Health Care Restructuring, Agricultural Reform, and Rural Women's Experiences of Paid and Unpaid Work

With the majority of Canadian women in the labour force, paid work is a fundamental feature of women's lives. Most employed women also perform unpaid work in the form of caring for family members and performing household tasks. In rural communities, many women also perform unpaid farm work. This study examined women's experiences of paid and unpaid work in the context of restructuring within two key economic sectors in rural Alberta: agriculture and health care.

Global economic changes, international competition, government debt, cutbacks, downsizing and outsourcing are features of restructuring in both the public and private sectors. Whereas farming and rural communities have been profoundly changed by specialization, mechanization, grain prices, biotechnology and changes in marketing and transport,1 they have also experienced the effects of health care restructuring, particularly regionalization and the resultant changes in the organization and management of health care services.2

This descriptive study explored women's accounts of their lives after restructuring in the health care and agricultural sectors. The researchers conducted semi-structured interviews (n=34) with farm women, public health nurses, and home care nurses in four southern, central and northern Alberta health regions. Eighteen women worked in both farming and nursing or other health-related work such as physiotherapy or continuing care. The other 16 women worked in either farming or nursing. Seven focus groups with 56 women were conducted in a second stage of the study with women in similar occupational groupings. Thematic analysis of all the data led to the identification of three themes in the accounts of these rural women: being strong, maintaining values, and struggling for control and balance.

"Being strong" captured women's experiences of living with uncertainty, working endlessly, dealing with loss and drawing on personal resources. "Maintaining values" referred to women's sense of being a "good" woman, valuing rural life and community, making a contribution and wanting recognition for that contribution. Finally, "struggling for control and balance" described women's efforts to maintain their health in the face of multiple demands. Few women described themselves as achieving such balance, most felt that they had to "just cope and go on."

It was clear in this study that both farming and health care were importance contributors to the local economy in these regions. Restructuring, in both agriculture and health care over the last ten years, was reported by the women as having a range of impacts that affected their decision-making abilities, the organization of paid and unpaid work and their feelings about their quality of life. The following sections describe some of women's experiences with restructuring.

The Impact of Health Care Restructuring

In 1994, Alberta's health care system underwent a process of regionalization that placed health decision-making in seventeen health regions. This radically altered the way health care services were managed. Restructuring brought closure of many rural hospitals, downsizing, reduced accessibility to health care services, and increased care burdens for family members. Many health care professionals left the profession or the province in search of employment in other areas, leaving behind overworked and stressed colleagues to deliver services.3

As a result of the changes in the structuring of health care, the nurses in this study felt they were challenged to provide the desired care with reduced and altered resources. Both public health nurses and home care nurses in this study were concerned about having less time and staff to deliver quality care. Budget cuts meant doing more with less. They were also concerned about the lack of focus on health promotion and prevention. "We've regionalized but they haven't really put money into the things that they talk about, like health promotion and prevention." The nurses lamented the loss of "holistic practice," the constant change and the "add-ons."

Moreover, the nurses in this study described rural life for nurses. One public health nurse commented that nurses in rural communities "go into their evenings, they miss their breaks, they miss their lunches because their clients are their priority... they live in the community, these are the people they live with, these are their neighbours....it creates a whole different feeling about your job." In rural life, personal and professional boundaries are blurred. In rural communities, residents do not hesitate to call a nurse at home in the evening and on weekends nor do they hesitate to request advice when a nurse in the community is attending community functions or shopping for her family. As a rural public health nurse or home care nurse, "You're always on." Although the demands on some of the nurses were great, they valued their connection to their communities, and the trust that community members placed in them.

However, the nurses in this study commented on how taking care of their own health was complicated by reduced accessibility to health services. This occurred when the retention of physicians became an issue, when they had to seek attention from a colleague-physician, or when they needed to seek help for themselves with the risk that others in the community would know. As well, the challenges of everyday work affected their health. One public health nurse commented, "Sometimes the stresses every day change the wellness model that I have in my head."

