Sociocultural Practices in Maternal Healthcare

该奖项是作为NSF的社会，行为和经济科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，工业或私营部门和政府的科学事业准备有前途的早期职业博士级科学家。SPRF的奖励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。NSF致力于促进来自科学界各部门的科学家，包括来自代表性不足的群体的科学家参与其研究计划和活动;博士后期间被认为是实现这一目标的专业发展的重要水平。每个博士后研究员必须解决推进各自学科领域的重要科学问题。在这个项目中，博士后研究员将有助于我们对医疗保健提供者和孕妇在分娩期间和分娩时发生的不尊重和虐待互动的原因的全球理解。虽然这项研究将在坦桑尼亚进行，但产科护理中的虐待问题最近作为一个全球性问题和改善孕妇和新生儿保健的重大挑战而受到关注。该项目将探讨妇女，他们的亲属和医疗保健提供者之间的相互作用，在卫生设施的设施实施新的分娩伴侣计划。政策制定者和公共卫生从业人员将陪伴分娩方案视为减少孕产妇和生殖健康环境中的虐待行为、改善保健质量和妇女在保健设施中的体验的一种途径。这项研究将揭示虐待行为的潜在因素，这些因素可用于探索美国的类似问题，特别是少数民族妇女继续经历更糟糕的孕产妇健康结果，以及地球仪的国家。通过公共卫生专家、法律和政策专家以及一名人类学家之间的合作，该项目提供了将社会科学研究成果直接转化为政策建议和方案的机会，这些建议和方案可用于改善妇女的健康。此外，合作还包括坦桑尼亚Ifakara健康研究所（IHI）和研究员将参与信息交流，以及培训IHI工作人员，以建立坦桑尼亚的研究能力，促进全球北方和南方研究人员之间的学术合作，共同目标是继续改善全球孕产妇健康。在坦桑尼亚等地，致力于实施生育伴侣计划的组织表示，他们面临着挑战，因为欧美版本的分娩和分娩期间的舒适，支持和选择无法与女性产生共鸣。虽然，从表面上看，程序失败似乎是由于分歧或冲突的条款和他们的价值，这个项目提出，而不是这些程序的潜在缺乏成功的主要是由于自我和社会关系，生物过程的概念之间更深层次的不兼容，霸权话语，已经使生物医学有效地在较低的资源设置为孕妇的唯一选择。在坦桑尼亚基戈马的一个新的陪伴分娩方案的背景下，该项目将调查分娩期间的护理和支助形式，以增加对这些主题的不同地方结构的理解。本研究的总体目标是通过三个子目标来调查社会文化和性别的概念和实践，包括怀孕和分娩期间的支持，舒适和护理：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现这些理想; 2）记录生物医学人员如何概念化的作用，优先考虑，并在劳动和分娩过程中实践不同形式的护理，舒适和支持; 3）记录助产士作为非医务人员的存在如何影响保健中心产科病房的环境。该研究员将进行混合方法，人种学实地考察，其中将包括访谈和文化共识分析。调查结果将提供深入了解性别谈判的权力和权力在这些情况下，并有助于更细致入微的理解选择，因为它涉及到生物医学护理寻求，集体决策群体，以及妇女自己的，表示希望在分娩期间护理。该项目还将深入了解不平等是如何形成的，制定，反对，或在分娩和分娩时在生物医学卫生设施内复制，以及这些过程如何导致不尊重和虐待的互动。

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.