Navigating relationship dynamics, pregnancy and fatherhood in the Bukhali trial: a qualitative study with men in Soweto, South Africa.

BACKGROUND: South Africa has a complex range of historical, social, political, and economic factors that have shaped fatherhood. In the context of the Bukhali randomised controlled trial with young women in Soweto, South Africa, a qualitative study was conducted with the male partners of young women who had become pregnant during the trial. This exploratory study aimed to explore individual perceptions around relationship dynamics, their partner's pregnancy, and fatherhood of partners of young women in Soweto, South Africa. METHODS: Individual, in-depth interviews were conducted with male partners (fathers, n = 19, 25-46 years old) of Bukhali participants. A thematic approach was taken to the descriptive and exploratory process of analysis, and three final themes and subthemes were identified: (1) relationship dynamics (nature of relationship, relationship challenges); (2) pregnancy (feelings about the pregnancy, effect of the pregnancy on their relationship, providing support during pregnancy; and 3) fatherhood (view of fatherhood, roles of fathers, influences on views and motivation, challenges of fatherhood). RESULTS: While most male participants were in a committed ("serious") relationship with their female partner, less than half of them were cohabiting. Most reported that their partner's pregnancy was not planned, and shared mixed feelings about the pregnancy (e.g., happy, excited, shocked, nervous), although their views about fatherhood were overwhelmingly positive. Many were concerned about how they would economically provide for their child and partner, particularly those who were unemployed. Participants identified both general and specific ways in which they provided support for their partner, e.g., being present, co-attending antenatal check-ups, providing material resources. For many, the most challenging aspect of fatherhood was having to provide financially. They seemed to understand the level of responsibility expected of them as a father, and that their involvement and presence related to love for and connection with their child. Participants' responses indicated that there were some changes in the norms around fatherhood, suggesting that there is a possibility for a shift in the fatherhood narrative in their context. CONCLUSIONS: These findings suggest that the complex array of factors influencing fatherhood in South Africa continue to play out in this generation, although promising changes are evident.

Containment and conversion: Urban livelihoods and the circulation of value amid South Africa's avian influenza outbreak.

In South Africa the racialized contours of economic life powerfully shape the distribution of who owns poultry enterprises, who is employed to labor in them, who consumes poultry products, and in which way. When, in late 2017, an outbreak of highly pathogenic avian influenza (H5N8) decimated the South African poultry sector, it revealed the ontological transformations of industrial egg-laying poultry into "cull birds" and then into imileqwa, the quintessential rural chicken. It thus showed how distinct regimes of value "articulate," blurring infectious and noninfectious concerns as new chains of conversion were inaugurated across domestic and global economies. Thanks to the mediations performed by the network of egg-laying chickens, (White) farmers, (Black African) consumers, and state veterinarians, translations of value take place in which industrialized egg-layer chickens turn into socially enlivened beings. Such beings sustain and nurture social reproduction in South Africa's postapartheid cities and beyond. [zoonosis, value, human-animal relations, global health, one health, race, urbanism, South Africa].

'The Good Doctor': the Making and Unmaking of the Physician Self in Contemporary South Africa.

In this article we examine the figure of the doctor in animated debates around public sector medicine in contemporary South Africa. The loss of health professionals from the South African public system is a key contributor to the present healthcare crisis. South African medical schools have revised curricula to engage trainee doctors with a broader set of social concerns, but the disjunctures between training, health systems failures, and a high disease burden call into question whether junior doctors are adequately prepared or whether conditions of care extend beyond medical training. A concern with 'resilience' suggests a correct ethical relation to a putative obligation to provide care in a struggling system. By examining the ways in which trainee doctors are expected to 'cope' with the demands of medical practice, to adopt the correct moral posture in relation to the urgency of care, and to enact a desirable ethical relation to the broader social and political context of medical practice, we examine the picture of humanist concern that animates the subjectivities and techniques of the self called for by this training, and advocate for endurance as an alternative framework for understanding the political and ethical relations between doctors, patients and health systems.

The Politics of Trauma: Gender, Futurity, and Violence Prevention in South Africa.

