Reproductive Travel to Ghana: Testimonies,Transnational Relationships,and Stratified Reproduction

ABSTRACT

In this article, I address reproductive travel to Ghana, based on research conducted in two private fertility clinics. Both clinics attract clients from West African countries as well as Ghanaian people living in the US and Europe. Their motivations to visit these clinics include positive “testimonies” about treatment results, “bioavailability” of matching donor material and surrogates, lower treatment costs and the circumvention of restricting regulations in the country of residence. Communication technologies are central in facilitating reproductive travel. Finally, I argue that the “international choreographies” of reproductive travel are co-shaped by the unique biographies and transnational relationships of the people involved.     

Reproductive Governance and the (Re)definition of Human Rights in Poland

ABSTRACT

Reproductive rights struggles have continued to dominate public debates in Poland since the political resurgence of the Catholic church in 1989. In 2015, the state passed a landmark “In Vitro Policy” to regulate assisted reproductive technologies. Its religiously based compromises may jeopardize other reproductive rights. I argue that the new policy negotiations demonstrate how versions of competing human rights claims are central to reproductive governance and struggles in the new Polish “ethical order.” These negotiations reveal a reciprocal and temporal effect between infertility and abortion laws, in which previously enacted abortion restrictions are used to limit and define “In Vitro” rights.     

Humanitarianism from Below: Sowa Rigpa,the Traditional Pharmaceutical Industry,and Global Health

ABSTRACT

In this article I explore, for the first time, the relationship between Sowa Rigpa (Tibetan medicine) and global health, tracing “the global” in ethical discourses and pharmaceutical innovation practices of Tibetan medical practitioners. I argue that Sowa Rigpa’s engagement with the world and its global health activities outside China can be understood as a form of “humanitarianism from below,” while its industrialization in China aligns with global health in different ways. In providing new insights into recent developments of Sowa Rigpa, I aim to decenter the notion of humanitarianism and contribute to a broader understanding of global health.     

Gendering the Gift of Life: Family Politics and Kidney Donation in Egypt and Mexico

ABSTRACT

In this article, we demonstrate how living kidney donation is a particularly gendered experience. We draw on anthropologists’ contributions to understanding the globalization of reproductive technologies to argue that kidney donation similarly endangers and preserves fertility, thereby unsettling and reifying gendered familial labor. Based on fieldwork in two ethnographic sites—Egypt and Mexico—we examine how kidney donation is figured as a form of social reproduction. In both settings, kidney recipients rely almost exclusively on organs from living donors. We focus on how particular gender ideologies—as evident, for example, in the trope of the “self-sacrificing mother”—can serve as a cultural technology to generate donations in an otherwise organ-scarce medical setting. Alternatively, transplantation can disrupt gender norms and reproductive viability. In demonstrating the pervasiveness of gendered tropes in the realm of transplantation, we unsettle assumptions about the “family” as the locus of pure, altruistic donation.     

Regulating Traditional Mexican Midwifery: Practices of Control,Strategies of Resistance

ABSTRACT

The institutionalization of Mexican midwifery has a long history. Despite global recommendations moving away from training traditional midwives, training courses still continue. Based on fieldwork in the State of Chiapas, I argue that while ongoing trainings offered to traditional midwives in Mexico aim at teaching them best practices, they also limit midwives’ autonomy and keep poor women’s reproductive behaviors under control. I demonstrate how midwives and medical personnel mobilize discourses of reproductive risk, women’s rights and indigenous cultural rights to reinforce or contest mechanisms of reproductive governance.     

Arbitrating Abortion: Sex-selection and Care Work among Abortion Providers in England

ABSTRACT

The UK’s on-going sex-selective abortion (SSA) controversy remains a major obstacle to the liberalization of national abortion governance, and is an issue broadly attributed to a “cultural” preference for sons among South Asian women. We conceptualize how healthcare professionals “arbitrate” requests for SSA by exploring the tension between its legal status and how requests are encountered by abortion providers. SSA is framed in this article as a legitimate care service that can support providers to meet the diverse reproductive health needs of women to the full extent of the law.     

