It is argued that power-based conceptual schemas may not adequately reflect the non-linear and complex strategic adaptations that are occurring among professional groups.

Finding a 'safe' place on the risk continuum: a case study of pregnancy and birthing in Lao PDR

Abstract: This paper addresses two questions. Firstly: are the risk regimes faced, and perceived, by pregnant women in rural Lao PDR substantially different from those experienced by pregnant women in western societies? Secondly, if the Lao experiences and perceptions are different, can improvements in maternal health in Lao PDR be achieved without Laotians inheriting the risk regimes of late modernity experienced by many women in western societies? Secondary analysis is undertaken of data collected in 2005 for the evaluation of a pilot maternity waiting home in Bolikhan, Lao PDR. The results suggest significantly different risk perceptions and experiences between Lao and western communities, based on contrasting views of embodiment, identity construction and cosmologies. In the Lao rural communities studied, there is little evidence yet of 'risk society' despite the introduction of western technologies and practices to improve maternal mortality and morbidity. It is argued that 'risk society' can be avoided. (author abstract)

Disciplining the medical profession? Implications of patient choice for medical dominance

Abstract: This paper deals with the dynamics of medical dominance and patient choice, primarily within the Britain, with reference to a range of other European countries too (including Germany, France and Greece) for comparative purposes. It will draw upon two concepts in particular: ‘responsibilisation’ and ‘protoprofessionalism’, the first undermining medical dominance the latter reinforcing it. The ongoing influence of a neo-liberal and managerialist agenda has eroded the certainties of the welfare state and the assumptions underpinning the dominant role of the medical profession, which has been subjected to increasing external state regulation and control (Dent 2003a). These reforms, which are associated with New Public Management, have been aimed at bringing the cost and quality of health care more effectively under the control of the state. This has involved redefining the compact or contract between the medical profession, public and the state. In this project greater emphasis is being formally given...

Civic engagement, gender and selfrated health in poor communities: Evidence from Jordan’s refugee camps

Abstract: This paper examines the association between civic engagement and self-rated health among a sample of adults living in refugee camps in Jordan. The analysis is based on a cross-sectional sample survey of all households residing in Palestinian refugee camps in Jordan, and interviewed in the spring and summer of 1999. The outcome variable is self-rated health. Associations between civic engagement and self-rated health are assessed using χ2 tests and logistic regression models. Findings from a logistic regression model show that civic engagement, as measured primarily by membership in clubs and other civic groups, has a significant association with self-rated health net of the effects of demographic, human capital and health risk factors. The final model shows that the effects of control variables are in the anticipated direction, with age, marital status, health risk, education and poverty statistically significant. However, the findings pertaining to civic engagement hold for men but not women. We ...

AIDS is a tear in the social fabric of Papua New Guinea: HIV and its impact, 2005-2025

Abstract: Using epidemiological data, this paper discusses the social impact of HIV in Papua New Guinea over the next two decades. It shows that the country will be facing an adult prevalence rate of nearly 11% by 2025, and that over 300,000 adults will die of AIDS related illness. HIV will impact particularly at the family and community levels, and women may bear a disproportionate burden of that impact. Immense pressure will be placed on families to cope with illness and death - both in terms of caring work and coping financially. This, in turn, will place pressure on village systems. These systems will be undermined by the loss of social capital that comes with widespread illness and the negative impact of the epidemic on the agriculture, education and health sectors. The major governance and security impacts will also be felt at village level - how to sustain viable local governance systems in the face of HIV. (author abstract)

Inescapable burden of choice? The impact of a culture of prenatal screening on women's experiences of pregnancy

Abstract: Drawing on research in progress, this paper examines the costs for pregnant women of trends towards routine screening in pregnancy. In particular, the notion that the array of choices contingent with prenatal screening may constitute an unwelcome ethical burden for pregnant women will be considered, as well as the extent to which women are able to give free and informed consent for screening. The development of new technologies in the area of reproductive health, including new tests to detect fetal abnormality during pregnancy, has triggered considerable ethical debate about the possible benefits and dangers of such screening. While such debate has tended to focus on the value of the individual technologies themselves, the ethics of how the technologies are implemented, of how the encounter between lay people and biotechnology is best to be conducted, have received comparatively little attention. This is particularly true in the case of prenatal ultrasound, a technology which has increasingly become part of routine prenatal care for the majority of pregnant women. This discussion will consider whether such screening may contribute to an ideological climate in which it may no longer be possible to experience pregnancy as a 'normal' embodied state. As an area of concern identified by participants in this research, the issue of informed consent for prenatal screening will be a key focus, including a brief case study highlighting one participant's experience. (author abstract)

