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

我的博士研究探索了孟加拉国最近向医疗分娩、孕产妇健康服务市场化和新的护理道德方面的转变。进入本世纪头十年，这个国家的绝大多数女性在家中分娩时，都有非专业的接生员在场。然而，最近几年见证了怀孕和分娩期间高度医疗化的快速转变。值得注意的是，到了2016年，虽然有一半的女性按照传统做法在家分娩，但超过30%的女性通过剖腹产分娩(NIPORT、ICDDR、b和MEASURE，2019年)。先进的生物医学怀孕和分娩护理形式，即剖腹产和超声波检查，主要是通过监管最少的医疗保健市场提供的，今天，这种技术使生活在最偏远地区的所有社会阶层的妇女都能获得这种技术。我的博士研究试图弄明白这些转变的意义，包括它们如何在女性和家庭中重塑“良好护理”的理念，创造新的医疗-社会景观，以及如何在道德取向内进行谈判和重新配置。这项工作对孟加拉和整个南半球都有重要的影响。这一奖学金将使我能够巩固我的发现，并最大限度地发挥我的研究影响。我将在我的博士研究的基础上产生大量的研究成果，从而为作为一名学术人类学家的成功职业生涯奠定基础。它将使我能够改变与全球南方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情况的细微差别的描述。该研究金的以下四个目标将协同工作以实现这些目标：1)巩固研究结果：返回我的博士现场，在私人卫生诊所呆一个月以生成人种学数据。这将使我能够测试和微调我的初步发现，以开发研究成果。2)将自己定位为一名人类学学者，置身于有关健康市场和孕产妇健康技术的辩论的前沿：根据我的博士论文制定出一份出书提案，并将其提交给领先的学术媒体，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。到奖学金结束时，我打算有一份可供出版的专著草稿，并按合同向出版迈进。我还将准备并向领先的同行评议的人类学杂志(例如，美国民族学家和/或文化人类学)提交至少一篇手稿，并在英国/欧洲至少一次大型社会科学会议(例如，EASA或ASA)上介绍我的研究。3)改变政策辩论：目前，孟加拉国与怀孕和生育护理技术化和商品化相关的政策辩论往往以城市为中心，将妇女视为不必要和有问题的过度使用商品化的孕产妇保健技术，并将私营卫生部门视为剥削性和折衷的临床质量，从而根据资本主义逻辑实现利润最大化。在作为全球卫生实践者和博士研究员在孟加拉国工作了十多年的基础上，我将利用我在国内的网络，与孟加拉国的合作者组织两次研讨会。这些会议将把公共卫生官员、私营卫生行为者、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，我们将起草并在一份全国性报纸上发表一篇评论文章，将政策和公共辩论超越以城市为中心的论述，这些论述强调私营医疗保健的提供和妇女寻求私营医疗服务的动机。4)扩展我的教学技能：通过在有限的范围内共同举办全球健康人类学课程来扩大我的教学技能的广度。

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.