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Discourses of Childlessness in Bangladesh 关于孟加拉国无子女的论述
Pub Date : 2021-11-18 DOI: 10.1093/oso/9780190130718.003.0012
Mirza Taslima Sultana
This chapter explores the discourses around medical and alternative treatments that emerged in the accounts of 11 middle-class Bengali women who sought treatment for their childlessness. Fertility has been considered a prime problem for Bangladesh since the 1980s, and policy documents still focus on fertility reduction, along with reducing maternal mortality. Yet, no recent policy documents considered childlessness as a problem. This investigation informs of the links between biomedical power and childlessness as they are emerging in urban Bangladesh. The sections of this chapter discuss the concepts of biopower and agency, illustrate the different trajectories interviewees pursued in dealing with childlessness, focus on the issue of the so-called perfect age for assisted reproductive technology (ART) treatments, and explore interviewees’ stories of their experiences of IVF. The concluding section discusses these women’s accounts of the beliefs according to which they actively decide their technological options.
本章探讨了11名孟加拉中产阶级妇女因无子女而寻求治疗的医疗和替代治疗的话语。自20世纪80年代以来,生育率一直被认为是孟加拉国的一个主要问题,政策文件仍然侧重于降低生育率,同时降低孕产妇死亡率。然而,最近的政策文件没有将无子女视为一个问题。这项调查揭示了在孟加拉国城市出现的生物医学权力与无子女之间的联系。本章讨论了生物权力和代理的概念,说明了受访者在处理无子女问题时所追求的不同轨迹,重点关注所谓的辅助生殖技术(ART)治疗的完美年龄问题,并探讨了受访者的试管婴儿经历故事。结束语部分讨论了这些女性的信仰,她们根据这些信仰积极地决定自己的技术选择。
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引用次数: 0
Son Preference in India 印度的重男轻女现象
Pub Date : 2021-11-18 DOI: 10.1093/oso/9780190130718.003.0010
Clémence Jullien
Through a focus on Rajasthan, this chapter analyses how government awareness campaigns for gender equality, as well as a sharp rise in institutional deliveries throughout the country in the 2000s, have affected how son preference is discussed and treated in hospitals. Drawing on 3 months of ethnographic fieldwork in a government hospital in Jaipur, this chapter shows that the condemnation of son preference has enhanced regimes of medical and moral surveillance within obstetric wards. Not only does it contribute to further castigation and self-disciplining mechanisms, but it also constitutes a new opportunity for social distinction. While condemning son preference practices, women, nurses, and doctors are constantly finding scapegoats in social classes, state, and generational differences. Thus, this chapter considers whether the public condemnation of son preference, currently jeopardizing the relationship of trust between caregivers and patients, could undermine government policies on safe motherhood.
本章以拉贾斯坦邦为重点,分析了政府宣传性别平等的运动,以及2000年代全国机构分娩数量的急剧上升,如何影响了医院讨论和治疗重男轻女的方式。根据在斋浦尔一家政府医院进行的为期3个月的人种学实地调查,本章表明,对重男轻女的谴责加强了产科病房内的医疗和道德监督制度。它不仅有助于进一步的惩罚和自律机制,而且还构成了社会区分的新机会。在谴责重男轻女的同时,妇女、护士和医生不断地从社会阶层、国家和代际差异中寻找替罪羊。因此,本章考虑公众对重男轻女的谴责是否会破坏政府关于安全孕产的政策,这种谴责目前正在危及护理人员和患者之间的信任关系。
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引用次数: 0
‘Since It’s a Pleasure to Save Somebody’s Life, I Do This’ “因为拯救别人的生命是一种乐趣,所以我这样做了”
Pub Date : 2021-11-18 DOI: 10.1093/oso/9780190130718.003.0005
H. Vallianatos
