Pertti J. Pelto

The Evolution of Alcohol Use in India

This paper traces the role of alcohol production and use in the daily lives of people in India, from ancient times to the present day. Alcohol use has been an issue of great ambivalence throughout the rich and long history of the Indian subcontinent. The behaviors and attitudes about alcohol use in India are very complex, contradictory and convoluted because of the many different influences in that history. The evolution of alcohol use patterns in India can be divided into four broad historical periods (time of written records), beginning with the Vedic era (ca. 1500–700 BCE). From 700 BCE to 1100 CE, (“Reinterpretation and Synthesis”) is the time of emergence of Buddhism and Jainism, with some new anti-alcohol doctrines, as well as post-Vedic developments in the Hindu traditions and scholarly writing. The writings of the renowned medical practitioners, Charaka and Susruta, added new lines of thought, including arguments for “moderate alcohol use.” The Period of Islamic Influence (1100–1800 CE), including the Mughal era from the 1520s to 1800, exhibited a complex interplay of widespread alcohol use, competing with the clear Quranic opposition to alcohol consumption. The fourth period (1800 to the present) includes the deep influence of British colonial rule and the recent half century of Indian independence, beginning in 1947. The contradictions and ambiguities—with widespread alcohol use in some sectors of society, including the high status caste of warriors/rulers (Kshatriyas), versus prohibitions and condemnation of alcohol use, especially for the Brahmin (scholar-priest) caste, have produced alcohol use patterns that include frequent high-risk, heavy and hazardous drinking. The recent increases in alcohol consumption in many sectors of the general Indian population, coupled with the strong evidence of the role of alcohol in the spread of HIV/STI infections and other health risks, point to the need for detailed understanding of the complex cross-currents emerging from the past history of alcohol use and abuse in India.

Developing applied medical anthropology in Third World countries: problems and actions.

Recognition of the usefulness of ethnographic research in Third World community health projects and programs developed rapidly during the 1980s. As a result, the various agencies and organizations promoting community health programs (UNICEF, WHO, NGOs) have greatly increased their recruiting of social scientists, particularly medical anthropologists, for research and other programmatic activities in primary health care, child survival (especially diarrhea, acute respiratory infections, maternal and child nutrition, infectious disease, and AIDS). However, it has proved very difficult to identify well-trained anthropologists and/or other social scientists for these roles, particularly in Third World countries. This paper examines some of the background of this problem, and presents examples of methodological training (in both qualitative and quantitative research techniques) that seek to increase the skills of social scientists and other researchers in the arena of international community health.

Exploring explanatory models of women's reproductive health in rural Bangladesh

This study illustrates the use of systematic elicitation techniques for cultural domain analysis, including free listing, pile sorting and severity ratings to identify salient illness categories and perceptions of illness severity among rural Bangladeshi women. The complementary strategies of in-depth interviewing and collecting of case studies were also employed for delineating explanatory models. Illnesses in the domain of womens reproductive health-for example, reproductive tract infections (RTI)-were found to be among the most salient and serious health problems for which care is sought. Data gathered through pile sorting demonstrate that women in this rural community have clear conceptions of illness groups, with different strategies of treatment for various categories. While concerns relating to reproductive tract infections, including those attributed to sexual transmission, and vaginal discharge are important to women, none of the available health facilities is particularly attuned to addressing these needs. Developing health care services taking womens explanatory models into consideration could be of importance for reducing the spread of RTI and sexually transmitted/HIV infection in rural Bangladesh.

The Personal Approach in Cultural Anthropological Research [and Comments and Reply]

The personal approach in cultural anthropology, self-consciously and deliberately undertaken, perceives value in the unique combination of interests, personal values, theoretical orientation, imagination, sensitivity, and other idiosyncratic qualities embodied in a particular competent investigator or team of investigators. Because of the uniqueness of the factors through which the personal approach yields knowledge, the approach is not easily taught, and the conclusions it reaches are incapable of being fully tested for their reliability. The credibility of the conclusions reached by that approach depends heavily on the cogency, consistency, logic, and persuasiveness with which they are argued and presented. From the time description is begun, through subsequent analysis of data, to the final presentation of conclusions, idiosyncratic factors enter research undertaken by the personal approach because of the nonstandardized vantage point from which the events are observed. Considering the very substantial part played by the personal qualities of the observer when knowledge is produced by this route, accuracy of conclusions cannot be equated with one-to-one faithfulness to independently existing facts. The personal approach has been more often utilized in ethnography and ethnology than in archeology and is most appropriate for research whose goal is historical narration, depicting a way of life, the interpretation of meaning, or tracing relationships between cultural patterns. The credibility of knowledge obtained through the approach is no more unstable than that of knowledge founded on the objective method; all knowledge is constantly being upset as new evidence, new techniques, new standards, or new theories are brought to bear on a topic.

