Care in Trouble: Ecologies of Support from Below and Beyond.

Over the last decades, care has proliferated as a notion aimed at capturing a vast array of practices, conditions, and sentiments. In this article, we argue that the analytics of care may benefit from being troubled, as it too often reduces the reproduction of life to matters of palliation and repair, fueling a politics of nationalism and identitarianism. Picking up the threads of insight from STS, "new materialisms," and postcolonial feminist and indigenous scholarship, we discuss care from "below" and "beyond," thus exposing tensions between the enveloping and the diverging, the enduring and the engendering, that play out in care practices. We propose "ecologies of support" as an analytic that attends to how humans are grounded in, traversed by, and undermined by more-than-human and often opaque, speculative, subterranean elements. Our proposal is for anthropology to not simply map life-sustaining ecologies, but to experimentally engage with troubling modes of inquiry and intervention.

Situating mobile health: a qualitative study of mHealth expectations in the rural health district of Nouna, Burkina Faso.

BACKGROUND: The implementation of mobile health (mHealth) projects in low- and middle-income countries raises high and well-documented expectations among development agencies, policymakers and researchers. By contrast, the expectations of direct and indirect mHealth users are not often examined. In preparation for a proposed intervention in the Nouna Health District, in rural Burkina Faso, this study investigates the expected benefits, challenges and limitations associated with mHealth, approaching these expectations as a form of situated knowledge, inseparable from local conditions, practices and experiences. METHODS: The study was conducted within the Nouna Health District. We used a qualitative approach, and conducted individual semi-structured interviews and group interviews (n = 10). Participants included healthcare workers (n = 19), godmothers (n = 24), pregnant women (n = 19), women with children aged 12-24 months (n = 33), and women of childbearing age (n = 92). Thematic and content qualitative analyses were conducted. RESULTS: Participants expect mHealth to help retrieve patients lost to follow-up, improve maternal care monitoring, and build stronger relationships between pregnant women and primary health centres. Expected benefits are not reducible to a technological realisation (sending messages), but rather point towards a wider network of support. mHealth implementation is expected to present considerable challenges, including technological barriers, organisational challenges, gender issues, confidentiality concerns and unplanned aftereffects. mHealth is also expected to come with intrinsic limitations, to be found as obstacles to maternal care access with which pregnant women are confronted and on which mHealth is not expected to have any significant impact. CONCLUSIONS: mHealth expectations appear as situated knowledges, inseparable from local health-related experiences, practices and constraints. This problematises universalistic approaches to mHealth knowledge, while nevertheless hinting at concrete, expected benefits. Findings from this study will help guide the design and implementation of mHealth initiatives, thus optimising their chances for success.