Doctoral Dissertation Research Improvement: Medical System-State Collaborations

这项研究调查了政府强制令如何影响对吸毒孕妇的医疗反应。联邦和州的规定越来越多地鼓励医疗提供者在怀疑孕妇使用围产期物质时发起惩罚性的州回应。这对医务人员作为患者护理提供者的专业角色提出了挑战。本研究使用多种定性的方法来调查不同的行为者在这一过程中的行为，国家行为者、医疗专业人员和孕妇。这项研究的结果有可能影响政府对药物使用孕妇的决策，以及医学专家和孕产妇健康倡导者的反应。本研究采用多层次分析来评估相互影响孕妇干预措施的宏观、微观和中级因素。为了评估宏观层面的进程，通过与医学专家和儿童福利倡导者等利益攸关方的访谈，进行了一项系统层面的分析，着眼于政策领域(包括药物政策、儿童福利政策和母婴健康政策)如何影响医疗议程并鼓励医疗-法律合作。在中级层面，一项为期一年的劳动和分娩单位人种学研究揭示了日常医疗实践是如何进行的，以及国家在多大程度上被邀请参与或干预这些过程。在微观层面上，对医疗专业人员和直接受医学启动的国家制裁影响的妇女进行的半结构化采访显示了医疗与国家合作如何影响护理结果和患者福祉。在整个过程中，一个关键的考虑因素是社会阶层和种族在塑造机构响应中所扮演的角色。这一奖项反映了NSF的法定使命，并通过使用基金会的智力优势和更广泛的影响审查标准进行评估，被认为值得支持。

The study examines how government mandates affect medical responses to substance-using pregnant women. Federal and state mandates increasingly encourage medical providers to initiate punitive state responses when they suspect perinatal substance use by pregnant women. This challenges the professional role of medical personnel as providers of care to their patients. This study uses a variety of qualitative methods to investigate the actions of the different actors in this process, state actors, medical professionals, and pregnant women. Findings of this research have the potential to influence government policy-making concerning substance-using pregnant women as well as the responses of medical experts and maternal health advocates. This study employs a multi-level analysis to assess macro, micro, and intermediate level factors that mutually shape interventions on pregnant women. To assess macro-level processes, a systems-level analysis informed by interviews with stakeholders such as medical experts and child welfare advocates looks at how policy domains (including drug policy, child welfare policy, and maternal-fetal health policy) shape medical agendas and encourage medico-legal collaborations. At an intermediate level, a year-long ethnographic study of a Labor and Delivery unit uncovers how day-to-day medical practices are carried out and to what extent the state is invited into or intervenes upon these processes. At the micro level, semi-structured interviews with medical professionals and women directly affected by medically-initiated state sanctions show how medical-state collaborations affect care outcomes and patient well-being. A key consideration throughout is the role that social class and race play in shaping institutional responses.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.