Obstetric Violence Observatory: Contributions of Argentina to the International Debate

ABSTRACT

In Latin America, over the past decade, the term “obstetric violence” has become part of the legal framework. Specific laws against obstetric violence – gender-based violence and the violation of human rights – exist in Venezuela, Argentina, Mexico, Brazil and Uruguay. In Europe, the issue is raised by human rights organizations, social movements and academics, but no country has yet passed legislation on the matter. In this article, I focus on the contribution of Argentina to this international debate, particularly with respect to the implementation of the Obstetric Violence Observatory.     

Learning from Me Too

For the past year, many around the world have said, “Me Too.” Women, trans folks, and increasingly men have shared their experiences of sexual assault, harassment, and unhealthy power dynamics in their personal and professional relationships. These experiences were not a surprise to people in bioethics, especially as they relate to the control of women's bodies and behaviors that we have observed in medicine, law, and society. In The Hastings Center's work in reproductive contexts, I have learned about women whose reproductive decisions or choices are negatively affected by external forces—either by restrictive laws and policies, explicit counsel from their physicians, or implicit pressures placed on them by society. Any person with a uterus can be forced to take contraceptives if they want access to other medications that could harm a fetus, even when they are not sexually active with men. And some women of color are criminalized for miscarriages. How can those of us working in reproductive ethics be even more attentive to these experiences and to the impact of gendered power dynamics on reproductive decision‐making?     

Louisiana's “Medically Futile” Unborn Child List: Ethical Lessons at the Post-Dobbs Intersection of Reproductive and Disability Justice

Ableist attitudes and structures are increasingly recognized across all sectors of health care delivery. After Dobbs, novel questions arose in the United States concerning how to protect reproductive autonomy while avoiding discrimination against and devaluation of disabled persons. In this essay, we examine the Louisiana Department of Health's emergency declaration, “List of Conditions That Shall Deem an Unborn Child ‘Medically Futile,’” issued August 1, 2022. We raise a number of medical, ethical, and public health concerns that lead us to argue that the declaration should be rescinded. Analysis of this ethically objectionable declaration provides valuable lessons about how to uphold both reproductive and disability justice in a post-Dobbs landscape.     

Medical educators: How they define themselves – Results of an international web survey

Background: Little is known about medical educators’ self-definition.

Aims: The aim of this study is to survey an international community of medical educators focusing on the medical educators’ self-definition.

Methods: Within a comprehensive, web-based survey, an open question on the participants’ views of how they would define a “medical educator” was sent to 2200 persons on the mailing list of the Association for Medical Education in Europe. The free text definitions were analysed using qualitative thematic analysis.

Results: Of the, 2200 medical educators invited to participate, 685 (31.1%) provided a definition of a “medical educator”. The qualitative analysis of the free text definitions revealed that medical educators defined themselves in 13 roles, primarily as “Professional Expert”, “Facilitator”, “Information Provider”, “Enthusiast”, “Faculty Developer”, “Mentor”, “Undergraduate and Postgraduate Trainer”, “Curriculum Developer”, “Assessor and Assessment Creator”, and “Researcher”.

Conclusions: Our survey revealed that medical educators predominantly define themselves as “Professional Experts” and identified 12 further self-defined roles of a medical educator, several of which not to have been reported previously. The results can be used to further the understanding of our professional identity.     

Exploring the feasibility and acceptability of using tactical decision games to develop final year medical students’ non-technical skills

Introduction: Clinical decision-making, situation awareness, task management, and teamwork are key non-technical skills (NTS) required by junior doctors. Tactical decision games (TDGs) are low-fidelity classroom-based activities designed to develop proficiency in NTS. This study aimed to explore the feasibility and acceptability of using TDGs as a novel teaching method for final year medical students.

Methods: Final year medical students at the University of Edinburgh participated in a single TDG session. Focus groups were then used to explore students’ perceptions of participating in the TDG session and transcribed data from the focus groups was thematically analyzed.

Results: Six key themes emerged from the data: “the value of non-medical games”; “giving and receiving feedback”; “observing and reflecting”; “recognizing and understanding NTS”; “dealing with uncertainty and ambiguity”, and “introducing TDGs into the curriculum”.

