ASA2016: Footprints and futures: the time of anthropology

(P40)
Reproductive futures in maternal and child health
Location Science Site/Engineering E101
Date and Start Time 05 July, 2016 at 09:00
Sessions 2

Convenors

  • Lucy Lowe (University of Edinburgh) email
  • Ian Harper (University of Edinburgh) email

Mail All Convenors

Short Abstract

Reproduction, and maternal and child health are central to social and political regimes. This panel explores the interstices of gender, medicine, commodities, and care in this arena.

Long Abstract

Reproductive capacities in the lives of women and their families are infused with hopes and fears for the future. Women's bodies have simultaneously always been central to regimes of social and political control. Reduction of maternal, neonatal and child morbidity and mortality, in addition to access to reproductive and sexual health services are key components of the Sustainable Development Goals (SDGs). Future projections of 2030, of the ideal world freed from unnecessary suffering suffuse these statements and engage our hopes and fears. Interfaced with the production of metrics, ideological trajectories (rights based approaches, ideal population demographics), the consequent new social forms, commodities and services, and medical interventions, the bodies and experiences of women lie at both the centre and periphery of many of these concerns. In this panel we explore these issues, and ask what anthropology has to offer the ongoing debates in these arenas of intervention?

We welcome papers addressing some of the following questions: In what ways do nationalism, reproduction, and migration intersect? What is the relationship between medical technologies, reproduction, and the state? How are claims to reproductive rights situated within broader social struggles? What is the relationship between development, religion, and reproductive health? What role for men in understandings of reproductive health?

This panel is closed to new paper proposals.

Papers

The migrant healthcare crisis in South Africa: narratives of maternal healthcare experiences of migrant women in Johannesburg, South Africa

Author: Tackson Makandwa (University of Witwatersrand)  email

Short Abstract

This paper considers the maternal healthcare experiences and help seeking behaviours among migrant women,and argues that in the context of migration, women’s reproductive life and maternal health is found contested in the politics of the nation State.

Long Abstract

In South Africa foreign migrants - legal, illegal and asylum seekers face xenophobia, and xenophobic attitude on a daily basis. Their stories dominate the media, and there is substantial debate on migrants and their health and wellbeing. All this occurs around popular perceptions that foreign migrants are placing an extra burden on national resources and local municipalities planning in South Africa. Research suggests that both internal and cross border migrants face numerous challenges in accessing healthcare during antenatal care and child birth in public healthcare facilities. However, foreign migrants in most cases face the greatest discrimination due to their position in the host society. Drawing from research conducted during my Masters work and preliminary fieldwork on my PhD work in inner-city Johannesburg, this paper seeks to explore the lived experiences and help-seeking behaviours of migrant women during pregnancy and child birth, as a way of giving insight on the migrant healthcare crisis in Southern Africa. The narratives documented from in-depth interviews, field notes and observations with cross border Zimbabwean women and internal migrant women reflect struggles by Governments in the region to provide healthcare for their citizens and migrants. They also demonstrate how in most cases migration is problematized through health and vice versa. Yet, as the paper will show, despite the challenges faced migrants have devised ways of maneuvering the healthcare system by also relying on churches for divine prayers and explanation and also consulting private doctors to be certain of the services from the public healthcare facilities.

Maternally displaced

Author: Lucy Lowe (University of Edinburgh)  email

Short Abstract

This paper explores the ways in which Somali refugee women navigate maternal health services in a context of displacement and legal ambiguity in Nairobi.

Long Abstract

In recent years, UNHCR and their implementing partners have sought to make reproductive health services more accessible for refugees, while simultaneously attempting to improve the services and conditions for the urban refugees, that now make up more than half of the world's displaced population. Yet in Kenya, where the leading causes of death for refugee women of reproductive age are related to childbearing and birth, thousands of Somali women seek maternal health services in private facilities, thereby refusing humanitarian responses and interventions. Drawing on ethnographic research among Somali refugees in Nairobi, this paper examines why such women reject both state and NGO services, and how they navigate a multitude of private facilities. In doing so, this paper illuminates the ways in which kinship networks are made and remade in contexts of displacement and uncertainty.

Reproductive cultures and conflicts in a 'hard to reach' group: a historical and ethnographic study amongst the Haredi Jewish minority of Manchester (UK)

Author: Ben Kasstan (Durham University)  email

Short Abstract

Haredi Jews are a growing minority group and maternity care is one of the few areas in which they interact with the state. This paper explores how Haredi reproductive carers mediate NHS maternity services and challenge biomedical protocols to oversee the group’s physical and social perpetuation.