In this article, I consider the framing of trauma as an epigenetic exposure that warrants intergenerational interventions. I draw on ethnographic research conducted in Khayelitsha, Cape Town, South Africa in 2014-15 to illustrate how violence prevention in this context is increasingly framed in epigenetic terms. I show that, in contrast to the anticipatory logic of a programmatic focus on maternal investment as a means to arrest intergenerational cycles of violence, violence produces different infrastructures of anticipation and effects on intergenerational relations. I argue against the speculative conflation of trauma and intergenerational epigenetics, to resist a newly biologized view of the bodily manifestations of apartheid history-in itself a re-inscription of damage, and a form of violence. Drawing on Murphy's concept of distributed reproduction (2017b), I argue for collectivized forms of intervention that aim for accountability and social justice.

"It's Never Too Early": Preconception Care and Postgenomic Models of Life.

In this article, we are concerned with the expanded public health interest in the "preconception period" as a window of opportunity for intervention to improve long-term population health outcomes. While definitions of the "preconception period" remain vague, new classifications and categories of life are becoming formalized as biomedicine begins to conduct research on, and suggest intervention in, this undefined and potentially unlimited time before conception. In particular, we focus on the burgeoning epidemiological interest in epigenetics and Developmental Origins of Health and Disease (DOHaD) research as simultaneously a theoretical spyglass into postgenomic biology and a catalyst toward a public health focus on preconception care. We historicize the notion that there are long-term implications of parental behaviors before conception, illustrating how, as Han and Das have noted, "newness comes to be embedded in older forms even as it transforms them" (Han and Das, 2015, p. 2). We then consider how DOHaD frameworks justify a number of fragmented claims about preconception by making novel evidentiary assertions. Engaging with the philosophy of Georges Canguilhem, we examine the relationship between reproductive risk and revised understandings of biological permeability, and discuss some of the epistemic and political implications of emerging claims in postgenomics.

The First Thousand Days: Motherhood, Scientific Knowledge, and Local Histories.

Since 2013, South African nutrition policy focuses on "the first thousand days," (conception to two years), informed by Developmental Origins of Health and Disease research. Drawing on ethnographic research, we show how policy foregrounds certain categories of persons and casts "the maternal" as a time frame for interventions to secure future health and argue that this constitutes a "knowledge effect" - the outcome of framing questions in a particular way and with specific knowledge horizons.

Critical orientations for humanising health sciences education in South Africa.

In this article, the authors make a case for the 'humanisation' and 'decolonisation' of health sciences curricula in South Africa, using integration as a guiding framework. Integration refers to an education that is built on a consolidated conceptual framework that includes and equally values the natural or biomedical sciences as well as the humanities, arts and social sciences, respecting that all of this knowledge has value for the practice of healthcare. An integrated curriculum goes beyond add-on or elective courses in the humanities and social sciences. It is a curriculum that includes previously marginalised sources of knowledge (challenging knowledge hierarchies and decolonising curricula); addresses an appropriate intellectual self-image in health sciences education (challenging the image of the health professional); promotes understanding of history and social context, centring issues of inclusion, access and social justice (cultivating a social ethic) and finally, focuses on care and relatedness as an essential aspect of clinical work (embedding relatedness in practice) The article offers a brief historical overview of challenges in health and health sciences education in South Africa since 1994, followed by a discussion of contemporary developments in critical health sciences pedagogies and the medical and health humanities in South Africa. It then draws on examples from South Africa to outline how these four critical orientations or competencies might be applied in practice, to educate health professionals that can meet the challenges of health and healthcare in contemporary South Africa.

Field notes in the clinic: on medicine, anthropology and pedagogy in South Africa.

This commentary is about medicine, anthropology and pedagogy: about the ways of knowing that different disciplinary orientations permit. I draw on a field note taken in the clinic to illustrate how cultures of healthcare and health sciences training in South Africa bracket the historical, social and political contexts of health and illness in this setting, at the expense of patient care and physician wellbeing. I consider what anthropological inquiry can offer to clinical practice, and advocate for critical orientations to clinical work and teaching that extend humanity to patients and providers.