Struggling to care: nurses' perceptions of caring for obese patients in an Australian bariatric ward

Abstract: With the virtual epidemic of obesity worldwide, the number of obese patients receiving acute care and other services is expected to increase sharply. This study explores nurses' perceptions and experiences of caring for obese patients in the context of an acute general surgical ward. This ward, within a major metropolitan private hospital in Australia, specialises in bariatric surgery. Ten semi- structured interviews were conducted and thematic analysis employed to analyse the transcripts. From this analysis, several themes emerged: competing perceptions of obesity, ambivalence to weight-loss-surgery (WLS), and obese patient responsibility. Three particular discourses were identified: discourses of medicine, nursing and neoliberalism. Each offers a different mode of caring for the body, and this study reveals how nurses, in caring for obese patients, function within these competing and often contradictory discourses. (author abstract)

Health lifestyle theory in an Asian context

Abstract: Health in Western society has become viewed as an achievement: something people are supposed to work at to enhance their quality of life or risk chronic illness and premature death. This is evident in the research documenting the close connection between chronic illnesses and health lifestyles. Almost all of this research is based on Western populations and much of it treats health behaviour and lifestyles as matters of individual choice or agency. While agency is important, structural conditions can 'act back' on individuals to configure their lifestyles in particular ways. The focus of this paper is to apply a new theoretical model to an Asian context. This model features a convergence between agency and structure and is supported by studies in Western countries. If the model is to have global relevance, it needs to be representative of health lifestyles in Asia as well. Unfortunately, there are very few relevant studies available in Asia. Consequently, the intent of this paper is to not only present an initial theoretical framework for such studies, but also to call attention to the need for research in Asia on this topic. Everyone has a health lifestyle and Asians are no exception, as their lifestyles undoubtedly play a decisive role in determining health in the Pacific region. (author abstract)

Geography and credentialism: assessment and accreditation of overseas-trained doctors

Abstract: The traditional stronghold of medical dominance, and thus the construction of the medical labour market, has been challenged by a number of contemporary trends While the social, economic and cultural trends driving this shift have been explored, the significance of geography as a key determinant in the construction of the medical labour market has yet to be addressed in detail This paper examines how geographical arrangements have shaped the credentialist requirements for overseas-trained doctors and thus the nature and shape of the stratified medical labour market The research traces the assessment and accreditation of overseas-trained general practitioners in NSW, focusing specifically on the registration process defining the last decade Throughout this period the process has been significantly transformed: in the 1990s there was only one pathway to assessment, registration and subsequent entry to the labour market, there are now multiple pathways An examination of this historical change illustrates how credentialist requirements are negotiated and renegotiated by the various stakeholders in light of shifting spatial demands (author abstract)

Is it consumer or community participation? Examining the links between 'community' and 'participation'

Abstract: In writing about community participation in health, the term 'community' is used loosely and ambiguously. On analysis, it appears that there is a conceptual shift in health policy to thinking about involvement of consumers in health planning and programs rather than communities. This shift is consistent with a managerialist approach to planning health service delivery. Participative processes are perceived as being initiated and directed by health administrators. Participants in the processes are to be 'representative' of health service consumers, rather than whole communities. However, in many Australian rural communities, there are enduring traditions of community participation in providing governance for local hospitals, developing infrastructure for general practice services, and providing in-kind support. Participation in health services is embedded in the way the community functions. Acknowledging and understanding the ways in which 'community participation' and 'consumer participation' are different may result in more effective participative processes. (author abstract)

Re-claiming or re-shaping fatherhood

Abstract: There is an emerging trend to recognise the importance of fathers in health service provision. This is consistent with feminist objectives to re-shape fatherhood to enhance gender equity in the home and in the workplace. How best to include fathers in services, overwhelmingly utilised by mothers, is now a topic of considerable interest. However, the desire to re-shape fatherhood in ways conducive to gender equity is easily co-opted by conservative political agendas which do not seek to re-shape fatherhood but re-claim the rights of fathers by re-instating paternal authority within the family. This cooption is facilitated by new fatherhood discourses utilised by many service providers which blame mothers for the lack of fathers’ involvement in early infant care. The paper argues that mother-blaming is aggravated by service providers who fail to understand the nature and extent of maternal anxiety and by unrealistic images of the new father.