The Impact of Agricultural Restructuring

Farming and rural communities in Alberta and elsewhere in Canada have been profoundly affected by specialization, biotechnology and major change in marketing and transportation. Global economic changes, international competition, government debt, cutbacks, downsizing and outsourcing have all played a role in the restructuring of public and private sectors. These external forces have placed decision-making power beyond the boundaries of geographic and cultural communities.4

Women in the study described this uncertainty in their lives. "The only thing we can be sure of is that nothing will stay the same" and "sometimes change seems to happen for no good reason." The women described financial, meteorological and organizational uncertainty. For some, financial uncertainty referred to reduced income on farms. Women described how costs had increased, product prices had fallen, and government regulations had increased taxes and charges for freight. When grain elevators were closed, it meant having to drive further to deliver grain, which increased fuel costs. "Without my wages, we would be on welfare, I know that," said one woman. Another study participant stated, "Self-confidence and worth get chipped away seeing friends having to sell farms and wondering, when is it my turn?"

The women described many losses in their lives as a result of changes in their communities. Losses included losing all or part of a farm, contact with nurse colleagues, neighbours or community, and access to experts and services. Other reported losses were reductions in income, and the disbandment of women's organizations. "The day of the auction sale, I hid in the house...I didn't want to be outside seeing all the stuff we had garnered...be sold and basically given away....I didn't realize how much of my identity was tied up in farming."

Some women had very little information about the reasons for restructuring and about the process of decision-making. Participants thought that more information would increase their input and ability to cope with change, yet the daily demands of managing their paid and unpaid work left them with little time to seek information. As well, many women felt distanced from policy makers and government.

Double Impact?

Women in this study experienced restructuring in different ways, some positive and some negative. One of the unique features of this study was the inclusion of both the providers and recipients of health care. As a result, the research was able to capture more comprehensive reports of the impact of restructuring on work and health in rural life. In this study, it became apparent that the boundaries between home, community, and work blurred considerably for rural women. For example, work income was used to pay farm bills or buy essentials for the home; while attending community events, nurses were expected to provide care or would be approached for advice about health problems.

This study captured the voices of rural Alberta women and their experiences of sectoral changes related to farming and health care. However, the double impact of restructuring on rural women needs to be further explored to better understand how restructuring directly affects women's work and health and how it indirectly affects women through their families and communities. This study also documents changing networks in rural communities and highlights the need for the development of mechanisms to allow for meaningful dialogue between policy makers and rural women.

A copy of the full report, Reflections of Rural Alberta Women: Work, Health, and Restructuring, can be downloaded at: www.yorku.ca/nnewh/netPubs_reports.htm, or contact:

National Network on Environments and Women's Health

Centre for Health Studies

York University

4700 Keele Street

Suite 214 York Lanes

Toronto, ON Canada M3J 1P3

www.yorku.ca/nnewh

Tel: (416) 736-5941

Fax: (416) 736-5986

nnewh@yorku.ca

NOTES

1. Hay DA. Rural Canada in Transition: Trends and Developments. In Hay DA and Basran GS (Eds.). Rural Sociology in Canada, Toronto: Oxford University Press, 1992;16-35. Keating NC. The Future of the Family Farm in Agricultural Communities. In Martin J (Ed.). Alternative Futures for Prairie Agricultural Communities. Edmonton: University of Alberta Printing Services, 1991;53-83.

2. Landesman A. Restructuring hospitals, restructuring nursing. The Canadian Nurse 1996;92:27-30. Skillen, DL Nurses' Work Hazards in Public Health Units. In Messing K, Neis B & Dumais L (Eds.). Invisible: Issues in Women's Occupational Health. Charlottetown: Gynergy Press, 1995;150-73.

3. Hay, 1992. Keating, 1991.

4. Landesman, 1996. Skillen, 1995.

D. Lynn Skillen, Faculty of Nursing, University of Alberta, Barbara Heather, Grant MacEwan College and Jennifer Young, Red Deer College

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