Sociocultural Practices in Maternal Healthcare

This award was provided as part of NSF's Social, Behavioral and Economic Sciences Postdoctoral Research Fellowships (SPRF) program. The goal of the SPRF program is to prepare promising, early career doctoral-level scientists for scientific careers in academia, industry or private sector, and government. SPRF awards involve two years of training under the sponsorship of established scientists and encourage Postdoctoral Fellows to perform independent research. NSF seeks to promote the participation of scientists from all segments of the scientific community, including those from underrepresented groups, in its research programs and activities; the postdoctoral period is considered to be an important level of professional development in attaining this goal. Each Postdoctoral Fellow must address important scientific questions that advance their respective disciplinary fields. In this project, the Postdoctoral Research Fellow will contribute to our global understanding of the causes of disrespectful and abusive interactions that occur between healthcare providers and pregnant women during labor and while giving birth. While this particular research will take place in Tanzania, the problem of abuse in obstetrics care has recently gained attention as a global problem and a significant challenge to improving healthcare for pregnant women and newborns. This project will explore the interactions between women, their relatives, and healthcare providers in health facilities as the facilities implement a new birth companion program. Policy makers and public health practitioners see birth companion programs as one avenue for reducing abuse in maternal and reproductive health settings, and improving the quality of care and women's experiences in health facilities. This research will reveal underlying contributors to abusive behaviors, which can be used to inform explorations of similar issues both in the United States, particularly as minority women continue to experience worse maternal health outcomes, and in countries across the globe. Through a collaboration between public health experts, law and policy experts, and an anthropologist, this project presents opportunities to directly translate social science research findings into policy recommendations and programs that can be implemented to improve women's health. Additionally, the collaboration includes the Tanzanian Ifakara Health Institute (IHI) and the Fellow will engage in exchange of information, as well as training IHI staff members to build research capacity in Tanzania and promote scholarly collaboration between researchers in the Global North and the Global South, with the collective goal of continuing to improve maternal health globally.

In places such as Tanzania, organizations working to implement birth companion programs say they are facing challenges as the Euro-American versions of comfort, support, and choice during labor and delivery fail to resonate with women. While, on the surface, program failure appears to result from disagreement or conflict over terms and their worth, this project proposes instead that the potential lack of success of these programs is largely due to deeper incompatibilities between conceptions of self and social connections, biological processes, and the hegemonic discourse that has come to make biomedicine effectively the only option for pregnant women in lower resource settings. In the context of a new birth companion program in Kigoma, Tanzania, this project will inquire about forms of care and support during childbirth to increase understanding of the diverse local constructions of these topics. The overall research objective is to investigate sociocultural and gendered concepts and practices of support, comfort, and care during pregnancy and childbirth, through three sub-objectives: 1) to elucidate women's and community member's perceptions of ideal birth experiences and how they enact these ideals; 2) to document how biomedical personnel conceptualize the role of, prioritize, and practice differing forms of care, comfort, and support during labor and delivery; and 3) to document how the presence of birth companions, as non-medical lay persons, influences the environment of maternity wards at health centers. The Fellow will conduct mixed-method, ethnographic fieldwork which will include interviews and cultural consensus analysis. The findings will provide insight into gendered negotiations of access to authority and power within these contexts and contribute to a more nuanced understanding of choice as it relates to biomedical care seeking, collective decision-making groups, and women's own, stated desires for care during childbirth. The project will also provide insight into how inequalities are formed, enacted, opposed, or reproduced within biomedical health facilities at the time of labor and childbirth, and how these processes can lead to disrespectful and abusive interactions.