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Welfare and Self Care

Institutionalized Visions for a Good Life in Danish Day-care Centres

Eva Gulløv

Using the case of early childcare institutions in contemporary Denmark, the aim of the article is to show that welfare entails visions of living that are made manifest through the requirements of everyday institutional practices. The main argument is that welfare institutions are designed not only to take care of people's basic needs but also to enable them to fare well in accordance with the dominant norms of society. This is particularly evident in the case of children. Children are objects of intense normative attention and are invested in as no other social group in order to ensure their enculturation. Therefore, studying the collective investments in children, for example by paying attention to the institutional arrangements set up for them, offers insight into dominant cultural priorities and hoped-for outcomes.

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Andrew Dawson

This biographical and, in part, phenomenological anthropology of older people in post-industrial England illuminates a local and generationally specific communitarian critique of and form of resistance against the process of individualisation. Rather than presenting communitarianism conventionally as an abstract political ideology or set of ideas about locality, it is conceptualised as emerging from and being reinforced by experiences of ageing, especially bodily ageing. It these respects, the article responds positively to Tatjana Thelen and Cati Coe’s call to take the anthropology of ageing out of its current condition of relative intellectual marginality, by recognising ageing and its related care arrangements as key structuring features within societies and political organisation and by treating them as a window onto understanding broad-scale social and political processes.

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Social security and care after socialism

Reconfigurations of public and private

Rosie Read and Tatjana Thelen

State frameworks for welfare and social security have been subject to processes of privatization, decentralization, and neoliberal reform in many parts of the world. This article explores how these developments might be theorized using anthropological understandings of social security in combination with feminist perspectives on care. In its application to post-1989 socioeconomic transformation in the former socialist region, this perspective overcomes the conceptual inadequacies of the "state withdrawal" model. It also illuminates the nuanced ways in which public and private (as spaces, subjectivities, institutions, moralities, and practices) re-emerge and change in the socialist era as well as today, continually shaping the trajectories and outcomes of reforms to care and social security.

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Anthropological Insights about a Tool for Improving Quality of Obstetric Care

The Experience of Case Review Audits in Burkina Faso

Marc-Eric Gruénais, Fatoumata Ouattara, Fabienne Richard and Vincent De Brouwere

The ratio of maternal morbidity and mortality in developing countries is high. The World Health Organization (WHO) and public health specialists promote case review audits as a means of improving quality of obstetric care. This reflects the need for high reactivity in health personnel's management of obstetric complications. Within an action-research programme in Burkina Faso, a trial of case review audits was implemented in a maternity ward. This was designed to help health personnel better align their practice with clinical standards and to enable more consideration of pregnant women's needs. Social anthropologists were involved in these case review audits in order to collect data about pregnant women's lifestyles and circumstances. They also worked to train health personnel to conduct interviews. Although it is important to take account of women's circumstances within audit sessions, conducting interviews in 'anthropological ways' (at women's homes, with observations) is time consuming and may sometimes be better replaced with interviews in hospital contexts. Anthropologically informed interviews may pinpoint socio-economic situations as key reasons for problems in healthcare, but health personnel are usually powerless to address these. However, anthropology contributes an awareness of the relevance of these issues for broader healthcare planning.

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Roberta Raffaetà and Mark Nichter

On 18 December 2014, the results of the U.K.’s Research Excellence Framework (REF) evaluation exercise were released. This extensive and very costly exercise is intended to take the pulse of U.K. university-based research and now happens once every six years or so. It is also the principal tool used to determine the allocation of approximately £1.6 billion of quality-related (QR) research funding which maintains the fabric of research activity in U.K. HE institutions. Given the fiscal consequences of REF performance it is not surprising that that universities expended considerable time and effort preparing their submissions in the run-up to the exercise and that the results were pored over by academics and their managers across the country. This was a very complex set of runes to read.

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Did Policy Change Work?

