Medicalised maternities, markets and moralities in Bangladesh: Building academic foundations and transforming debates

我的博士研究探讨了孟加拉国最近对医疗分娩、孕产妇保健服务市场化和护理新道德的转变。进入21世纪后，该国绝大多数妇女在家中分娩，有非专业助产士在场。然而，近年来，在怀孕和分娩期间，人们迅速转向高度医疗化的做法。值得注意的是，到2016年，虽然有一半的妇女按照“传统”做法在家中分娩，但超过30%的妇女通过剖腹产分娩（NIPORT、icddr、b和MEASURE， 2019年）。先进的生物医学形式的怀孕和分娩护理，即剖腹产和超声波检查，主要是通过最低限度管制的保健市场提供的，该市场今天使生活在最偏远地区的所有社会阶层的妇女都能获得这些技术。我的博士研究试图弄清楚这些转变的意义，包括它们如何重塑妇女和家庭中的“良好护理”观念，产生新的医疗社会景观，以及在内部进行谈判并重新配置道德取向。这项工作对孟加拉国和整个全球南方的背景具有重要意义。这项奖学金将使我能够巩固我的发现，并最大限度地提高我的研究影响力。我将在博士研究的基础上产生大量的研究成果，从而为成为一名成功的学术人类学家奠定基础。它将使我能够改变与全球南方孕产妇保健技术和保健市场有关的学术和政策辩论，以适应对这种治疗前景的细致入微的描述。该奖学金的以下四个目标将协同工作，以实现这些目标：1)巩固发现：回到我的博士研究地点，花一个月的时间在私人健康诊所生成人种学数据。这将使我能够测试和调整我的初步发现，以发展研究成果。2)将自己定位为处于健康市场和孕产妇保健技术辩论前沿的人类学学者：从我的博士论文中制定出书建议，并将其提交给领先的学术出版社，例如康奈尔大学，斯坦福大学，杜克大学或剑桥大学，并将我的论文转化为学术专著。在奖学金结束时，我打算有一个准备出版的专著草案，并在合同下出版。我还将准备并提交至少一份手稿给一个领先的同行评审的人类学期刊，例如，美国民族学家和/或文化人类学，并在至少一个大型社会科学会议上展示我的研究在英国/欧洲（例如，EASA或ASA）。3)转变政策辩论：目前，与孟加拉国怀孕和分娩护理的技术和商品化有关的政策辩论往往以城市为中心，将妇女本质上视为不必要和有问题地过度使用商品化的孕产妇保健技术，并对私营卫生部门持负面态度，认为这是剥削和损害临床质量，以便根据资本主义逻辑实现利润最大化。作为一名全球卫生从业人员和博士研究员，我在孟加拉国工作了十多年，在此基础上，我将利用我的国内网络与孟加拉国合作者组织两次讲习班。这些会议将把公共卫生官员、私营卫生行为体、发展伙伴和研究人员聚集在一起，交流知识，推动辩论超越具体化的话语。在研讨会的基础上，我们将在一份全国性报纸上起草和发表一篇专栏文章，以推动政策和公共辩论超越以城市为中心的话语，这些话语强调私人保健提供和妇女寻求私人保健服务的动机。4)拓展我的教学技能：通过在有限范围内共同召集全球健康人类学课程，拓展我的教学技能广度。

My PhD research explored recent transformations towards medicalised childbirth, marketisation of maternal health services, and new moralities of care in Bangladesh. Well into the 2000s, the vast majority of women in the country gave birth at home in the presence of non-professionalised attendants. However, recent years have witnessed rapid shifts toward highly medicalised practices during pregnancy and birth. Remarkably, by 2016, while half of women gave birth at home according to 'traditional' practices, over 30% of women gave birth through caesarean (NIPORT, icddr,b and MEASURE, 2019). Advanced biomedical forms of pregnancy and birth care, i.e., caesarean and ultrasonograms, are primarily made available through a minimally regulated healthcare market which today places such technologies within reach of women of all social classes living in even the most remote areas. My PhD research sought to make sense of these transformations, including how they reshape ideas of 'good care' among women and families, generate new medico-social landscapes, and are negotiated within and reconfigure moral orientations. This work has important implications for Bangladesh and contexts throughout the Global South.This fellowship will allow me to consolidate my findings and maximise my research impact. I will generate substantial research outputs based on my PhD research, thereby laying the foundation for a successful career as an academic anthropologist. It will allow me to transform academic and policy debates related to maternal health technologies and health markets in the global South to accommodate nuanced accounts of the situatedness of such therapeutic landscapes. The following four objectives of this fellowship will work synergistically to achieve these aims:1) Consolidate findings: Return to my PhD field site and spend one month in private health clinics to generate ethnographic data. This will allow me to test and finetune my initial findings for developing research outputs. 2) Position myself as a scholar in anthropology at the forefront of debates on health markets and maternal health technologies: Develop a book proposal from my PhD thesis and submit it to a leading academic press, e.g., Cornell, Stanford, Duke or Cambridge, and transform my thesis into an academic monograph. By the end of the fellowship, I intend to have a publication-ready monograph draft moving towards publication under contract. I will also prepare and submit at least one manuscript to a leading peer-reviewed anthropology journal, e.g., the American Ethnologist and/or Cultural Anthropology, and present my research during at least one large social science conference in UK/Europe (e.g., EASA or ASA).3) Transform policy debates: Currently, policy debates related to the technologisation and commodification of pregnancy and birth care in Bangladesh tend to be urban-centric, essentialise women as unnecessarily and problematically overusing commodified maternal health technologies and carry a negative valence toward the private health sector as exploitative and compromising clinical quality in the interest of maximising profits according to capitalist logics. Building on over a decade of work in Bangladesh as a global health practicioner and PhD researcher, I will leverage my in-country networks to organise two workshops with Bangladeshi collaborators. These will bring together public health officials, private health actors, development partners and researchers to exchange knowledge and push debates past reified discourses. Based on the workshops, we will draft and publish an op-ed in a national newspaper to move policy and public debates past urban-centric discourses that essentialise private health care provision and women's motivations for seeking private health services. 4) Expand my teaching skillset: Expand the breadth of my teaching skillset through co-convening, in a limited scope, the Anthropology of Global Health course.