Sociocultural Practices in Maternal Healthcare

孕产妇保健的社会文化实践

• 批准号: 1714358
• 负责人: Adrienne Strong
• 金额: $ 15.76万
• 依托单位: Strong Adrienne E
• 依托单位国家: 美国
• 项目类别: Fellowship Award
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-01 至 2019-07-31
• 项目状态: 已结题
• 来源: https://www.nsf.gov/awardsearch/showAward?AWD_ID=1714358&HistoricalAwards=false
• 关键词: Sociocultural; Practices; Maternal; Healthcare

This award was provided as part of NSF's Social, Behavioral and Economic Sciences Postdoctoral Research Fellowships (SPRF) program. The goal of the SPRF program is to prepare promising, early career doctoral-level scientists for scientific careers in academia, industry or private sector, and government. SPRF awards involve two years of training under the sponsorship of established scientists and encourage Postdoctoral Fellows to perform independent research. NSF seeks to promote the participation of scientists from all segments of the scientific community, including those from underrepresented groups, in its research programs and activities; the postdoctoral period is considered to be an important level of professional development in attaining this goal. Each Postdoctoral Fellow must address important scientific questions that advance their respective disciplinary fields. In this project, the Postdoctoral Research Fellow will contribute to our global understanding of the causes of disrespectful and abusive interactions that occur between healthcare providers and pregnant women during labor and while giving birth. While this particular research will take place in Tanzania, the problem of abuse in obstetrics care has recently gained attention as a global problem and a significant challenge to improving healthcare for pregnant women and newborns. This project will explore the interactions between women, their relatives, and healthcare providers in health facilities as the facilities implement a new birth companion program. Policy makers and public health practitioners see birth companion programs as one avenue for reducing abuse in maternal and reproductive health settings, and improving the quality of care and women's experiences in health facilities. This research will reveal underlying contributors to abusive behaviors, which can be used to inform explorations of similar issues both in the United States, particularly as minority women continue to experience worse maternal health outcomes, and in countries across the globe. Through a collaboration between public health experts, law and policy experts, and an anthropologist, this project presents opportunities to directly translate social science research findings into policy recommendations and programs that can be implemented to improve women's health. Additionally, the collaboration includes the Tanzanian Ifakara Health Institute (IHI) and the Fellow will engage in exchange of information, as well as training IHI staff members to build research capacity in Tanzania and promote scholarly collaboration between researchers in the Global North and the Global South, with the collective goal of continuing to improve maternal health globally.In places such as Tanzania, organizations working to implement birth companion programs say they are facing challenges as the Euro-American versions of comfort, support, and choice during labor and delivery fail to resonate with women. While, on the surface, program failure appears to result from disagreement or conflict over terms and their worth, this project proposes instead that the potential lack of success of these programs is largely due to deeper incompatibilities between conceptions of self and social connections, biological processes, and the hegemonic discourse that has come to make biomedicine effectively the only option for pregnant women in lower resource settings. In the context of a new birth companion program in Kigoma, Tanzania, this project will inquire about forms of care and support during childbirth to increase understanding of the diverse local constructions of these topics. The overall research objective is to investigate sociocultural and gendered concepts and practices of support, comfort, and care during pregnancy and childbirth, through three sub-objectives: 1) to elucidate women's and community member's perceptions of ideal birth experiences and how they enact these ideals; 2) to document how biomedical personnel conceptualize the role of, prioritize, and practice differing forms of care, comfort, and support during labor and delivery; and 3) to document how the presence of birth companions, as non-medical lay persons, influences the environment of maternity wards at health centers. The Fellow will conduct mixed-method, ethnographic fieldwork which will include interviews and cultural consensus analysis. The findings will provide insight into gendered negotiations of access to authority and power within these contexts and contribute to a more nuanced understanding of choice as it relates to biomedical care seeking, collective decision-making groups, and women's own, stated desires for care during childbirth. The project will also provide insight into how inequalities are formed, enacted, opposed, or reproduced within biomedical health facilities at the time of labor and childbirth, and how these processes can lead to disrespectful and abusive interactions.

该奖项是作为NSF社会、行为和经济学博士后研究奖学金(SPRF)计划的一部分提供的。SPRF计划的目标是为学术界、工业界或私营部门和政府的科学职业生涯培养有前途的、早期职业博士水平的科学家。SPRF奖项包括在知名科学家的赞助下进行两年的培训，并鼓励博士后研究员进行独立研究。国家科学基金会致力于促进科学界所有阶层的科学家参与其研究方案和活动，包括那些来自代表性不足的群体的科学家；博士后阶段被认为是实现这一目标的专业发展的一个重要水平。每个博士后研究员都必须解决推动各自学科领域向前发展的重要科学问题。在这个项目中，博士后研究员将有助于我们在全球范围内了解医疗保健提供者和孕妇在分娩期间和分娩期间发生不尊重和辱骂互动的原因。虽然这项特别的研究将在坦桑尼亚进行，但产科护理中的滥用问题最近已作为一个全球性问题受到关注，并对改善孕妇和新生儿的医疗保健提出了重大挑战。这个项目将探索妇女、她们的亲属和卫生设施中的医疗保健提供者之间的互动，因为这些设施实施了一个新的陪伴分娩计划。政策制定者和公共卫生从业者将陪伴计划视为减少孕产妇和生殖健康环境中的虐待行为、改善护理质量和妇女在卫生设施中的体验的途径之一。这项研究将揭示虐待行为的潜在贡献者，这可用于在美国和全球各国探索类似问题，特别是在少数族裔妇女继续经历更糟糕的孕产妇健康结果的情况下。通过公共卫生专家、法律和政策专家以及人类学家之间的合作，该项目提供了机会，将社会科学研究成果直接转化为可实施的政策建议和方案，以改善妇女的健康。此外，这项合作还包括坦桑尼亚Ifakara健康研究所(IHI)，该研究员将参与信息交流，以及培训IHI工作人员，以建设坦桑尼亚的研究能力，促进全球北方和全球南方研究人员之间的学术合作，共同目标是继续在全球范围内改善产妇健康。在坦桑尼亚等地，致力于实施陪伴分娩计划的组织表示，他们面临着挑战，因为欧美版本的舒适、支持和分娩选择未能引起女性的共鸣。虽然从表面上看，项目失败似乎是由于对条款及其价值的分歧或冲突，但该项目提出，这些项目潜在的不成功在很大程度上是由于自我和社会关系、生物过程以及霸权话语之间更深层次的不相容，而霸权话语已使生物医学有效地成为资源较少的孕妇的唯一选择。在坦桑尼亚基戈马一个新的陪伴分娩方案的背景下，该项目将询问分娩期间的护理和支持形式，以增加对这些专题的不同地方结构的了解。总体研究目标是通过三个子目标调查怀孕和分娩期间支持、舒适和护理的社会文化和性别概念和实践：1)阐明妇女和社区成员对理想分娩体验的看法，以及他们如何实施这些理想；2)记录生物医疗人员如何概念化、优先排序和实践不同形式的分娩、舒适和支持；以及3)记录产伴作为非医疗人员的存在如何影响保健中心产科病房的环境。这位研究员将进行混合方法的人种学田野调查，其中将包括采访和文化共识分析。这些发现将为在这些背景下获得权威和权力的性别谈判提供洞察，并有助于对选择的更微妙的理解，因为这涉及到生物医学护理寻求、集体决策小组以及妇女自己声明的分娩期间护理的愿望。该项目还将深入了解在分娩和分娩时，不平等是如何在生物医学卫生设施内形成、制定、反对或复制的，以及这些过程如何导致不尊重和辱骂的互动。