Authoritative knowledge and single women's unintentional pregnancies,abortions, adoption,and single motherhood: social stigma and structural violence

This article explores the sources of authoritative knowledge that shaped single, white, middle-class women's unintentional pregnancies and child-bearing decisions throughout five reproductive eras. Women who terminated a pregnancy were most influenced by their own personal needs and circumstances. birth mothers' decisions were based on external sources of knowledge, such as their mothers, social workers, and social pressures. In contrast, single mothers based their decision on instincts and their religious or moral beliefs. Reproductive policies further constrained and significantly shaped women's experiences. The social stigma associated with these forms of stratified maternity suggests that categorizing pregnant women by their marital status, or births as out-of-wedlock, reproduces the structural violence implicit to normative models of female sexuality and maternity. This mixed-method study included focus groups to determine the kinds of knowledge women considered authoritative, a mailed survey to quantify these identified sources, and one-on-one interviews to explore outcomes in depth.     

Exploration and local utilization of medicinal vegetation naturally grown in the Deusai plateau of Gilgit,Pakistan

In the study area, the traditional knowledge regarding the uses of local wild medicinal plants for the health care of human and domestic animals is totally in hold of old people. The young ones are unaware about such an indispensable practices. The objective of the current study was to transfer this sort of precious knowledge from old members of the community to young generations in documented form.     

Articulating silences: experiential and biomedical constructions of hypertension symptomatology

In this article, we explore the flexible configuration of a local knowledge system about hypertension symptoms, foregrounding it against prevailing biomedical assertions regarding the asymptomatic or "silent" nature of hypertension. The complex and coherent knowledge system held by older African Americans living in a southern, rural community stands in contrast to the current scientific discourse and local biomedical perspectives on hypertension symptomatology. The older African American participants in this study apply local knowledge of hypertension symptomatology to make health decisions nearly every day. Despite this, most biomedical practitioners maintain a distance from these lay sources of knowledge, often remaining stalwart in their refusal to recognize the existence or influence of symptoms. We conclude that authoritative knowledge ultimately lies in the minds and bodies of the elders, who have encountered symptoms as guideposts that direct action, rather than with a biomedical "reality" that is yet unresolved.     

Local Perceptions,Cultural Beliefs and Practices That Shape Umbilical Cord Care: A Qualitative Study in Southern Province,Zambia

Background

Global policy regarding optimal umbilical cord care to prevent neonatal illness is an active discussion among researchers and policy makers. In preparation for a large cluster-randomized control trial to measure the impact of 4% chlorhexidine as an umbilical wash versus dry cord care on neonatal mortality in Southern Province, Zambia, we performed a qualitative study to determine local perceptions of cord health and illness and the cultural belief system that shapes umbilical cord care knowledge, attitudes, and practices.

Methods and Findings

This study consisted of 36 focus group discussions with breastfeeding mothers, grandmothers, and traditional birth attendants, and 42 in-depth interviews with key community informants. Semi-structured field guides were used to lead discussions and interviews at urban and rural sites. A wide variation in knowledge, beliefs, and practices surrounding cord care was discovered. For home deliveries, cords were cut with non-sterile razor blades or local grass. Cord applications included drying agents (e.g., charcoal, baby powder, dust), lubricating agents (e.g., Vaseline, cooking oil, used motor oil) and agents intended for medicinal/protective purposes (e.g., breast milk, cow dung, chicken feces). Concerns regarding the length of time until cord detachment were universally expressed. Blood clots in the umbilical cord, bulongo-longo, were perceived to foreshadow neonatal illness. Management of bulongo-longo or infected umbilical cords included multiple traditional remedies and treatment at government health centers.

Conclusion

Umbilical cord care practices and beliefs were diverse. Dry cord care, as recommended by the World Health Organization at the time of the study, is not widely practiced in Southern Province, Zambia. A cultural health systems model that depicts all stakeholders is proposed as an approach for policy makers and program implementers to work synergistically with existing cultural beliefs and practices in order to maximize effectiveness of evidence-based interventions.     