What Is So New About Mixed Methods

In this article, I dispute claims that mixed methods research emerged only recently in the social sciences. I argue that some anthropologists and sociologists (and others) have used mixed methods in fieldwork for at least 80 years, and there are studies from early in the 20th century that clearly fall within the definition of “mixed methods.” I explore some of the history of the mixing of qualitative and quantitative data in earlier ethnographic works and show that in some sectors of social science research, the “emergence” and proliferation of mixed methods were particularly notable around the middle of the 20th century. Furthermore, concerning issues about “paradigms of research” in the social sciences, I identify some of the types of research in which the mixing of QUAL and QUAN approaches was more likely to occur. I suggest that some of the literature about research paradigms has involved a certain amount of “myth-making” in connection with descriptions of qualitative and quantitative research assumptions and styles.

Abortion Providers and Safety of Abortion: A Community-Based Study in a Rural District of Tamil Nadu, India

Abstract This paper reports on a community-based study in 2001—02 in a rural district of Tamil Nadu, India, among 97 women who had had recent abortions, to examine their decision-making processes, the types of facility they attended and the extent of post-abortion complications they experienced. The 36 facilities they attended, both government and private, were ranked by 18 village health nurses, acting as key informants, as regards safety and quality of care. Three categories — qualified and safe, intermediate or unqualified and unsafe — were identified. Most of the providers were medically trained, and 75 of the 97 women went to facilities that were ranked as high or intermediate in quality. Government abortion services were mostly ranked intermediate in quality, and criticised by both women and village health nurses. There has been a substantial decrease in the numbers of traditional and unqualified providers. However, about 30% of the women experienced moderate to serious post-abortion complications, including women who went to facilities ranked high. We recommend that government facilities, both the district hospital and primary health centres, should improve their quality of care, that unqualified providers should be stopped from practising, and that all providers should be using the safer methods of vacuum aspiration and medical methods to reduce post-abortion complications. Résumé Une étude communautaire réalisée dans un district rural du Tamil Nadu, Inde, auprès de 97 femmes ayant récemment avorté a examiné leurs processus de décision, les types d’installations fréquentées et les complications après l’avortement. Les 36 centres, publics et privés, utilisés par les femmes étaient gérés par 18 infirmières de village qui servaient d’informatrices clés pour la sécurité et la qualité des soins. Trois catégories — soins qualifiés et s rs, intermédiaires ou non qualifiés et non s rs — ont été identifiées. La plupart des prestataires avaient suivi une formation médicale et 75 des 97 femmes s’étaient rendues dans des centres de qualité élevée ou intermédiaire. Les services publics d’avortement étaient généralement de qualité intermédiaire, et critiqués par les femmes et les infirmières de village. Le nombre de prestataires traditionnels et non qualifiés avait nettement diminué. Néanmoins, près de 30% des femmes avaient souffert de complications modéréesàgraves après l’avortement, mÁme celles qui étaient allées dans des centres bien classés. Nous recommandons que les centres publics, aussi bien l’hÁpital de district que les centres de soins de santé primaires, améliorent la qualité des soins ; les prestataires non qualifiés devraient Átre interdits de pratique et tous les praticiens devraient utiliser des techniques plus s res comme l’aspiration et les méthodes médicamenteuses pour réduire les complications après l’avortement. Resumen Este articulo informa sobre un estudio comunitario realizado en un distrito rural de Tamil Nadu, la India, en 97 mujeres que habáan experimentado un aborto reciente a fin de analizar sus procesos de toma de decisión, los tipos de establecimientos de salud que consultaron y el grado de complicaciones postaborto que presentaron. Los 36 establecimientos de salud, tanto gubernamentales como privados, fueron clasificados por 18 enfermeras del poblado, como informantes clave, respecto a la seguridad y calidad de la atención. Se establecieron tres categoráas: calificado y seguro, intermedio o no calificado e inseguro. La mayoráa de los prestadores de servicios tenáan formación médica, y 75 de las 97 mujeres acudieron a establecimientos de calidad alta o intermedia. Los servicios gubernamentales, clasificados principalmente como de calidad intermedia, recibieron cráticas tanto de las pacientes como de las enfermeras. Se ha visto una considerable disminución en el número de proveedores tradicionales y no calificados. No obstante, un 30% de las mujeres presentaron complicaciones postaborto de moderadas a graves, incluidas las mujeres que asistieron a los establecimientos de alta calidad. Recomendamos que los establecimientos de salud gubernamentales, mejoren su calidad de atención, sea prohibida la práctica de los proveedores no calificados y todos los proveedores utilicen los métodos más seguros de aspiración y métodos con medicamentos para disminuir las complicaciones postaborto.