Health development efforts to decrease maternal and neonatal morbidity and mortality in South Asia have included a role for trained and/or traditional birth attendants since the late 20th century. Birth attendants are typically older women, who assist not only during birth but who also can provide counsel during pregnancy and lactation. Based on an ethnographic case study, focused on a jhuggi-jhopri (squatter) settlement in New Delhi, this chapter differentiates between two types of birth attendants. Traditional birth attendants are women who have learned their skills and knowledge, typically from elder women relatives, through apprenticeship. Their tools of practice include herbal knowledge as well as ‘modern’ medical kits they may have received through health education efforts (for example, scissors to cut the umbilical cord). In contrast, trained birth attendants are older women who were recruited through local health organizations (both governmental and non-governmental) and trained by biomedical practitioners to provide frontline care. This chapter examines both traditional and trained birth attendants’ perspectives on assisting local mothers, examining how local mothers view traditional versus trained birth attendants and, in turn, how this may affect their birth experiences
自20世纪末以来,为降低南亚孕产妇和新生儿发病率和死亡率而作出的卫生发展努力包括发挥训练有素和(或)传统助产士的作用。助产士通常是年龄较大的妇女,她们不仅在分娩期间提供帮助,而且还可以在怀孕和哺乳期间提供咨询。本章以一个民族志案例研究为基础,重点研究了新德里的jhuggi-jhopri(寮屋者)定居点,区分了两种类型的接生员。传统的助产士是通过学徒制从年长的女性亲属那里学习技能和知识的妇女。她们的实践工具包括草药知识以及她们可能通过健康教育工作获得的“现代”医疗包(例如剪脐带的剪刀)。相比之下,训练有素的助产士是通过当地卫生组织(政府和非政府)招募的老年妇女,由生物医学从业人员培训,提供一线护理。本章考察了传统助产士和训练有素的助产士在协助当地母亲方面的观点,考察了当地母亲如何看待传统助产士和训练有素的助产士,以及这可能如何影响她们的分娩经历
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引用次数: 0
Outsiders in the Village 村里的外人
Pub Date : 2021-11-18 DOI: 10.1093/oso/9780190130718.003.0007
J. Killmer
A shortage of women doctors in Rajasthan’s rural government sector has left sizeable gaps in the provision of women’s healthcare. This chapter explores how, in their narratives, women doctors position themselves as outsiders in the village, unable to create successful careers and lives in rural spaces. Medical graduates considering a rural career must contend with the hierarchy of medical prestige that places cities above villages and the timescale that frames villages as ‘backwards’ spaces. In doctors’ narratives of the village, doctors used the village as code for low educational and class status—and by separating themselves from the geographical space of the village, they also put metaphorical distance between themselves and their subaltern Other. Women doctors’ reluctance to occupy rural space illuminates the ways that class, space, and gender overlap to shape the practice of healthcare, with impacts felt far beyond the careers of doctors.
拉贾斯坦邦农村政府部门的女医生短缺,在提供妇女保健方面留下了相当大的差距。这一章探讨了在她们的叙述中,女医生如何将自己定位为农村的局外人,无法在农村空间创造成功的事业和生活。考虑到农村工作的医学毕业生必须与城市高于乡村的医疗声望等级制度和将乡村定义为“落后”空间的时间尺度作斗争。在医生对村庄的叙述中,医生将村庄作为低教育和低阶级地位的代号,通过将自己与村庄的地理空间分离,他们也在自己与次等的他者之间建立了隐喻性的距离。女医生不愿占据农村空间,说明了阶级、空间和性别重叠影响医疗保健实践的方式,其影响远远超出了医生的职业生涯。
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引用次数: 0
Training Birth Attendants in India 在印度培训助产士
Pub Date : 2021-11-18 DOI: 10.1093/oso/9780190130718.003.0004
P. H. Petitet
This chapter documents the local and global processes of construction, legitimization and delegitimization, and the political uses of the knowledge of traditional birth attendants—TBAs. Based on four years’ ethnographical investigation in Tamil Nadu, this chapter discusses the issue from various points of view. It looks at the debates of actors involved in the national and international public health agendas, Indian movements promoting ‘Natural Childbirth’, and movements in favour of the preservation of traditional systems of medicine. TBAs are variously perceived as wicked mothers whose archaic practices must be controlled, the archetypal ambassadors of traditional knowledge, or as relevant actors bringing together ideal elements of any development activity—locality, community, and low cost. This careful reading of the contemporary social representations of TBAs and of their role reconfigurations offers a lens to examine authoritative knowledge’s social forms, practices, and paradoxes.