Responsible choices: situating pregnancy intention among Haitians in South Florida

In this article, I focus on unintended pregnancy as a means to interrogate the intersections of abortion and prenatal discourses in the United States, and the ways in which these discourses assume certain kinds of moral, liberal subjects. Using media material, congressional legislation, public health policy, and ethnographic data from South Florida (2004-06), I trace how these discourses assume that women will behave in "rational," "responsible" ways to plan their reproductive futures, and how these assumptions intersect with Haitian women migrants' lived experiences in South Florida. My research illustrates how decisions about family planning are situated within particular local moral worlds, where gender relations, religion, power, and desires for children inform women's everyday lives.     

Claiming respectable American motherhood: homebirth mothers, medical officials, and the state

Based on ethnographic research regarding public policy and grassroots organizing for midwifery in Virginia, this article explores how medical discourses around appropriate health care practices intersect with state discourses about what practices are considered "respectable" versus "pathological" for its citizens. In recent legislative debates about the legalization of direct-entry midwifery, medical officials have extended their criticism of midwifery and homebirth to mothers who resist state-sanctioned childbirth practices. This article examines how medical officials challenge the respectable mothering practices of homebirthers by linking them with women they deem pathological--child abusers, negligent mothers, and drug users--and placing them outside the cadre of "normal" American mothers who acknowledge the "logical" and "natural" superiority of biomedical childbirth practices. I also address homebirth mothers' responses, which assert that their political advocacy for midwives is a respectable mothering practice because they are responsible citizens who desire what they deem the best care for their children.     

ARE PREGNANT WOMEN FETAL CONTAINERS?

Purdy explores the argument that women's rights to control their bodies should be subordinated to the welfare of their fetuses. She gives examples ofinstances where women's decisions about pregnancy and childbirth have been overridden by physicians and judges. She examines the nature of the mother fetus relationship, the social context of the current conflict between maternal and fetal rights, and the extent of a woman's legally enforceable duty to her fetus. Purdy acknowledges that women may owe a reasonable duty to their fetuses to try to prevent disease or handicap. However, given the uncertainties of modern medicine, the value-laden nature of many physicians' decisions, and the lack of adequate adequate prenatal care, women should not be held responsible for situations that are due largely to society's shortcomings. Purdy concludes that it is unjust to use the law to coerce women into accepting medical advice.     

Gendering Local Knowledge: Medicinal Plant Use and Primary Health Care in the Amazon

Local knowledge is becoming increasingly important in primary health care projects. However, these projects often incorporate local knowledge in an uncritical manner. One area where this is apparent is in the lack of attention paid to the gendered nature of local knowledge. I use one example, women's knowledge and use of medicinal plants in a low-income community in the Brazilian Amazon, to illustrate the links among authority, knowledge, and gender. In this article I argue that policy makers must pay attention to the relationships among authority, gender, and local knowledge and examine how the use of local knowledge in development strategies can affect existing (gendered) power relationships. Women's roles as managers of household health (which includes medicinal plant use) are a source of authority for them. Because of that, the way in which local knowledge is incorporated into primary health care programs can have a significant impact on women's authority.     

Gender expectations: natural bodies and natural births in the new midwifery in Canada

In this article, I examine the meaning of natural bodies and natural births in contemporary midwifery in Canada and explore the impact of these central concepts on the embodied experiences of pregnant and birthing women. The ideal of a natural birth has been used as a successful rhetorical strategy in scholarly and popular feminist works on childbirth to counter and critique the predominant biomedical or "technocratic" model of the pregnant and birthing body as inherently problematic and potentially dangerous to the fetus. Contemporary Canadian midwifery--which only as recently as 1994 made a historic transition from a grassroots social movement to a full profession within the public health care system--continues to work discursively through the idiom of nature to affect women's knowledge and experience of their bodies and selves in pregnancy and birth. However, my key finding in this ethnographic study, which focused primarily on midwifery in the province of Ontario in the years following professionalization, is that natural birth is being redefined by the personal, political, and pragmatic choices of midwives and their clients. I argue that the construction, negotiation, and experience of natural birth in contemporary midwifery both reflects and promotes a fundamental shift away from essentialized understandings as it makes room for biomedical technology and hospital spaces, underpinned by the midwifery logics of caring and choice. Natural birth in this context also carries important cultural messages--gender expectations--that posit women as persons and bodies as naturally competent and knowing.     