Conclusions: TDGs are an easy-to-use, low-fidelity method of teaching medical students about the importance of NTS. Medical students view TDGs as a valuable learning activity that appears to increase awareness and understanding of the importance of NTS.     

Paces of Costly Care: Rare Disease Drug Access in Canada

ABSTRACT

Pharmaceutical industry representatives and public drug plan managers hold competing visions of drug access, ones I theorize as “fast” and “slow” care paces. The relationship between free market imaginaries and population-based biopolitics is negotiated through these paces from within the flexible political category of rare disease. In this article, I explore expensive rare disease drug access in Canada’s universal health system through a temporal lens. I show how two families navigate these powerful negotiations, asserting themselves as deserving of resources while finding ways to consider life and death outside of this clash between health system pragmatics and pharmaceutical promise.     

Interprofessional learning through shadowing: Insights and lessons learned

Background: Interprofessional education (IPE) aims to improve patient outcomes. Interprofessional shadowing improves students’ knowledge of different roles and attitudes toward other professionals.

Aim: This study evaluates (1) how pre-clinical medical students describe the roles of the healthcare professionals they shadowed, and (2) whether shadowing can be used to introduce medical students to the benefits of interprofessional collaboration, and if so, in what ways.

Methods: Second-year medical students shadow another discipline and write a reflection on the shadowed discipline (SD)’s role and collaboration in patient care. A non-proportional stratified random sample of these reflections was coded during an iterative process. Any number of the 13 possible codes could be assigned to each reflection. Codes relevant to the research questions underwent narrative analysis.

Results: The most frequent codes were “specific function of SD” (88%), “SD’s general purpose” (86%), and “value of SD’s role” (68%). One-third of reflections referenced “communication,” and one-third mentioned “teamwork.” Insights gained included an appreciation for interprofessional care and a global perspective on patient care, extending beyond the inpatient encounter.

Conclusion: Through shadowing, students achieve several IPE core competencies and a broader perspective on patient care. Shadowing is an effective pedagogical method for IPE in the pre-clerkship curriculum.     

The Winners of Socialism: Fighting Infertility in Pronatalist Romania

Drawing from interviews and life histories, I consider the singular reproductive trajectories of women who fought infertility during the enforced pronatalist policies of the late communist era in Romania. I aim to explore the role of fine-grained ethnography in revealing both the localized mechanisms of reproductive governance and the diverse subjectivities produced by citizens’ encounters with biopower. I argue that, through an analysis of these ethnographic cases, we can further conceptualize reproductive vulnerability as an intersubjective notion. In addition, women’s atypical stories give us a glimpse into the typical workings of the recording and reporting practices of the pronatalist regime.     

Realizing Abortion Rights at the Margins of Legality in Mexico

ABSTRACT

I analyze the alternative tactics and logics of Las Fuertes, a feminist organization that has taken an “alegal” approach to realizing the human right to abortion in the conservative Mexican state of Guanajuato. Since a series of United Nations agreements throughout the 1990s enshrined reproductive rights as universal human rights, Mexican feminists have adopted the human rights platform as a lobbying tool to pressure the government to reform restrictive abortion laws. This strategy bore fruit in Mexico City, with passage of the historic 2007 abortion legalization. Las Fuertes has leveraged the human rights strategy differently – to justify the direct provision of local abortion accompaniment in a context of near-total abortion criminalization. By directly seizing abortion rights, rather than seeking to implement them through legalistic channels, Las Fuertes has effectively challenged Mexican reproductive governance in an adversarial political environment.     

Empty Spaces

“I'm Jewish, you know, and my mother said, ‘Always trust the rabbis.’” I never heard Mr. Weisman's refrain from his own lips. I never heard him say any words all. By the time I met him he was in a vegetative state, a man on the precipice of invisibility—white hair, thin pale limbs, melting into sheets of the same color. When I think about Mr. Weisman, I see empty spaces—the absence of his voice, the too‐large bed for his shrinking frame, the always‐empty chair by his bedside, and most of all, the myriad gaps in his life story. He was what in hospitals is often called a “patient alone”: someone who lacks decisional capacity and has no surrogate to make medical decisions for him. Mr. Weisman's aloneness prompted his primary team to consult our bioethics service in order to formulate goals of care for him, including the possibility of hospice care.     

