Beyond “toxic bodies”: Multiplied rationalities of women's reproductive health in a high-risk environmental area (Taranto,Italy)

This study investigates women's reproductive health concerns in Taranto, a steel town and a “high-risk environmental area” in Italy. It draws on participatory ethnographic research (body mapping, interviews and fieldnotes) and analyses political and social aspects of women's reproductive health in relation to pollution. I argue that in highly polluted environments, both political rationalities and women's health concerns over their bodies are multiplied, extending beyond a focus on their bodies as shaped by toxic exposure. Women make sense of knowledge about their reproductive health and questions of responsibility in relation not only to societal norms, but also through reference to the wider polluted environment and the political-economic structures they inhabit. By focusing on women's own experiences, the study contributes to our understanding of women's agency over their environment-health relations and seeks to complicate women's role as environmental subjects beyond “toxic bodies”.     

Having A “Safe Delivery”: Conflicting Views from Tibet

In the Tibetan Autonomous Region (TAR) of the People's Republic of China (PRC) maternal mortality ratios remain among the highest in the world. Although traditional Tibetan medical theory, practice, and pharmacology include information on maternal and child health care, Tibet is one of the few societies in the world that does not have traditional birth attendants or midwives. Using ethnographic methods, we gathered data from individual interviews with rural Tibetan women (N = 38) about their beliefs and behaviors surrounding pregnancy and childbirth. Additional data were gathered through interviews with prefecture, county, and township health care providers. These data were used to develop a culturally appropriate village birth attendant training program in rural Tibet. We describe Tibetan women's perspectives of “having a safe delivery” in relation to concepts about “safe delivery” according to evidence-based medicine in the West. Our work also provides an example of the benefits and challenges that arise when ethnographic research methods are used to design and implement health care interventions.     

On sitting and doing: Ethnography as action in global health

Contemporary discussions within the arenas of medical anthropology and global health are often restricted by the driving imperatives to “do something” about a particular health problem. Drawing on ethnographic fieldwork conducted in Nepal in 1997, which sought to follow the translation of AIDS prevention policies into local awareness, this paper addresses the need to revitalize theories of ethnography for an understanding of global health goals. The Nepal example underscores how the path toward decisions is never entirely clear, nor is it always obvious who benefits or loses from different approaches, even as public health discourse seeks to set a strict agenda around what the problem is and what should be done about it. Ethnography shows that definitions of what matters as well as understandings of why certain things matter are formulated from specific social locations. The paper therefore advocates for a practice of patient ethnographic “sitting” as a means to understanding, as a form of critical reflexivity, and as a diagnostic of the politics of relevance.     

Was Mackenbach right? Towards a practical political science of redistribution and health inequalities

In 2010, Mackenbach reflected on England's lack of success in reducing health inequalities between 1997 and 2010, asserting that “it is difficult to imagine a longer window of opportunity for tackling health inequalities”; asking “[i]f this did not work, what will?”; and concluding that reducing health inequalities was not politically feasible at least in that jurisdiction. Exploring the empirics of that observation offers a window into the politics of reducing health inequalities. For purposes of future comparative research, I outline three (not mutually exclusive) perspectives on political feasibility, identify their implications for a political science of health inequalities, and explore what they mean for advocacy in support of reducing those inequalities.     

Male and female genital cutting among Southern Thailand's Muslims: rituals,biomedical practice and local discourses

This paper explores the manifestation of HIV‐related stigma in seven‐ and eight‐year‐old white South African children's responses to HIV and AIDS. Drawing from elements of ethnographic and interview data, it shows how young children's responses to HIV and AIDS are inscribed within popular accounts of contagion and articulate gendered, sexual, raced and classed discourses in South Africa. Rejecting static accounts of stigma, the paper shows how children resist and confirm power inequalities involving intense self‐regulation as well as inscribing within discourses of care and concern for others infected with HIV and AIDS. The findings have implications for scaling up educational efforts to address awareness of HIV and AIDS and stigma, but also to build on positive insights that young children demonstrate with regard to the disease.     

The Language of Substance Use and Recovery: Novel Use of the Go/No–Go Association Task to Measure Implicit Bias

ABSTRACT

Previous research has found initial evidence that word choice impacts the perception and treatment of those with behavioral health disorders through explicit bias (i.e., stigma). A more robust picture of behavioral health disorder stigma should incorporate both explicit and implicit bias, rather than relying on only one form.

