Doctoral Dissertation Research:Improved Modeling of Medical Decision-Making around Maternal Health Care

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This research aims to improve scientific understanding of the variables that contribute to the distrust of mainstream medical and scientific knowledge. Research has shown that mistrust in mainstream medicine is increasing among communities who tend to be socially, economically, and politically powerful, and that these beliefs are associated in certain contexts with public health events, such as outbreaks of vaccine-preventable diseases. An improved understanding of how social factors can render resistance to medical authority attractive can uncover ways to better understand, predict, and address mistrust in medicine and science more broadly. This project provides a scalable set of methodological and theoretical innovations aimed at understanding resistance to mainstream medicine that will provide frameworks to help researchers better understand medical mistrust in other communities. In addition to training a doctoral student in qualitative and quantitative data collection methods and anthropological theory, the results of this research will be disseminated broadly to scholarly, medical, and lay communities. Specifically, this project focuses on medical decision-making during pregnancy, birth, infancy, and early childhood (when questions of routine vaccinations must be addressed), among a community that has not been historically mistreated by biomedical research, but where medical mistrust has been observed in prior research. It will investigate potential overlap between preferring non-mainstream care during birth and being mistrustful of mainstream medicine more generally. Investigators use ethnographic, pile sorts, and survey methodologies to examine whether and how medical decisions that reject the authority of mainstream medicine might be shaped by shared, subjective, and local ontologies, whether there are social and epistemological characteristics that distinguish mistrustful communities from others, and what characteristics might make medical interventions in pregnancy and early childhood more, or less, acceptable. Findings from this project will improve anthropological understandings about resistance to medical authority, how people make medical decisions, and how groups perceive and engage (or not) with mainstream medicine and other powerful social institutions.This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.