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Rubashkin N. Epistemic Silences and Experiential Knowledge in Decisions After a First Cesarean: The case of a vaginal birth after cesarean calculator. Med Anthropol Q 2023; 37:341-353. [PMID: 37459454 PMCID: PMC10993819 DOI: 10.1111/maq.12784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 05/01/2023] [Indexed: 12/02/2023]
Abstract
Evidence-based obstetrics can employ statistical models to justify greater use of cesareans, sometimes excluding experiential elements from informed decision making. Over the past decade, prenatal providers adopted a vaginal birth after cesarean (VBAC) calculator designed to support patients in making informed decisions about their births by estimating their probability for a VBAC. Among other factors, the calculator used race and ethnicity to make its estimate, assigning lower probabilities for a successful VBAC to Black and Hispanic patients. I analyze how a diverse group of women and their providers engaged with the VBAC calculator. Some providers used low calculator scores to remove a shared decision-making model by prescriptively counseling Black and Hispanic women who desired a VBAC into undergoing repeat cesareans. Consequently, women racialized by the calculator as Black or Hispanic used experiential knowledge to challenge the calculator's assessment of their supposed lesser ability to give birth vaginally.
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Affiliation(s)
- Nicholas Rubashkin
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California at San Francisco, San Francisco, United States
- Institute for Global Health Sciences, University of California at San Francisco, San Francisco, United States
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Greiner R. Towards Critical Studies of Disabilities: engaging Latin American theoretical perspectives on Congenital Zika Syndrome. HORIZONTES ANTROPOLÓGICOS 2022. [DOI: 10.1590/s0104-71832022000300006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Abstract Infection with the Zika virus during pregnancy can cause disability, yet disability remains under theorised in studies on Congenital Zika Syndrome (CZS). Existing studies are largely exploratory and descriptive in nature, and thus a deeper analysis is needed. Where theory has been applied, there is limited engagement with Latin American theoretical perspectives. The social construction of disability, and of caregiver identity in particular warrant further analysis. Understanding that disability is constructed through an ‘ideology of normality’ can help make sense of parents’ reactions to a diagnosis of CZS. Caregivers resistance to biomedical narratives about disability is apparent in the case of CZS and deserves further attention. Consideration has been given to the ways that social location and shared temporality in relationships of care shape caregiver identity. Here I read these together to reach a fuller understanding of how caregivers and the people they care for develop a shared embodiment. An analysis bringing together Latin American Critical Disability Studies with other critical theoretical perspectives can advance theorisations of disability and the experiences of caregivers in their social, political, economic and historical contexts.
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Cristea F, Weishaar H, Geurts B, Delamou A, Tan MMJ, Legido-Quigley H, Aminu K, Mari-Sáez A, Rocha C, Camara B, Barry L, Thea P, Boucsein J, Bahr T, Al-Awlaqi S, Pozo-Martin F, Boklage E, Jegede AS, Bcheraoui CE. A comparative analysis of experienced uncertainties in relation to risk communication during COVID19: a four-country study. Global Health 2022; 18:66. [PMID: 35761365 PMCID: PMC9235152 DOI: 10.1186/s12992-022-00857-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/10/2022] [Indexed: 11/25/2022] Open
Abstract
Background During outbreaks, uncertainties experienced by affected communities can influence their compliance to government guidance on public health. Communicators and authorities are, hence, encouraged to acknowledge and address such uncertainties. However, in the midst of public health crises, it can become difficult to define and identify uncertainties that are most relevant to address. We analyzed data on COVID-19-related uncertainties from four socio-economic contexts to explore how uncertainties can influence people’s perception of, and response to Risk Communication and Community Engagement (RCCE) strategies. Results This qualitative study, which adopts an interpretative approach, is based on data from a documentary review, key informant interviews (KII), and focus group discussions (FGD) with members of the general public and people with barriers to information from Germany, Guinea, Nigeria, and Singapore. Transcripts from the KII and FGD were coded and analyzed thematically. We interviewed a total of 155 KIs and conducted 73 FGD. Our analysis uncovered a divergence between uncertainties deemed relevant by stakeholders involved in policy making and uncertainties that people reportedly had to navigate in their everyday lives and which they considered relevant during the pandemic. We identified four types of uncertainties that seemed to have influenced people’s assessment of the disease risk and their trust in the pandemic control strategies including RCCE efforts: epidemiological uncertainties (related to the nature and severity of the virus), information uncertainties (related to access to reliable information), social uncertainties (related to social behavior in times of heightened risk), and economic uncertainties (related to financial insecurities). Conclusion We suggest that in future outbreaks, communicators and policy makers could improve the way in which affected communities assess their risk, and increase the trust of these communities in response efforts by addressing non-epidemiological uncertainties in RCCE strategies.