The current study uses the Go/No–Go Association Task to calculate a d′ (sensitivity) indexed score of automatic attitudes (i.e., implicit associations) to two terms, “addict” and “person with substance use disorder.”

Participants have significantly more negative automatic attitudes (i.e., implicit bias) toward the term “addict” in isolation as well as when compared to “person with a substance use disorder.”

Consistent with previous research on explicit bias, implicit bias does exist for terms commonly used in the behavioral health field. “Addict” should not be used in professional or lay settings. Additionally, these results constitute the second pilot study employed the Go/No–Go Association Task in this manner, suggesting it is a viable option for continued linguistic stigma related research.     

BDSM,becoming and the flows of desire

Based on a five-year qualitative ethnographic study of Bondage and Discipline/Dominance and Submission/Sadism and Masochism (BDSM) in Sweden, this paper examines the process of becoming among BDSM practitioners. In-depth interviews were completed with 29 self-defined BDSM practitioners, and their accounts were analysed using thematic analysis. Focusing on the Deleuzian concept of becoming, BDSM is understood as a dynamic and collective phenomenon closely connected to fantasies, memories and longing, and enabled through flows of desire. Practising BDSM can be understood as a process of increasing expansion, creation and connection, in which desire is seen not as something we lack or need but rather as a process of striving and self-enhancement. Exploring the becoming process more fully can provide a better understanding as to why some people choose to practise BDSM.     

Who and What Is a “Population”? Historical Debates,Current Controversies,and Implications for Understanding “Population Health” and Rectifying Health Inequities

Context: The idea of “population” is core to the population sciences but is rarely defined except in statistical terms. Yet who and what defines and makes a population has everything to do with whether population means are meaningful or meaningless, with profound implications for work on population health and health inequities. Methods: In this article, I review the current conventional definitions of, and historical debates over, the meaning(s) of “population,” trace back the contemporary emphasis on populations as statistical rather than substantive entities to Adolphe Quetelet's powerful astronomical metaphor, conceived in the 1830s, of l’homme moyen (the average man), and argue for an alternative definition of populations as relational beings. As informed by the ecosocial theory of disease distribution, I then analyze several case examples to explore the utility of critical population‐informed thinking for research, knowledge, and policy involving population health and health inequities. Findings: Four propositions emerge: (1) the meaningfulness of means depends on how meaningfully the populations are defined in relation to the inherent intrinsic and extrinsic dynamic generative relationships by which they are constituted; (2) structured chance drives population distributions of health and entails conceptualizing health and disease, including biomarkers, as embodied phenotype and health inequities as historically contingent; (3) persons included in population health research are study participants, and the casual equation of this term with “study population” should be avoided; and (4) the conventional cleavage of “internal validity” and “generalizability” is misleading, since a meaningful choice of study participants must be in relation to the range of exposures experienced (or not) in the real‐world societies, that is, meaningful populations, of which they are a part. Conclusions: To improve conceptual clarity, causal inference, and action to promote health equity, population sciences need to expand and deepen their theorizing about who and what makes populations and their means.     

‘It is surprising how much nonsense you hear’: How residents experience and react to living in a stigmatised place. A narrative synthesis of the qualitative evidence

There are significant geographical inequalities in health. Spatial stigma - negative representations of particular localities - could be an important mechanism through which place influences population health. To explore this, we undertook a narrative synthesis of studies reporting residents' perspectives of living in stigmatised localities. Qualitative research (38 studies) was reviewed to identify how spatial stigma manifested in residents’ lives, their strategies to cope with stigma and the health consequences. The review found residents internalised stigma, but also resisted it differently. Although relatively few studies purposefully investigated health, living somewhere stigmatised had psychological effects and constrained life opportunities that have implications for health.     

Theorizing eldercare work: An orders of worth analysis

ABSTRACT

Eldercare is often regarded as “dirty work” due to its association with dysfunctional, decaying, and diseased bodies. This paper focuses on eldercare work, and studies how current practices and organization of eldercare have been justified and legitimized in different and sometimes conflicting ways. Drawing on ethnographic fieldwork with workers in nursing homes for the elderly and homecare service, this paper examines eldercare work through the theoretical lens of “orders of worth.” The concept of orders of worth affords a moral political analysis of eldercare work that helps to explain those dilemmas and situations which eldercare workers encounter and negotiate. Through the analysis, the moral entanglements between individual practices, institutional logics, and the political economy of care labor are systematically revealed.     