Continuity and change in meal patterns: the case of urban Finland

To identify elements of continuity and change from traditional meal patterns characterizing Finland before World War II, accounts of “typical workday” eating were elicited from 102 married women in Helsinki in 1984. Since the 1920s Finnish breakfast has changed from a prepared meal into a lighter eating event differing significantly from lunch and dinner. Earlier the three meals were simitar. The basic structure of lunch and dinner has not changed. Items used in traditional meals are still included. However, the hot meat/fish dish, instead of cereals and potatoes, is now the most important component. Total number of daily meals has decreased. None of the women followed the traditional pattern of three prepared meals. Half ate lunch and dinner and a snack‐type breakfast. The others skipped lunch or dinner.

A Model for Translating Ethnography and Theory into Culturally Constructed Clinical Practices

AbstractThis article describes the development of a dynamic culturally constructed clinical practice model for HIV/STI prevention, the Narrative Intervention Model (NIM), and illustrates its application in practice, within the context of a 6-year transdisciplinary research program in Mumbai, India. Theory and research from anthropology, psychology, and public health, and mixed-method ethnographic research with practitioners, patients, and community members, contributed to the articulation of the NIM for HIV/STI risk reduction and prevention among married men living in low-income communities. The NIM involves a process of negotiation of patient narratives regarding their sexual health problems and related risk factors to facilitate risk reduction. The goal of the NIM is to facilitate cognitive-behavioral change through a three-stage process of co-construction (eliciting patient narrative), deconstruction (articulating discrepancies between current and desired narrative), and reconstruction (proposing alternative narratives that facilitate risk reduction). The NIM process extends the traditional clinical approach through the integration of biological, psychological, interpersonal, and cultural factors as depicted in the patient narrative. Our work demonstrates the use of a recursive integration of research and practice to address limitations of current evidence-based intervention approaches that fail to address the diversity of cultural constructions across populations and contexts.

A methodology for building culture and gender norms into intervention: An example from Mumbai, India

This paper responds to the call for culturally-relevant intervention research by introducing a methodology for identifying community norms and resources in order to more effectively implement sustainable interventions strategies. Results of an analysis of community norms, specifically attitudes toward gender equity, are presented from an HIV/STI research and intervention project in a low-income community in Mumbai, India (2008-2012). Community gender norms were explored because of their relevance to sexual risk in settings characterized by high levels of gender inequity. This paper recommends approaches that interventionists and social scientists can take to incorporate cultural insights into formative assessments and project implementation These approaches include how to (1) examine modal beliefs and norms and any patterned variation within the community; (2) identify and assess variation in cultural beliefs and norms among community members (including leaders, social workers, members of civil society and the religious sector); and (3) identify differential needs among sectors of the community and key types of individuals best suited to help formulate and disseminate culturally-relevant intervention messages. Using a multi-method approach that includes the progressive translation of qualitative interviews into a quantitative survey of cultural norms, along with an analysis of community consensus, we outline a means for measuring variation in cultural expectations and beliefs about gender relations in an urban community in Mumbai. Results illustrate how intervention strategies and implementation can benefit from an organic (versus a priori and/or stereotypical) approach to cultural characteristics and analysis of community resources and vulnerabilities.

Coping with a nutrient deficiency: cultural models of vitamin A deficiency in northern Niger.

Cultural explanations and management strategies for specific signs and symptoms of vitamin A deficiency are explored in a Hausa-speaking community in northern Niger. Their interpretations of the etiology of nightblindness in young children and pregnant women focus on food-related causes, in which “lack of good food” is central. In parallel with the significance of food in the etiology of nightblindness, the recommended treatments are home food remedies, primarily involving liver, meat, or green leaves. The locally attributed etiology for the more severe manifestation of vitamin A deficiency, xerophthalmia, stands in sharp contrast to this. People believe the primary cause is “heat” produced by acute infectious disease (particularly measles). A trip to the medical dispensary or a reliance upon home remedies are the preferred treatment options for this condition. We explore the striking correspondence between local interpretations of nightblindness and contemporary medical knowledge and treatment in relation to the very different explanations and curative measures offered for more serious manifestations of vitamin A deficiency.