本章记录了当地和全球的建设、合法化和非合法化的过程,以及传统助产士(tbas)知识的政治用途。本章基于对泰米尔纳德邦四年的民族志调查,从多个角度探讨了这一问题。它着眼于参与国家和国际公共卫生议程的行动者的辩论,促进“自然分娩”的印度运动,以及有利于保护传统医学系统的运动。TBAs被认为是邪恶的母亲,其古老的做法必须得到控制,是传统知识的典型大使,或者是将任何发展活动的理想元素——地方、社区和低成本——汇集在一起的相关角色。这种对tba的当代社会表现及其角色重新配置的仔细阅读,提供了一个审视权威知识的社会形式、实践和悖论的镜头。
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引用次数: 0
Politics of Childbirth in Nepal 尼泊尔的分娩政治
Pub Date : 2021-11-18 DOI: 10.1093/oso/9780190130718.003.0011
J. Sharma, R. Adhikari
Nepal has been hailed as a global success in reducing the maternal mortality ratio from around 540 women dying per 100,000 births in 1996 to about 240 in 2016. The chapter will critically analyse two interventions implemented around 2005. First, we will look at the USAID-funded Nepal Family Health Program, through which oral misoprostol (to control bleeding after delivery) was launched across Nepal. Second, we will look at Aama Surakshya Karyakram (or mother programme), which was implemented to promote institutional delivery. These two programmes, despite aiming to address high maternal mortality ratio in Nepal, adopted very different approaches, reflecting ideological struggles on women’s agency and the politics of childbirth. The chapter concludes that the costs of these changes (such as the lack of resources or the commercialization of healthcare) have been overlooked in the claims of Nepal’s ‘success’.
尼泊尔被誉为全球成功地将孕产妇死亡率从1996年的每10万例分娩约540例死亡降至2016年的约240例死亡。本章将批判性地分析2005年前后实施的两项干预措施。首先,我们将考察由美国国际开发署资助的尼泊尔家庭健康项目,通过该项目在尼泊尔各地推出口服米索前列醇(用于控制产后出血)。其次,我们将研究Aama Surakshya Karyakram(或母方案),该方案的实施是为了促进机构交付。这两个方案虽然旨在解决尼泊尔的高产妇死亡率问题,但采用了截然不同的方法,反映了妇女机构和分娩政治方面的意识形态斗争。这一章的结论是,这些变化的成本(如缺乏资源或医疗保健的商业化)在尼泊尔的“成功”的说法中被忽视了。
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引用次数: 0
Care’s Profit 护理的利润
Pub Date : 2021-11-18 DOI: 10.1093/oso/9780190130718.003.0008
Isabelle L Lange, Sunita Bhadauria, Sunita Singh, Loveday Penn-Kekana
Using a layered, ethnographic approach focusing on four small non-corporate private maternity hospitals, we turn a critical lens on what it means to work within this self-regulated bubble and examine the ‘creation’ of a cadre of healthcare workers. Our analysis addresses how a space of care and business is generated out of the precarious positions of both women and the health workers who depend on employment there. Clinic owners’ staffing strategies centred on hiring unlicensed labour room staff, trained on the job rather than in accredited institutes, who take care of all aspects of patient care, including deliveries. By exploring narratives surrounding training and overtreatment, this chapter highlights the tensions between the value placed on profit, care, and working conditions in the private maternal health sector, and examines the structural vulnerability of unlicensed health providers working there.
我们以四家小型非企业私立妇产医院为研究对象,采用一种分层的民族志方法,从关键的角度审视在这个自我监管的泡沫中工作意味着什么,并审视医疗工作者骨干队伍的“创造”。我们的分析涉及如何从妇女和依赖在那里就业的卫生工作者的不稳定地位中创造出一个护理和商业空间。诊所所有者的人员配置策略集中在雇用无照的产房工作人员,他们接受过在职培训,而不是在认可的机构接受培训,负责病人护理的各个方面,包括分娩。通过探讨培训和过度治疗的相关叙述,本章强调了私营孕产妇保健部门利润、护理和工作条件之间的紧张关系,并检查了在那里工作的无证医疗服务提供者的结构性脆弱性。
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引用次数: 0
Changing Childbirth in Twenty-First-Century South Asia 21世纪南亚的分娩变化
Pub Date : 2021-11-18 DOI: 10.1093/oso/9780190130718.003.0001
Clémence Jullien, R. Jeffery
This introduction sets out why childbirth is a salient and timely issue for South Asia—for example, continuing, relatively high maternal and child mortality rates; growing health inequities within the countries; and new and unprecedented government schemes. It discusses the old challenges and new paradoxes of childbirth in South Asia in a global context, by reviewing the main turning points of state policies of four South Asian countries (India, Pakistan, Nepal, and Bangladesh) over the last century.After offering an overview of some main policy reforms, the introduction explores the ambivalent effects of the introduction of new obstetrical technologies (including institutional practices) and the medicalization of childbirth. A third section reflects on the scope and the importance of rights-based approaches in maternal healthcare. The chapter concludes by explaining the structure of the book and briefly introducing each chapter.
