Linda M. Whiteford

Stigma: The hidden burden of infertility

Infertility is experienced by 5 million U.S. couples, some of whom perceive it a stigmatizing condition. Recent technological innovations have created a multitude of medical interventions for those infertile individuals who can financially afford them. For some infertile women, those interventions also transform infertility from a private pain to a public, prolonged crisis. Our research focuses on 25 U.S. women who sought medical treatment for infertility and describes their perception of the stigma associated with infertility. We apply a critical, feminist perspective to our analysis of the womens lived experiences within the social and medical contexts in which they occur.

Community Resilience and Volcano Hazard: The Eruption of Tungurahua and Evacuation of the Faldas in Ecuador

Official response to explosive volcano hazards usually involves evacuation of local inhabitants to safe shelters. Enforcement is often difficult and problems can be exacerbated when major eruptions do not ensue. Families are deprived of livelihoods and pressure to return to hazardous areas builds. Concomitantly, prevailing socio-economic and political conditions limit activities and can influence vulnerability. This paper addresses these issues, examining an ongoing volcano hazard (Tungurahua) in Ecuador where contextual realities significantly constrain responses. Fieldwork involved interviewing government officials, selecting focus groups and conducting surveys of evacuees in four locations: a temporary shelter, a permanent resettlement, with returnees and with a control group. Differences in perceptions of risk and health conditions, and in the potential for economic recovery were found among groups with different evacuation experiences. The long-term goal is to develop a model of community resilience in long-term stress environments.

Volcanic hazard or economic destitution: hard choices in Banos, Ecuador

Abstract In 1999, the entire population of tourism-dependent Baños, Ecuador, some 16,000 people, was evacuated in anticipation of a violent eruption of Mount Tungurahua. Subsequently, many areas in the risk zone experienced heavy ash falls, lahars, and landslides, although no cataclysmic events occurred. Many small rural communities were also evacuated. While these communities became impacted by the hazard, Baños avoided most direct effects. Conditions for all evacuees were grim, and their conditions compounded because Ecuador was simultaneously undergoing profound economic and political crises. Absent livelihood alternatives, community leaders from Baños organized a return to their town even though it remained under an evacuation order. An aggressive campaign brought tourists and more residents back and Baños revived economically; however, this was achieved at the cost of hazard awareness among both groups, tourists and residents, and public safety became compromised.

Cross-Cultural and Site-Based Influences on Demographic, Well-being, and Social Network Predictors of Risk Perception in Hazard and Disaster Settings in Ecuador and Mexico

Although virtually all comparative research about risk perception focuses on which hazards are of concern to people in different culture groups, much can be gained by focusing on predictors of levels of risk perception in various countries and places. In this case, we examine standard and novel predictors of risk perception in seven sites among communities affected by a flood in Mexico (one site) and volcanic eruptions in Mexico (one site) and Ecuador (five sites). We conducted more than 450 interviews with questions about how people feel at the time (after the disaster) regarding what happened in the past, their current concerns, and their expectations for the future. We explore how aspects of the context in which people live have an effect on how strongly people perceive natural hazards in relationship with demographic, well-being, and social network factors. Generally, our research indicates that levels of risk perception for past, present, and future aspects of a specific hazard are similar across these two countries and seven sites. However, these contexts produced different predictors of risk perception—in other words, there was little overlap between sites in the variables that predicted the past, present, or future aspects of risk perception in each site. Generally, current stress was related to perception of past danger of an event in the Mexican sites, but not in Ecuador; network variables were mainly important for perception of past danger (rather than future or present danger), although specific network correlates varied from site to site across the countries.

A question of adequacy: primary health care in the Dominican Republic.

This article applies a critical medical anthropology perspective to an analysis of primary health care in the Caribbean. It takes an historical view of the development of a primary health system in the Dominican Republic and argues that both the development and dissolution of that system can be understood only in light of U.S. foreign policy. Primary health care in the Dominican Republic is an example of how health care and development assistance have been extensions of U.S. foreign policy used to influence foreign domestic policies.

Pregnancy and addiction: Translating research into practice

In some areas of the United States pregnant women are incarcerated if they are addicted to illegal substances, particularly crack cocaine. However, incarceration does not happen to all pregnant addicts, but instead reflects racial/ethnic and socioeconomic categories of prejudice. In the following article, the authors suggest that analysis of this pattern of incarceration is clarified by the use of critical medical anthropology perspective with its explicit historical, political and economic foci. In addition, the authors introduce a program for addicted women that incorporates into practice the findings of the initial research and demonstrates how research can be translated into practice.

Child and maternal health and international economic policies

The following article suggests that the current economic crisis in the Dominican Republic could have serious consequences for the health of women and children. Health status will be affected both indirectly and directly by the crisis: that indirect effect can be seen in changes in dietary patterns, increased nutritional risk, increased incidence of infectious disease, and in time, increased mortality among women and children. The direct effect can be seen in higher unemployment, reduced wages, increased prices of basic commodities, and reduced government support for public health care delivery systems. Examples are drawn from observations in public health postpartum wards.

New approaches to human reproduction: social and ethical dimensions.

This book consists of 13 studies by various authors on the ethical and social issues surrounding the new reproductive technology and particularly the implications of the transfer of much of the control of pregnancy and childbirth from women and nature to medical procedures and technicians. The studies are divided into three main subject areas: the ethics of quality access and care during pregnancy; ethical decisions in the treatment of newborns; and ethical implications of family formation by surrogacy. (ANNOTATION)

Access and utility as reflections of cultural constructions of pregnancy.

Health care providers can give their patients better care if they understand how their patients view pregnancy and birth. This article provides some examples of how women from various cultural backgrounds understand pregnancy and how these beliefs affect womens decisions to seek prenatal care and to utilize prenatal services regularly throughout their pregnancies. These concepts-access and utility-provide the frame for this article, and the case studies from diverse ethnic groups provide examples of a variety of cultural beliefs and womens decisions to seek and to value biomedical direction during pregnancy. The conclusion includes several recommendations that health care providers can employ to enhance the quality and effectiveness of care.

Gendered Access to Formal and Informal Resources in Postdisaster Development in the Ecuadorian Andes

Abstract The devastating eruptions of Mount Tungurahua in the Ecuadorian highlands in 1999 and 2006 left many communities struggling to rebuild their homes and others permanently displaced to settlements built by state and nongovernmental organizations. For several years afterward, households diversified their economic strategies to compensate for losses, communities organized to promote local development, and the state and nongovernmental organizations sponsored many economic recovery programs in the affected communities. Our study examined the ways in which gender and gender roles were associated with different levels and paths of access to scarce resources in these communities. Specifically, this article contrasts the experiences of men and women in accessing household necessities and project assistance through formal institutions and informal networks. We found that women and men used different types of informal social support networks, with men receiving significantly more material, emotional, and informational support than women. We also found that men and women experienced different challenges and advantages when pursuing support through local and extralocal institutions and that these institutions often coordinated in ways that reified their biases. We present a methodology that is replicable in a wide variety of disaster, resettlement, and development settings, and we advocate an inductive, evidence-based approach to policy, built upon an understanding of local gender, class, and ethnic dynamics affecting access to formal and informal resources. This evidence should be used to build more robust local institutions that can resist wider social and cultural pressures for male dominance and gendered exclusion.