Neonatal mortality and prevalence of practices for newborn care in a squatter settlement of Karachi, Pakistan: a cross-sectional study

Background

During the past two decades there has been a sustained decline in child and infant mortality, however neonatal mortality has remained relatively unchanged. Almost all neonatal deaths (99%) occur in developing countries, where the majority are delivered at homes. Evidence suggests that these deaths could be prevented by simple, inexpensive practices and interventions during the pregnancy, delivery and postnatal period. In Pakistan over the last decade extensive efforts have been made by the international donors and government to implement these practices. However, limited attempts have been made to explore if these efforts have made a difference at the grass root level. This study assessed the burden of neonatal mortality and prevalence of practices for newborn care in a squatter settlement of Karachi, Pakistan.

Methodology/Principal Findings

A community based cross-sectional study was performed. A pre-tested structured questionnaire was administered to 565 women who had recently delivered. Information was collected on neonatal morbidity, mortality and practices of women regarding care during pregnancy, child birth and for newborn, till 28th day of birth. Although 70% of women mentioned receiving antenatal care by a skilled provider, only 54.5% had four or more visits. Tetanus toxoid was received by 79% of women while only 56% delivered at a health care facility by a skilled attendant. Newborn care practices like bathing the baby immediately after birth (56%), giving pre-lacteals (79.5%), late initiation of breast feeding (80.3%), application of substances on umbilical cord (58%) and body massage (89%) were common. Most neonates (81.1%) received BCG injection and polio drops after birth. Neonatal mortality rate was 27/1000 live births with the majority of deaths occurring during the first three days of life.

Conclusion

Even after years of efforts by government and nongovernmental sector to reduce newborn morbidity and mortality, inadequate antenatal care, home deliveries and unhealthy newborn care practices are highly prevalent. This leads us to important questions of why practices and behaviors have not changed. Who is responsible and what strategies are needed to bring this change?     

Pregnancy-Related Health Information-Seeking Behaviors Among Rural Pregnant Women in India: Validating the Wilson Model in the Indian Context

Objectives: Understanding health information-seeking behaviors and barriers to care and access among pregnant women can potentially moderate the consistent negative associations between poverty, low levels of literacy, and negative maternal and child health outcomes in India. Our seminal study explores health information needs, health information-seeking behaviors, and perceived information support of low-income pregnant women in rural India. Methods: Using the Wilson Model of health information-seeking framework, we designed a culturally tailored guided interview to assess information-seeking behaviors and barriers to information seeking among pregnant women. We used a local informant and health care worker to recruit 14 expectant women for two focus group interviews lasting 45 minutes to an hour each. Thirteen other related individuals including husbands, mothers, mothers-in-law, and health care providers were also recruited by hospital counselors for in-depth interviews regarding their pregnant wives/daughters and daughters-in-law. Interviews were transcribed and analyzed by coding the data into thematic categories. Results: The data were coded manually and emerging themes included pregnancy-related knowledge and misconceptions and personal, societal, and structural barriers, as well as risk perceptions and self-efficacy. Lack of access to health care and pregnancy-related health information led participants to rely heavily on information and misconceptions about pregnancy gleaned from elder women, friends, and mothers-in-law and husbands. Doctors and para-medical staff were only consulted during complications. All women faced personal, societal, and structural level barriers, including feelings of shame and embarrassment, fear of repercussion for discussing their pregnancies with their doctors, and inadequate time with their doctors. Conclusion: Lack of access and adequate health care information were of primary concern to pregnant women and their families. Policy Implications: Our study can help inform policies and multi-sectoral approaches that are being taken by the Indian government to reduce maternal and child morbidity and burdens.     

