Trading in harms: COVID-19 and sexual and reproductive health disparities during the first surge in New York state.

In March 2020, New York City was the national epicenter of the novel coronavirus in the United States. This article draws on rapid qualitative research from July to October of 2020 with sexual and reproductive healthcare (SRH) providers who served low-income people from racial and ethnic minority groups in New York State to examine their perceptions of the effects of COVID-related adaptations to care on healthcare access and quality. We found that care delivery protocols during the early months of the pandemic compromised healthcare interactions and clinical experiences by limiting support persons, separating newborns from parents, and restricting care time in hospitals. Additionally, closures of in-person SRH services and prohibitions on prenatal support persons increased obstacles to access and utilization of care. Our intersectional analysis underscores how COVID protocols interacted with other axes of inequality to compound disparities in SRH access and quality of care. Early COVID policies prioritized controlling the risk of viral exposure over the risk of harm from the policies themselves, reflecting zero-sum approaches that we describe as "trading in harms." Our research thus raises crucial questions about how institutions and governing bodies conceive of, and organize, emergency preparedness. We argue that emergency preparedness must center concerns around racial, class, and gender equity, among others, to foreground the risks and benefits of emergency responses for different groups.

Clinicians' criteria for fetal moral status: viability and relationality, not sentience.

The antiabortion movement is increasingly using ostensibly scientific measurements such as 'fetal heartbeat' and 'fetal pain' to provide 'objective' evidence of the moral status of fetuses. However, there is little knowledge on how clinicians conceptualise and operationalise the moral status of fetuses. We interviewed obstetrician/gynaecologists and neonatologists on this topic since their practice regularly includes clinical management of entities of the same gestational age. Contrary to our expectations, there was consensus among clinicians about conceptions of moral status regardless of specialty. First, clinicians tended to take a gradualist approach to moral status during pregnancy as they developed and viewed viability, the ability to live outside of the uterus, as morally significant. Second, in contrast to 'fetal pain' laws and philosophical discussions about the ethical salience of sentience, the clinicians in our study did not consider the ability to feel pain as a morally relevant factor in moral status determinations. Third, during previability and perviability, clinicians viewed moral status as a personal value decision, which should be made by pregnant people and parents of neonates.

Conceptualizing Pain and Personhood in the Periviable Period: Perspectives from Reproductive Health and Neonatal Intensive Care Unit Clinicians.

In 2020, the Pain Capable Unborn Child Protection Act was brought to an unsuccessful Senate vote for the third time in five years. The Act seeks to prohibit abortions after 20 weeks post-conception based on the scientifically contested claim that fetuses are at that point capable of feeling pain. It thus seeks to undermine Roe v. Wade's viability standard by asserting that the capacity for pain perception is sufficient for "compelling governmental interest" in fetal life. The ability of many NICUs to offer life-sustaining interventions for periviable neonates means that, in many states, neonatologists and physicians who provide second-trimester abortion care may manage cases of the same gestational age. Given this overlap, this qualitative study examines how clinicians think about the capacity of periviable entities to feel pain and how these ideas shape clinical practice and understandings of compassionate care. Drawing on twenty semi-structured interviews conducted between June 2019 and April 2020 with clinicians providing second-trimester abortion care and NICU care in the Northeast United States, it examines how pain is "known" in the periviable period and how clinicians think about pain in relationship to personhood. A key finding is that the meaning of pain and implications for clinical care is shaped by the anticipated futures and personhood status of periviable entities as determined by pregnant people and families of neonates. Clinicians also stated that concerns around the alleviation of suffering, defined as long-term or chronic distress for pregnant people and/or neonates and their families, were more pressing than the potential experience of short-term physical pain. Legislative attempts to make contested ideas of "fetal pain" the basis for "governmental interest" ignores other forms of suffering that might result from denial of options, and potentially places clinicians at odds with their own conceptions of competent and compassionate care.

Race-ing Time: Clinical Temporalities and Inequality in Public Prenatal Care.

Analysis of clinical temporalities, or the social organization of time in the clinic, offers insights into how racism coheres in pregnant bodies and institutions, with implications for health care experiences for patients and providers. Based on research at a public prenatal clinic, I argue that long patient wait-times and pressure on providers to speed up are temporal instantiations of the same racist structures that shape public health care in the US. Through these temporal experiences, racialized patient populations and staff who work in racialized systems of public health care encounter the lesser value assigned to their time, bodies, and labor.

The Erosion of Rights to Abortion Care in the United States: A Call for a Renewed Anthropological Engagement with the Politics of Abortion.

Women's rights to legal abortion in the United States are now facing their greatest social and legislative challenges since its 1973 legalization. Legislation restricting rights and access to abortion care has been passed at state and federal levels at an unprecedented rate. Given the renewed vigor of anti-abortion movements, we call on anthropologists to engage with this shifting landscape of reproductive politics. This article examines recent legislation that has severely limited abortion access and maps possible directions for future anthropological analysis. We argue that anthropology can provide unique contributions to broader abortion research. The study of abortion politics in the United States today is not only a rich opportunity for applied and policy-oriented ethnographic research. It also provides a sharply focused lens onto broader theoretical concerns in anthropology and new social formations across moral, medical, political, and scientific fields in 21st-century America.

Perceptions of primary care-based breastfeeding promotion interventions: qualitative analysis of randomized controlled trial participant interviews.

OBJECTIVE: This study examined women's perceptions and reported effects of routine, primary care-based interventions to increase breastfeeding. SUBJECTS AND METHODS: A subsample (n=67) of participants in randomized controlled trials (RCTs) completed semistructured exit interviews at 6 months postpartum. RCT arms included the following: (a) routine pre-/postnatal lactation consultant (LC) support (LC group); (b) electronic prompts (EP) guiding providers to discuss breastfeeding during prenatal care visits (EP group); (c) a combined intervention (LC+EP group); and (d) controls. Interview transcripts were coded and analyzed in MAX.qda. RESULTS: Key findings included the following: (1) Brief, non-directive assessment of feeding via postpartum interviews focused attention upon feeding practices. When coupled with breastfeeding promotion interventions, interviews promoted breastfeeding. (2) The EP and LC interventions were complementary: EPs influenced initiation, while LCs helped overcome barriers and sustain breastfeeding. (3) Prenatal intent to feed both breastmilk and formula was associated with the greatest receptivity to study messages. CONCLUSIONS: Findings underscore the need for interventions across the continuum of care. Trained LCs in prenatal/postpartum settings and prenatal care providers play important complementary roles that, when coupled with brief telephone feeding assessments, may improve breastfeeding rates.

The gift of health: Socialist medical practice and shifting material and moral economies in post-Soviet Cuba.

Drawing on ethnographic data collected over 13 months of fieldwork in family doctor clinics in Havana from 2004 to 2005, I examine the shifting moral and material economies of Cuban socialist medical practice. In both official ideology and in daily practice, the moral economy of ideal socialist medicine is based on an ethos of reciprocal social exchange-that is, the gift-that informs not only doctors' relationships with the Cuban state and with individual patients but also the state's policies of international medical service to developing nations. The social and economic upheavals after the fall of t Soviet Union, however, have compelled both the state and individual doctors to operate in a new local and global economy. The gift remains the central metaphor of Cuban medical practice. Nonetheless, as ideologies and practices of gifting and reciprocity encounter an emerging market economy, gifts--whether on the level of the state policies of international humanism or in patient-doctor relations--are open to new significations that highlight the shifting material and moral economies of post-Soviet Cuba.