“The Tools of Your Chants and Spells”: Stories of Madwomen and Indian Practical Healing

ABSTRACT

A longstanding trope in Indian psychiatry, and in popular representations of it, involves the efficacy of incantations and exorcism in healing afflictions of the mind, notably hysteria. In many accounts, from nineteenth century medical journals to twenty-first century popular films, a medicine deemed at once ‘Western’ and universal is granted the ability to diagnose neurotic afflictions, but rendered incapable of curing them, while bodily techniques referred to as ‘Indian’ are granted efficacy. In this article, I explore the subtleties and implications of this recurrent knowledge paradigm. I argue that a particular arrangement—one in which difference is established through equivalence—undergirds the terms by which medicine comes to be viewed as a cultural encounter. As these progressive formulations are often founded on stories about women’s madness, I ask, what are the implications of an arguably pragmatic ethos founded on an uneven—and deeply gendered—resolution to postcolonial knowledge problems?     

Tattered Textures of Kinship: The Effects of Torture Among Iraqi Families in Denmark

ABSTRACT

Drawing on ethnographic fieldwork in Denmark, primarily among Iraqi women and secondarily among Iraqi men who are either direct or indirect victims of torture, I explore how the memories of torture are distributed in the everyday lives of Danish families originating from Iraq. I argue that torture is folded into kin histories and the everyday work of bearing and resisting painful memories. Consequently, torture affects not only the mental and physical health of the singular survivor, but also the entire texture of kin relatedness around him or her, to the extent that kinship normativity may be disrupted. Leaning on the metaphor of a rugged cloth, I conclude by arguing that the way in which torture makes and unmakes kin relatedness congeals in what I term tattered textures of kinship.     

Psychiatry,Sex, and Science: The Making of “Adolescent” Motherhood in Southern Brazil

ABSTRACT

Research linking teen motherhood to psychoneurodevelopmental causes and pathologies has proliferated in the past two decades. In Brazil, a psychodevelopmental project of teen motherhood has gained traction despite many experts’ long-standing commitment to psychodynamic psychiatry and social epidemiology, generating epistemic tension rather than substitution. Drawing on historical ethnography conducted in Southern Brazil, I explore how this project materialized through the co-production of epistemic struggles, remedial interventions, and ontological politics. In showing how this co-production became interwoven with incremental changes in young women’s emotions, sexualities, relationships, and bodies, I describe how one particular “kind” of teen motherhood emerged and became entangled with both psychiatric knowledge-production and the angst of working-class political agency. In giving women a contested psychiatric language with which to rework their social–moral worlds, I argue that science did more than conceptualize teen childbearing in pathological terms; it contributed to its troubled transformation.     

Development of cognitive processing and judgments of knowledge in medical students: Analysis of progress test results

Background: Beside acquiring knowledge, medical students should also develop the ability to apply and reflect on it, requiring higher-order cognitive processing. Ideally, students should have reached higher-order cognitive processing when they enter the clinical program. Whether this is the case, is unknown. We investigated students’ cognitive processing, and awareness of their knowledge during medical school.

Methods: Data were gathered from 347 first-year preclinical and 196 first-year clinical students concerning the 2008 and 2011 Dutch progress tests. Questions were classified based upon Bloom’s taxonomy: “simple questions” requiring lower and “vignette questions” requiring higher-order cognitive processing. Subsequently, we compared students’ performance and awareness of their knowledge in 2008 to that in 2011 for each question type.

Results: Students’ performance on each type of question increased as students progressed. Preclinical and first-year clinical students performed better on simple questions than on vignette questions. Third-year clinical students performed better on vignette questions than on simple questions. The accuracy of students’ judgment of knowledge decreased over time.

Conclusions: The progress test is a useful tool to assess students’ cognitive processing and awareness of their knowledge. At the end of medical school, students achieved higher-order cognitive processing but their awareness of their knowledge had decreased.