Jill Allison

Wombs at risk, wombs as risk: Fat women’s experiences of reproductive care

ABSTRACT Using the Foucaultian concepts of biopower and biocitizenship, critical scholars of childhood “obesity” have shown how fat mothers are labeled as “risks” not only to their children, but also to the State. Such discourses are salient even for fat women who have yet to birth children, as fat women’s “poor utero environments” are now imagined as “at-risk” spaces for babies particularly by the medical community. Critical theorists are only beginning to trace how such discourses of in-utero risk impact fat women who are attempting to conceive and who are pregnant. The authors add to this nascent scholarship by relating the results of a Canadian study exploring the weight-related healthcare experiences of fat women accessing reproductive healthcare while attempting to conceive, while pregnant, or while giving birth. Participants described how fetal risk was ubiquitously emphasized by healthcare professionals who continuously communicated fat women’s unfitness as mothers. At the extreme, participants described experiences resonating with so-called “hard” eugenic practices, wherein participants were routinely denied certain procedures that would have allowed them to attempt conception, including the removal of birth control devices. The authors suggest, then, that current medical biopolitics of “maternal obesity” are one inflection of a “new eugenics” that not only produces and manipulates life, but also prevents it all together.

Introducing global health into the undergraduate medical school curriculum using an e-learning program: a mixed method pilot study

BackgroundPhysicians need global health competencies to provide effective care to culturally and linguistically diverse patients. Medical schools are seeking innovative approaches to support global health learning. This pilot study evaluated e-learning versus peer-reviewed articles to improve conceptual knowledge of global health.MethodsA mixed methods study using a randomized-controlled trial (RCT) and qualitative inquiry consisting of four post-intervention focus groups. Outcomes included pre/post knowledge quiz and self-assessment measures based on validated tools from a Global Health CanMEDS Competency Model. RCT results were analyzed using SPSS-21 and focus group transcripts coded using NVivo-9 and recoded using thematic analysis.ResultsOne hundred and sixty-one pre-clerkship medical students from three Canadian medical schools participated in 2012–2013: 59 completed all elements of the RCT, 24 participated in the focus groups. Overall, comparing pre to post results, both groups showed a significant increase in the mean knowledge (quiz) scores and for 5/7 self-assessed competencies (p < 0.05). These quantitative data were triangulated with the focus groups findings that revealed knowledge acquisition with both approaches. There was no statistically significant difference between the two approaches. Participants highlighted their preference for e-learning to introduce new global health knowledge and as a repository of resources. They also mentioned personal interest in global health, online convenience and integration into the curriculum as incentives to complete the e-learning. Beta version e-learning barriers included content overload and technical difficulties.ConclusionsBoth the e-learning and the peer reviewed PDF articles improved global health conceptual knowledge. Many students however, preferred e-learning given its interactive, multi-media approach, access to links and reference materials and its capacity to engage and re-engage over long periods of time.

Enduring politics: the culture of obstacles in legislating for assisted reproduction technologies in Ireland

Assisted reproductive technology has become a normalized part of reproductive medicine in many countries around the world. Access, however, is uneven and inconsistent, facilitated and restricted by such factors as affordability, social and moral acceptance or refusal and local cultures of medical practice. In Ireland, assisted reproductive technology has been available since 1987 but remains unregulated by legislation. This creates an uncertain and untenable legal circumstance given the contested issues related to constitutional protection of the right to life of the unborn and the indeterminate legal status of embryos in vitro. This paper examines the impact of an enduring political impasse. It explores how clinical assisted reproductive technology services in Ireland operate both inside and outside dominant institutional frameworks, meeting a pronatalist and pro-family social and political agenda, while sometimes contradicting the pro-life politics that has continued to shape women’s reproductive lives. The medical approaches to infertility thus intersect with the ongoing debates around abortion, the failure of the government to regulate, and notions of embodied motherhood and responsibility within changing meanings of family and kinship. At the same time women and their partners seek assisted reproductive technology treatment in other countries throughout the European Union where laws differ and availability of services varies. A decade has passed since the Commission on Assisted Human Reproduction in Ireland released its recommendations; the enduring legislative vacuum leaves women, families and practitioners in potential legal limbo.