本导言阐述了为什么生育对南亚来说是一个突出和及时的问题——例如,持续的、相对较高的孕产妇和儿童死亡率;各国内部卫生不平等现象日益严重;以及前所未有的新政府计划。它通过回顾上个世纪四个南亚国家(印度、巴基斯坦、尼泊尔和孟加拉国)国家政策的主要转折点,讨论了在全球背景下南亚生育的旧挑战和新悖论。在概述了一些主要的政策改革之后,引言探讨了引入新的产科技术(包括机构实践)和分娩医疗化的矛盾影响。第三部分反映了在孕产妇保健中基于权利的做法的范围和重要性。本章最后解释了本书的结构,并简要介绍了每一章。
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引用次数: 0
Digitalizing Community Health 数字化社区卫生
Pub Date : 2021-11-18 DOI: 10.1093/oso/9780190130718.003.0013
Marine Al Dahdah, Alok Kumar
Through the study of ‘Motech’—a global mHealth programme on maternal health implemented in Ghana and India—this chapter offers the first analysis of the use of mobile phones as a tool in such programmes. This chapter focuses on the particular role of community health workers in establishing this programme. It questions the competing strategies to enhance or substitute these workers that are linked to the expansion of these new technical artefacts. This vision—of the health worker assisted by the mobile—is twofold: on the one hand, it would make the health worker efficient and omniscient; on the other hand, it calls into question the knowledge of health workers and their autonomy through an automated system of communication. This research provides a better understanding of the special status of mobile phones and mHealth applications for community health workers and how their use changes the practice of community health.
通过对“Motech”——一个在加纳和印度实施的关于孕产妇健康的全球移动医疗方案——的研究,本章首次分析了在此类方案中使用移动电话作为工具的情况。本章的重点是社区保健工作者在制定这一方案方面的特殊作用。它质疑提高或替代这些工人的竞争策略,这些工人与这些新技术人工制品的扩展有关。这种由移动设备辅助的卫生工作者的愿景是双重的:一方面,它将使卫生工作者变得高效和无所不知;另一方面,它对卫生工作者的知识和他们通过自动化通信系统的自主权提出了质疑。本研究更好地了解了移动电话和移动健康应用程序对社区卫生工作者的特殊地位,以及它们的使用如何改变社区卫生实践。
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引用次数: 0
Forms and Ethics of Baloch Midwifery 俾路支助产的形式和伦理
Pub Date : 2021-11-18 DOI: 10.1093/oso/9780190130718.003.0003
Fouzieyha Towghi
In Pakistan, the rise of unnecessary uterotonic injections to induce childbirth, sometimes also resulting in hysterectomies, has women returning to dhīnabogs (Baloch midwives) to heal the iatrogenic effects of biomedical interventions; and reinforcing local assumptions about the benefits of Balochi dhawā/medicine, dhīnabogiri or midwifery, and homebirths. Drawing on ethnographic research in Balochistan the chapter traces how dhīnabogs’ work, ethical stances, and critical outlook concerning the iatrogenic effects of biomedical interventions are non-oppositional forms of everyday resistance. The protective role of dhīnabogiri is embedded in the intimate aspects of childbirth that profoundly structure the ethical relationship between the labouring woman and her dhīnabog. This relationship is defined not only by dhīnabogs’ concern for the well-being of mother and child, but also by their character and ethics, which are inscribed in the vernacular and social authorized praxis of dhīnabogs , kawwās (expert midwives) and balluk (granny midwives).
在巴基斯坦,为引产而进行的不必要的子宫扩张注射增多,有时也导致子宫切除,这使妇女回到dh纳博格(俾路支助产士)那里治疗生物医学干预的医源性影响;并强化了当地关于俾路支医疗、助产和家庭分娩的好处的假设。本章以俾路支省的民族志研究为基础,追溯了dh纳博格关于生物医学干预的医源性影响的工作、伦理立场和批判观点是如何成为日常抵抗的非对立形式的。dh纳博吉里的保护作用嵌入了分娩的亲密方面,深刻地构建了劳动妇女和她的dh纳博吉之间的伦理关系。这种关系不仅体现在dh纳博格对母亲和孩子幸福的关心上,还体现在他们的性格和道德规范上,这些都刻在了dh纳博格的方言和社会认可的实践中,kawwās(专业助产士)和balluk(奶奶助产士)。
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引用次数: 0
期刊
Childbirth in South Asia
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