A Cross-Sectional Analytic Study of Postpartum Health Care Service Utilization in the Philippines

Background

The maternal mortality ratio in the Philippines remains high; thus, it will be difficult to achieve the Millennium Development Goals 5 by 2015. Approximately two-thirds of all maternal deaths occur during the postpartum period. Therefore, we conducted the present study to examine the current state of postpartum health care service utilization in the Philippines, and identify challenges to accessing postpartum care.

Methods

A questionnaire and knowledge test were distributed to postpartum women in the Philippines. The questionnaire collected demographical characteristics and information about their utilization of health care services during pregnancy and the postpartum period. The knowledge test consisted of 11 questions regarding 6 topics related to possible physical and mental symptoms after delivery. Sixty-four questionnaires and knowledge tests were analyzed.

Results

The mean time of first postpartum health care visit was 5.1±5.2 days after delivery. Postpartum utilization of health care services was significantly correlated with delivery location (P<0.01). Women who delivered at home had a lower rate of postpartum health care service utilization than women who delivered at medical facilities. The majority of participants scored low on the knowledge test.

Conclusion

We found inadequate postpartum health care service utilization, especially for women who delivered at home. Our results also suggest that postpartum women lack knowledge about postpartum health concerns. In the Philippines, Barangay health workers may play a role in educating postpartum women regarding health care service utilization to improve their knowledge of possible concerns and their overall utilization of health care services.     

Knowledge,Attitudes, and Practices Concerning Malaria in Pregnancy: Results from a Qualitative Study in Madang,Papua New Guinea

Background

Malaria is the leading cause of illness and death in Papua New Guinea (PNG). Infection during pregnancy with falciparum or vivax malaria, as occurs in PNG, has health implications for mother and child, causing complications such as maternal anemia, low birth weight and miscarriage. This article explores knowledge, attitudes and practices concerning malaria during pregnancy and it’s prevention in Madang, PNG, a high prevalence area.

Methods

As part of a qualitative study in Madang, exploring MiP, participatory techniques (free-listing and sorting) were conducted along with focus group discussions, in-depth interviews (with pregnant women, health staff and other community members) and observations in the local community and health facilities.

Results

The main themes explored were attitudes towards and knowledge of MiP, its risks, and prevention. Although there was a general awareness of the term “malaria”, it was often conflated with general sickness or with pregnancy-related symptoms. Moreover, many preventive methods for MiP were related to practices of general healthy living. Indeed, varied messages from health staff about the risks of MiP were observed. In addition to ideas about the seriousness and risk of MiP, other factors influenced the uptake of interventions: availability and perceived comfort of sleeping under insecticide-treated mosquito nets were important determinants of usage, and women’s heavy workload influenced Chloroquine adherence.

Conclusion

The non-specific symptoms of MiP and its resultant conflation with symptoms of pregnancy that are perceived as normal have implications for MiP prevention and control. However, in Madang, PNG, this was compounded by the inadequacy of health staff’s message about MiP.     

Sonography and sociality: obstetrical ultrasound imaging in urban Vietnam

This article is about new reproductive technologies, maternal anxieties, and existential uncertainties. It explores the question of why pregnant women in Vietnam's capital, Hanoi, have become avid consumers of obstetrical ultrasound scanning even while expressing profound doubts regarding the reliability and safety of this new technology of pregnancy. Through a phenomenological analysis of the social production of women's sense of reproductive risks and uncertainties, the article shows how Hanoian women's paradoxical stances toward ultrasound imaging can be explained through a consideration of embodied and historically generated experiences within everyday local worlds. The article argues that the "scientific stories" of fetal well-being and normality that are produced through ultrasonography are challenged by vivid and continual exchanges in everyday lives of stories of the inherent uncertainties of existence in general and of human reproduction in particular.     