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Affiliation(s)
- Florin Cristea
- Evidence-Based Public Health Unit, Centre for International Health Protection, Robert Koch Institute, Nordufer 20, 13353, Berlin, Germany
| | - Heide Weishaar
- Evidence-Based Public Health Unit, Centre for International Health Protection, Robert Koch Institute, Nordufer 20, 13353, Berlin, Germany
| | - Brogan Geurts
- Evidence-Based Public Health Unit, Centre for International Health Protection, Robert Koch Institute, Nordufer 20, 13353, Berlin, Germany
| | - Alexandre Delamou
- African Center of Excellence for the Prevention and Control of Communicable Diseases & Centre de Formation et de Recherche en Santé Rurale de Maferinyah, PoBox 1017, Dixinn, Conakry, Guinea
| | - Melisa Mei Jin Tan
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Kafayat Aminu
- Department of Sociology, Faculty of the Social Sciences, University of Ibadan, 1, Oyo Road, Agbowo, Ibadan, Nigeria
| | - Almudena Mari-Sáez
- Centre for International Health Protection, Robert Koch Institute, Nordufer 20, 13353, Berlin, Germany
| | - Carlos Rocha
- Centre for International Health Protection, Robert Koch Institute, Nordufer 20, 13353, Berlin, Germany
| | - Bienvenu Camara
- Centre de Formation et de Recherche en Santé Rurale de Maferinyah, Département de Recherche, Unité de Socio-Anthropologie, Conakry, Guinea
| | - Lansana Barry
- African Center of Excellence for the Prevention and Control of Communicable Diseases, PoBox 1017, Dixinn, Conakry, Guinea
| | - Paul Thea
- African Center of Excellence for the Prevention and Control of Communicable Diseases, PoBox 1017, Dixinn, Conakry, Guinea
| | - Johannes Boucsein
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Nordufer 20, 13353, Berlin, Germany.,Postgraduate Training for Applied Epidemiology (PAE), Robert Koch Institute, Berlin, Germany.,European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Thurid Bahr
- Evidence-Based Public Health Unit, Centre for International Health Protection, Robert Koch Institute, Nordufer 20, 13353, Berlin, Germany
| | - Sameh Al-Awlaqi
- Evidence-Based Public Health Unit, Centre for International Health Protection, Robert Koch Institute, Nordufer 20, 13353, Berlin, Germany
| | - Francisco Pozo-Martin
- Evidence-Based Public Health Unit, Centre for International Health Protection, Robert Koch Institute, Nordufer 20, 13353, Berlin, Germany
| | - Evgeniya Boklage
- Health Information Centre for International Health Protection unit, Centre for International Health Protection, Robert Koch Institute, Nordufer 20, 13353, Berlin, Germany
| | - Ayodele Samuel Jegede
- Department of Sociology, Faculty of the Social Sciences, University of Ibadan, 1, Oyo Road, Agbowo, Ibadan, Nigeria
| | - Charbel El Bcheraoui
- Evidence-Based Public Health Unit, Centre for International Health Protection, Robert Koch Institute, Nordufer 20, 13353, Berlin, Germany.
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Kameda K, Kelly AH, Lezaun J, Löwy I. Imperfect diagnosis: The truncated legacies of Zika testing. SOCIAL STUDIES OF SCIENCE 2021; 51:683-706. [PMID: 34461777 PMCID: PMC8474320 DOI: 10.1177/03063127211035492] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
When the Zika virus burst onto the international scene in the second half of 2015, the development of diagnostic tools was seen as an urgent global health priority. Diagnostic capacity was restricted to a small number of reference laboratories, and none of the few available molecular or serological tests had been validated for extensive use in an outbreak setting. In the early weeks of the crisis, key funders stepped in to accelerate research and development efforts, and the WHO took responsibility for steering diagnostic standardization, a role it had successfully played during the West Africa Ebola virus outbreak. Yet when the WHO declared the end of the Zika Public Health Emergency of International Concern in November 2016, diagnostic capacity remained patchy, and few tools were available at the scale required in the countries that bore the brunt of the epidemic, particularly Brazil. This article analyses the limited impact of global R&D efforts on the availability of Zika diagnostic options where they were most needed and for those most vulnerable: women who might have been exposed to the virus during their pregnancy and children born with suspected congenital Zika syndrome. The truncated legacies of testing during the Zika crisis reveal some of the fault lines in the global health enterprise, particularly the limits of 'emergency R&D' to operate in geopolitical contexts that do not conform to the ideal type of a humanitarian crisis, or to tackle technical issues that are inextricably linked to domestic struggles over the scope and distribution of biological citizenship. Diagnostic shortcomings, we argue, lie at the heart of the stunning transformation, in less than two years, in the status of Zika: from international public health emergency to neglected disease.
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Affiliation(s)
- Koichi Kameda
- Institute for Research and
Innovation in Society (IFRIS), Paris, France
| | - Ann H Kelly
- Department of Global Health and
Social Medicine, King’s College London, London, UK
| | - Javier Lezaun
- Institute for Science, Innovation
and Society, University of Oxford, Oxford, UK
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