Long Abstract

This paper presents a historical and ethnographic study of reproductive cultures in the UK's Haredi (or 'ultra-Orthodox') Jewish minority, who are viewed as 'hard to reach' by English health authority. The Haredi population are estimated to have the highest total fertility rates for any religious group in England, and are projected to form the majority of the Jewish population in the UK, U.S., and Israel by mid-century. Haredi Jewish populations are characterised by self-insulation and self-protection, but maternal and infant care services are a strategic point of study given they remain one of the few areas in which the state and its Haredi minority encounter each other. Today, Jewish midwives, doulas, and breastfeeding supporters form a collective of what I call 'reproductive carers' and gratuitously provide ante-natal, labour, and post-natal support to Haredi women at a time of increasingly cutback NHS services.

A historical and ethnographic approach illustrates how reproductive care has been entangled with pressures to assimilate and integrate over time. Some Haredi doulas challenge biomedical conducts which interfere with the religious cosmology, and perform a fundamental role in reproducing the Jewish social body within the mainstream biomedical culture. The reproductive carers consequently perform an "unorthodox" role within this 'ultra-Orthodox' and 'hard to reach' group.

The study therefore offers an understanding of the strategies used by an ethno-religious minority group to oversee maternal and infant care - as well as the physical and social reproduction - at a time of continued and radical changes to mainstream maternity services.

The first thousand days: global health and local futures in Khayelitsha, South Africa

Author: Michelle Pentecost (University of Oxford)  email

Short Abstract

I draw on 14 months of fieldwork in Khayelitsha, South Africa, to interrogate the logics and implications of a new global health focus on ’the first thousand days of life’, in the context of local conceptions of citizenship, responsibility, care and the future.

Long Abstract

A preoccupation with the future is a central tenet of development ideologies, but this is newly formalised by epigenetic research, which implies a transgenerational transmission of disease risk and amplifies the scope of the future to create a multi-generational temporality in which epidemiology and policy must operate. Global health policy reflects this emergent knowledge in its call for a focus on the 'first thousand days of life'. The period from conception to age two is considered to be the 'international window of opportunity' for nutrition interventions to target undernutrition and stunting, promote future 'human capital', and prevent a potential future burden of adult non-communicable disease. This paper draws on 14 months of fieldwork in the antenatal clinics and maternal communities of Khayelitsha, South Africa, to chart the ways in which the utopian and dystopian versions of the future encapsulated in the first thousand days project are in concert with and/or in conflict with other aspirations and potentialities that shape the landscapes of women and their (future) children here. The new discourses of risk, potential and good citizenship that are embedded in contemporary perinatal health services are shown to be incongruent with local notions of citizenship, responsibility, care, and the future, and it is thus necessary to rethink the notions of 'environment' and 'exposure' central to contemporary epigenetic epidemiological frameworks that influence health policy in this setting.

Operationalising MCH interventions in Nepal

Authors: Jeevan Sharma (University of Edinburgh)  email
Ian Harper (University of Edinburgh)  email

Short Abstract

Drawing on fieldwork in Nepal, this paper discusses how government, bilateral donors and NGOs coordinate, compete and cooperate to operationalise their policies around MCH interventions.

Long Abstract

Maternal Child Health (MCH) interventions in the context of development are frequently focused on programmes, mediated and run by constellations of organisations, all in the name of futures freed from MCH morbidity and mortality. In this paper we focus on MCH interventions in the context of Nepal: A misoprostol trial for the prevention of post-partum haemmorhage; incentives for women to attend health facilities for birth; and the mobilisation of female community health volunteers. We compare and contrast these programmes, to explore how government, bilaterals, and NGOs coordinate, compete, and cooperate to operationalise their policies around these interventions.

Building the nation's body: the contested role of abortion and family planning in post-war South Sudan

Authors: Jennifer Palmer (University of Edinburgh)  email
Katerini Storeng (University of Oslo)  email

Short Abstract

In this ethnography of reproductive health policy change in post-conflict South Sudan, we examine how ethnic movements and global humanitarian actors configure family planning and abortion in relation to the idea of the nation and the societal tension elicited when their discourses compete.

