Families, markets, and medicalization: the role of paid support for childbirth and breastfeeding.

Much attention has been given to the commercialization of care and its relationship to the outsourcing of family life, as well as larger social and cultural processes that can change the nature of caring. I engage with this question of why certain aspects of care are provided by the market, using 72 interviews with lactation consultants, doulas, clients, and clinicians, as well as 150 hours of ethnographic observation in the USA. Examining how participants understood the role of these services in the maternity care system and the reasons why clients turned to these services, I found that, in several ways, these forms of care work reflected outsourcing trends. However, lactation consultants and doulas were also acting as advocates and guides, helping their clients navigate the complex medical maternity system. This reflects a fundamental transformation in the nature of maternity support, attributed to the impact of medicalization, both historically and currently.

Medicalizing to demedicalize: lactation consultants and the (de)medicalization of breastfeeding.

This paper uses the domain of breastfeeding in the U.S. and the work of International Board Certified Lactation Consultants to refine the concept of medicalization-demedicalization. Given lactation consultants' origins and current role in maternity care, they provide a unique lens on these processes because they are positioned at the crossroads of medicalization and demedicalization. Using 150 h of ethnographic observation and 39 interviews conducted between 2008 and 2012, I identify aspects of medicalization-demedicalization in the work of lactation consultants according to four dimensions: medical definition, medical control, pathology, and medical technology. Lactation consultants work to demedicalize breastfeeding by challenging the construction of breastfeeding pathology and limiting intervention. At the same time, they hold a position of medical control and medicalize breastfeeding by reinforcing a medical definition and using medical technology to treat breastfeeding problems. However, lactation consultants are not only working toward demedicalization and medicalization simultaneously, but are also medicalizing to demedicalize. Their position of medical control over breastfeeding provides them with a certain measure of authority that they can use in their efforts to depathologize breastfeeding and limit medical intervention. These findings build upon previous research that has identified cases of medicalization and demedicalization occurring simultaneously and draw attention to the need for an understanding of medicalization-demedicalization as a continuous process. Furthermore, the concept of "medicalizing to demedicalize" provides a novel contribution to the literature.

Breast milk and labour support: lactation consultants' and doulas' strategies for navigating the medical context of maternity care.

This article provides a comparison of two occupational groups working in maternity care: International Board Certified Lactation Consultants, who assist women with breastfeeding, and DONA International certified birth doulas, who provide physical, emotional and informational support to birthing women. Using interviews with 18 lactation consultants and 16 doulas working in the USA, I compare these two groups' strategies for gaining entrance to the maternity care team and their abilities to create change in maternity care practices. Due to the organisation of occupational boundaries in maternity care and differences between the influence of the medicalisation of breastfeeding versus that of childbirth on those boundaries, lactation consultants are able to utilise a front-door entrance to the medical maternity system, entering as lactation specialists and advocates, while doulas use a back-door entrance, emphasising their care work and downplaying their advocacy. These different strategies result in different methods being available to each for effecting change. Lactation consultants create formal change, such as changing hospital policies and practices to be more pro-breastfeeding. Doulas create change informally, 'one birth at a time', by creating space for natural birth to occur in the hospital, as well as exposing medical providers to non-medical ways of giving birth.

Sexual harassment policies in K-12 schools: examining accessibility to students and content.

BACKGROUND: Peer sexual harassment is a significant social problem with consequences for both students and schools. Four out of 5 students report experiencing sexual harassment. These experiences have been linked to poor psychological health and academic withdrawal. Recognizing the seriousness of sexual harassment in schools, Supreme Court rulings have established school liability for known instances of sexual harassment under Title IX of the Education Amendments of 1972. Federal guidelines established by the Office for Civil Rights of the US Department of Education mandate schools to develop sexual harassment policies; however, the implementation of these guidelines has not been examined. Therefore, this study assessed the degree to which sexual harassment policies in primary and secondary schools adhered to said guidelines. METHODS: This study evaluated 784 primary and secondary school sexual harassment policies across 4 states on 3 key factors: accessibility to students (ie, via the Internet), consistency with federal guidelines regarding their content and the inclusion of 10 key components, and consistency of content across educational levels. RESULTS: Only 14% of sexual harassment policies were available online; the majority of policies incorporated only 5 of the 10 critical components, and elementary school policies contained significantly fewer components than all other educational levels. CONCLUSIONS: The Internet is an underused resource for disseminating school sexual harassment policies to students. When policies are available, they rarely incorporate the key elements specified in the federal guidelines. Particularly troubling are the inaccessibility and incompleteness of elementary school policies. Greater attention to policy accessibility and comprehensiveness is needed.