ADAPTATION OF HEALTH CARE SEEKING BEHAVIOR DURING CHILDBIRTH: FOCUS GROUP DISCUSSIONS WITH WOMEN LIVING IN THE SUBURBAN AREAS OF LUANDA,ANGOLA

The aim of this study was to explore how various factors influenced women's decisions regarding place of confinement in Luanda, Angola. Ten focus group discussions were conducted with pregnant and nonpregnant women residing in suburban areas of Luanda and the data were analyzed using the grounded theory technique. Four patterns of action of the main theme, “the molding of women's care-seeking behavior during childbirth,” were identified: (I) the “labor process ‘on-course’ avoiding pattern”; (II) the “labor process ‘off-course’ avoiding pattern”; (III) the “labor process ‘on-course’ approaching pattern”; and (IV) the “labor process ‘off-course’ approaching pattern.” Our findings indicate that personal “courage” and social support empowered women and impacted on their preference for home birth, whereas demand for informal user fees and perceived low quality of care influenced women to avoid institutional care during childbirth, sometimes even in spite of complications. Ability to meet demands for informal user fees and knowledge of childbirth influenced women to seek institutional care. The study highlights the need to improve the quality of available maternal health care addressing the implicit educational, attitudinal, and ethical issues.     

The breast cancer fanfare: Sociocultural factors and women's health in Ghana

Traditional notions of the “full” woman and sociocultural beliefs about gender roles contribute to a unique experience of breast cancer in Africa. I used the critical feminist lens to analyze dis-courses about breast cancer in mainstream Ghanaian media. I found that breast cancer awareness is promoted amidst fanfare and that cultural notions of the female breasts, including their sexual appeal, are implied in breast cancer discourse. This obscures a nuanced understanding of the disease and women's health globally, limits the power of women to name their experiences, and contributes to the late presentation of the dis-ease in sub-Saharan Africa. I discuss the implications of the findings for international, interdisciplinary scholarship.     

Jacob and the preacher: Conversations in context,part I

“You're the child care worker. Right?” “I'm the child care worker.” “So, wadda you want? I told the old lady I'd see you because she was freaking out. I got ten minutes. Talk.” “I want to buy you a cup of coffee and tell you how to save your life.” “I don't drink coffee.” “So? What about your life?” “What are you, a missionary from the local church? Or are you just an asshole?” “If I gotta make a choice, I'd rather be an asshole. What about you?” “You're fucking crazy, man. Me, I wouldn't make a choice like that.” “That's the problem. You're not making choices. That's why your life is going to hell. And that's why I'm here: to give you the choice of saving your life. Now. Do you want to do it or don't you?” “Are you paying attention here, preacher?” “Sorry, Jacob. I was thinking about your history.” “Who gives a shit? Pay attention. I was asking you if you wanted to go over to the park with me. I got something I gotta do.” “Is it safe for me?” “Sure. Don't worry. I'll look after you. Nobody's gonna touch you if you're with me. The only thing is, you gotta do what I tell you.” “I'm glad you're looking after me, son. It always feels good to know somebody's taking care of you.”     

Triple jeopardy: Adolescent experiences of sex work and migration in Zimbabwe

Adolescence, migration and sex work are independent risk factors for HIV and other poor health outcomes. They are usually targeted separately with little consideration on how their intersection can enhance vulnerability. We interviewed ten women in Zimbabwe who experienced sex work and migration during adolescence, exploring implications for their health and for services to meet their needs. For most, mobility was routine throughout childhood due to family instability and political upheaval. The determinants of mobility, e.g. inability to pay school fees or desire for independence from difficult circumstances, also catalysed entry into sex work, which then led to further migration to maximise income. Respondents described their adolescence as a time of both vulnerability and opportunity, during which they developed survival skills. While these women did not fit neatly into separate risk profiles of “sex worker” “migrant” or “adolescent”, the overlap of these experiences shaped their health and access to services. To address the needs of marginalised populations we must understand the intersection of multiple risks, avoiding simplified assumptions about each category.     

The Women's Health Care Empowerment Model as a Catalyst for Change in Developing Countries

Women's empowerment has been attempted through a number of different fields including the realms of politics, finance, and education, yet none of these domains are as promising as health care. Here we review preliminary work in this domain and introduce a model for women's empowerment through involvement in health care, titled the “women's health care empowerment model.” Principles upon which our model is built include: acknowledging the appropriate definition of empowerment within the cultural context, creating a women's network for communication, integrating local culture and tradition into training women, and increasing the capability of women to care for their children and other women.     