"Change yourself and the whole world will become kinder": Russian activists for reproductive health and the limits of claims making for women

This article views reproductive health activism as a fruitful site for analyzing the cultural logics through which legitimate claims for women's needs become expressed and circumscribed. It begins from the observation that in the United States and Britain, reproductive health has been a key arena for feminist political claims and struggles for women's rights, bodily integrity, access to health care, and demands for authority in relations with experts. These concerns and struggles have not, however, emerged in all postsocialist contexts, and new activism in Russia reveals strikingly different agendas. Innovative groups of health providers seeking to increase women's access to birth control methods and safe sex, home birth opportunities, and improved health services work outside of feminist perspectives and reject political paths for change. By examining the ideological inspirations, cultural logics, and political-economic constraints shaping the outreach work of Russian health practitioners, the article explains how and why health activism became a site for personal "spiritual" revival and the strengthening of nuclear families. It also explores how conditions following the collapse of socialism have further legitimized activists' rejection of political agendas for change.     

FINDING AUTONOMY IN BIRTH

Over the last several years, as cesarean deliveries have grown increasingly common, there has been a great deal of public and professional interest in the phenomenon of women 'choosing' to deliver by cesarean section in the absence of any specific medical indication. The issue has sparked intense conversation, as it raises questions about the nature of autonomy in birth. Whereas mainstream bioethical discourse is used to associating autonomy with having a large array of choices, this conception of autonomy does not seem adequate to capture concerns and intuitions that have a strong grip outside this discourse. An empirical and conceptual exploration of how delivery decisions ought to be negotiated must be guided by a rich understanding of women's agency and its placement within a complicated set of cultural meanings and pressures surrounding birth. It is too early to be 'for' or 'against' women's access to cesarean delivery in the absence of traditional medical indications – and indeed, a simple pro- or con- position is never going to do justice to the subtlety of the issue. The right question is not whether women ought to be allowed to choose their delivery approach but, rather, taking the value of women's autonomy in decision-making around birth as a given, what sorts of guidelines, practices, and social conditions will best promote and protect women's full inclusion in a safe and positive birth process.     

Assessing midwives' breastfeeding knowledge: Properties of the Newborn Feeding Ability questionnaire and Breastfeeding Initiation Practices scale

Background

Appropriate feeding practices are of fundamental importance for the survival, growth, development and health of infants and young children. The aim of the present study was to collect baseline information on current infant and young child feeding practices, attitudes and knowledge in Mazabuka, Zambia, using a qualitative approach.

Methods

The study was conducted in Mazabuka, 130 km south of Lusaka in Zambia in January and February in 2005. Nine focus group discussions with mothers and a total of 18 in-depth interviews with fathers, grandmothers, health staff and traditional birth attendants were performed in both rural and urban areas.

Results

Breastfeeding was reported to be universal, the use of pre-lacteal feeds appeared to be low, colostrum was rarely discarded, and attitudes to and knowledge about exclusive breastfeeding were generally good. However, few practised exclusive breastfeeding. The barriers revealed were: (1) the perception of insufficient milk, (2) the fear of dying or becoming too sick to be able to breastfeed, (3) convention, (4) the perception of 'bad milk' and (5) lack of knowledge on the subject. The health staff and traditional birth attendants were the most important actors in transmitting knowledge about infant feeding to the mothers. Both categories appeared to have updated knowledge on child health and were well respected in the society. Fathers and grandmothers tended to be less knowledgeable on novel subjects such as exclusive breastfeeding and often showed a negative attitude towards it. At the same time they had considerable authority over mothers and children and infant feeding decisions. The rural population was in general less educated and more prone to conventional non-exclusive feeding practices.

Conclusion

The message that exclusive breastfeeding (EBF) is beneficial for child health had reached the health workers and was taught to mothers. However, conventions and expectations from family members in this Zambian community were important barriers in preventing the message of EBF from being translated into practice. The deep-rooted beliefs that prohibit EBF need to be addressed in projects and campaigns promoting EBF.