Oregon Women Continue to Encounter Delays in Medicaid Coverage for Abortion

Bayla Ostrach

Women in poverty experience greater delays in the process of seeking abortion. Timely access to both safe abortion care and early prenatal care reduces morbidity and mortality among pregnant women. This article examines the impacts of a policy change intended to facilitate poor women's applications for pregnancy-related Medicaid (a federally funded, state-administered health coverage programme for the poorest Americans), in Oregon (Western U.S.). The mixed-methods data from this applied anthropology study demonstrate that though health coverage waiting times grew shorter on average, poor women and the clinic staff who cared for them continued to perceive delays in obtaining Medicaid coverage for abortion. Implementation of the Affordable Care Act in the U.S.A. (aka Obama-care) is now thought to be contributing to a return to greater delays in accessing prenatal care and abortion. More research and advocacy are needed to improve access to reproductive health care through state Medicaid programmes.

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When Frost Happens

A Case Study of an Organization Committed to Care

Philip Kao

This article draws from my time spent working as a caregiver in a 350-plus resident not-for-profit Continuing Care Retirement Community (CCRC) in the American Midwest. Caregivers working in CCRCs provide care and support to elderly residents who live out the rest of their lives in these transitional 'homes'. Yet even these organizations are transforming and changing the way care is being constructed and delivered. This paper examines how a long-term care facility (LTCF) is grappling with specific discourses about the nature of person-centred care, and its self-professed commitment to the journey of life. I show ethnographically how an organization centred on the business of care deals with the process of ageing, and that while the life course has been subject to forms of social and medical regimen, the ageing person is ontologically greater than his or her experiences in the nursing home, no matter how totalizing the institution.

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High-tech Romania?

Commoditisation and Informal Relations in the Managerialist Informatisation of the Romanian Health-Care System

Sabina Stan and Valentin-Veron Toma

While informatisation has officially been hailed as a major component of the modernisation of the Romanian health-care system, this paper, based on ethnographic research in Romanian hospitals, shows that it has been mostly geared towards managerialist goals of administrative control and cost containment. Paradoxically, informal relations, which were supposed to be suppressed as a result of both informatisation and managerialist marketisation, continue to thrive in the Romanian health-care system.

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Aging Away

Immigrant Families, Elderly Care, Ethnography and Policy

Rita Henderson

This article considers how immigrant retention relates to family obligations, drawing a complex portrait of a common family dilemma involving the care of aging kin. The ethnographic life-history approach offers an important perspective on how health and well-being are not simply structured by formal access to institutions of care, but by the socio-cultural, economic and geographic flexibility of families to accommodate their needs. Analysis draws on the interdependant migration histories of a family of six adult sisters originating in Tanzania. In the case of this family, the dilemma surrounding the care of aging parents is not so much caused by migration's disruption of traditional filial obligations. Instead, it is the effect of social pressures stirred in both sending and receiving countries, which frame opportunities for eventual social integration, relocation or sometimes reluctant repatriation. A reflexive approach argues for the active presence of ethnographers in policy debates.

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Place of Birth and Concepts of Wellbeing

An Analysis from Two Ethnographic Studies of Midwifery Units in England

Christine McCourt, Juliet Rayment, Susanna Rance and Jane Sandall

This article is based on analysis of a series of ethnographic case studies of midwifery units in England. Midwifery units1 are spaces that were developed to provide more home-like and less medically oriented care for birth that would support physiological processes of labour, women’s comfort and a positive experience of birth for women and their families. They are run by midwives, either on a hospital site alongside an obstetric unit (Alongside Midwifery Unit – AMU) or a freestanding unit away from an obstetric unit (Freestanding Midwifery Unit – FMU). Midwifery units have been designed and intended specifically as locations of wellbeing and although the meaning of the term is used very loosely in public discourse, this claim is supported by a large epidemiological study, which found that they provide safe care for babies while reducing use of medical interventions and with better health outcomes for the women. Our research indicated that midwifery units function as a protected space, one which uses domestic features as metaphors of home in order to promote a sense of wellbeing and to re-normalise concepts of birth, which had become inhabited by medical models and a preoccupation with risk. However, we argue that this protected space has a function for midwives as well as for birthing women. Midwifery units are intended to support midwives’ wellbeing following decades of professional struggles to maintain autonomy, midwife-led care and a professional identity founded on supporting normal, healthy birth. This development, which is focused on place of birth rather than other aspects of maternity care such as continuity, shows potential for restoring wellbeing on individual, professional and community levels, through improving rates of normal physiological birth and improving experiences of providing and receiving care. Nevertheless, this very focus also poses challenges for health service providers attempting to provide a ‘social model of care’ within an institutional context.