The experiences of foundation doctors with dyspraxia: a phenomenological study

Dyspraxia, otherwise known as Developmental Coordination Disorder (DCD), is a specific learning difficulty (SpLD). Its main difficulties manifest as problems with motor coordination, organisation, academic and social difficulties. There are now more students arriving at university with SpLDs, and, therefore, a similar rise may be expected within medical education. There has been no previous research focusing on dyspraxia in doctors. An interpretive phenomenological approach was used. Six UK foundation schools disseminated the announcements. Three participants took part in loosely structured telephone interviews regarding their experiences of undertaking medical school and foundation school with dyspraxia. These were transcribed verbatim and then thematically analysed. The themes could be split into two main categories: “Weakness and Coping Strategies” and “Perspectives of Dyspraxia”. “Weakness” included: clumsiness, organisation and needing extra time. The participants focused on their “Coping Strategies” that included: Ensuring safety, adapted learning preferences and external support. “Perspectives of Dyspraxia” included: diagnosis, career choice, stigma, “normalisation” and the “difference view” or “medical deficit” view of dyspraxia. Doctors with dyspraxia often mask their difficulties through sophisticated coping strategies. These were determined and hardworking individuals who believe that their dyspraxia was a positive aspect of their identity, adopting a “difference view”. They felt further education is needed about dyspraxia to change the perceived stigma. There is now a need for further research in this area.

     

‘We Are Mothers First’: Localocentric Articulation of Sex Worker Identity as a Key in HIV/AIDS Communication

The connection between identity and health communication has been amply documented in communication research. How an individual frames oneself with respect to and in conjunction with one's interpersonal relationships and material and communicative structures shapes one's identity. This in turn shapes how one enacts the self, given the relationships and available contexts one is embedded in, all of which have a significant influence on how one communicates about and negotiates health and illness. This study reports the results of an ethnographic field study conducted during two periods—June and August 2007 and July and August 2009, which examined, chiefly through interviews of 46 participants, how members of a community of sex workers in Kalighat, in the city of Kolkata in India, communicatively constructed their selves with respect to their prevalent cultural indices and available structures, and how enunciations and enactments of sex worker selves as “mothers first” influenced localized patterns of HIV/AIDS communication and related work practices. Sex worker narratives suggested that mainstream assumptions and identity labels that depict sex workers as incapable mothers and the concurrent HIV/AIDS practices sex workers are asked to adopt need to be questioned and transformed to effect positive changes in health and HIV/AIDS negotiation practices among members of this marginalized community.     

The Clinical Supervisor-Practitioner Working Alliance

Abstract

The focus of my presentation this morning is the core dynamics and skills of the supervisor-practitioner working alliance, or what I will refer to as the working relationship. I will present a model that suggests that the use of certain communication, relationship and problem-solving skills by the supervisor can influence the development of a positive working relationship with the supervisee, and that this working relationship is the medium through which the supervisor influences the practitioner. I stress the words “influence” because a central assumption of this approach is that both supervision and direct practice are interactional in nature. The supervisor and the supervisee each play a part in the process. The outcome of supervision is the result of how well each contributes to the process. This morning's presentation focuses on the supervisor's role. One of the discussions is the concept of the “parallel process.” While the role of the supervisor and the purpose of supervision are quite different from counseling and therapy, nevertheless there are striking parallels in the dynamics and skills. There is a suggestion that “more is caught than taught” and that our supervisees watch us very closely. Whether we like it or not, whether we are aware of it or not, our supervisees learn more about practice from the way we work with them than from what we say about their actual practice. Supervision is not therapy. In fact, supervisors who are seduced into a therapeutic relationship with their supervisees actually model poor practice since they lose sight of the true purpose of clinical supervision and their role in the process.     

Factors influencing nurses' perceptions of occupational safety

To determine nurses' perceptions of occupational safety and their work environment and examine the sociodemographic traits and job characteristics that influence their occupational safety, we studied a sample of 278 nurses. According to the nurses, the quality of their work environment is average, and occupational safety is insufficient. In the subdimensions of the work environment scale, it was determined that the nurses think “labor force and other resources” are insufficient. In the occupational safety subdimensions “occupational illnesses and complaints” and “administrative support and approaches,” they considered occupational safety to be insufficient. “Doctor-nurse-colleague relationships,” “exposure to violence,” and “work unit” (eg, internal medicine, surgical, intensive care) are the main factors that affect occupational safety. This study determined that hospital administrations should develop and immediately implement plans to ameliorate communication and clinical precautions and to reduce exposure to violence.