Long Abstract

The expansion of public health policy and services, including for reproductive health, is an integral part of post-conflict nation-building and efforts to establish state legitimacy. Family planning and abortion are particularly poignant sites for the enactment of reproductive identity negotiation, policing and conflict. Through an analysis of policy discourses in post-conflict South Sudan, this paper explores ethnographically how reproduction is configured in relation to the idea of the nation. We draw on document review, observations of the media and policy environment and interviews conducted with 54 key informants between 2013 and 2015. Reproductive health discourses have been actively shaped by two rapidly evolving institutions - ethnic movements and global humanitarian actors - in ways that appeal differently to South Sudanese peoples' aspirations to live in a country of their own making. During the civil war, the Sudan People's Liberation Army/Movement mobilised customary pro-natalist ideals for military gain by entreating women to amplify reproduction to replace those lost to war and rejecting family planning and abortion. International donors and the Ministry of Health have re-conceptualised such services as among other modern developments denied by war. Tensions between these competing discourses have given rise to a range of societal responses, including disagreements that erupt in legal battles, heated debate, violence towards women and health workers and intra-communal conflicts in United Nations camps. In a context where modern contraceptives and abortion services are largely unfamiliar, conflict around South Sudan's nation-building project is partially manifest through tensions and violence in the domain of reproduction.

Majority perceptions versus minority needs: an examination of reproductive politics in Romania

Author: Charlotte Kühlbrandt (London School of Hygiene and Tropical Medicine)  email

Short Abstract

Drawing on my recent fieldwork I highlight ways in which an intervention attempting to increase access to reproductive health care for vulnerable individuals may also be instrumentalised and serve state institutions and health professionals to surveil and control socially excluded populations.

Long Abstract

The Roma health mediation programme is a state-run 'Roma inclusion' programme that aims to empower communities and improve access to care. One of the programme's focus points is to educate Romani women on contraception. Taking into consideration the Romanian political and social context, this paper highlights how the emphasis on family planning is not based on needs identified by communities themselves, but on perceptions of need that have been shaped by the majority about Roma communities as sources of infection and dirt, and as a demographic threat. While conducting fieldwork in Romania I often heard people say, 'gypsies have too many children'. Aside from the difficulty of verifying such claims (lack of ethnically segregated data; difficulty in drawing meaningful ethnic boundaries), the notion of higher fertility rates among Romani women must be recognised as part of as a orientalist construct of overly 'primitive' and sexualised 'Roma'. Drawing on interviews and fieldwork observations, I suggest that the educational approach of Roma health mediation is premised the individual 'choice' of having many children, ignoring poverty and other complex community determinants that may impede access to contraception in this highly heterogeneous and disadvantaged minority population. Health mediation founders where its greatest potential strength lies: rather than acting as a community-led emancipatory project, it has allowed itself to be appropriated as an instrumental approach to curb Roma fertility rates. It thereby unintentionally perpetuates racist discourses and assists state institutions to surveil and control Roma communities.

One in four: renegotiating reproduction after the diagnosis of MCADD

Author: Pauline Herbst (University of Auckland)  email

Short Abstract

The diagnosis of the genetic condition MCADD creates genetically ‘disordered’ subjects, and infuses future reproductive hopes with fear. Already a space where medical technologies, reproduction, and the state collide, the mother’s body becomes a site of moral decision-making.

Long Abstract

Medium-chain Acyl-CoA dehydrogenase deficiency (MCADD) is an inherited metabolic disorder of fat breakdown that was added to the New Zealand newborn screening programme in 2006. Infections, fasting or vomiting can lead to serious illness with a risk of sudden death. In addition to creating genetically 'disordered', asymptomatic subjects, the diagnosis of MCADD infuses future reproductive hopes with fear and further medicalises subsequent pregnancies and births. This paper examines the experiences and decision-making of women and men in New Zealand as they navigate subsequent pregnancies (both with and without IVF) after the diagnosis of a child with MCADD. Within the neoliberal New Zealand healthcare system, the patient is privileged to manage her own disorder (or that of her children) as an autonomous, individual subject. However, the management of this disorder is carried out within a network of competing responsibilities. This paper argues that the asymptomatic, liminal nature of the disorder, which could at any time shift management of the disorder back to the state, plays a part in these parents wishing to pursue their reproductive dreams, despite the potential risks.

This panel is closed to new paper proposals.