Body norms and normative bodies in Highland Guatemala.

OBJECTIVES: The concept of bionormalcy highlights the potential tensions between bodies defined clinically as normal or healthy, bodies that are normative (frequent) within a population, and bodies defined within a given social context as abnormal or devalued. Theories of resource scarcity predict preferences for larger bodies should deviate from what is biologically normative (i.e., most frequent) or clinically defined as healthy. Using the case of adult women in a Guatemalan community with chronically low food security, we test how food scarcity shapes individual views of smaller, larger, and clinically categorized normal bodies. METHODS: Participants were 102 women from a community in the Central Highlands of Guatemala. Using the Stunkard figure scale and a word elicitation task, participants attributed positive and negative characteristics to male and female silhouettes clinically defined as underweight, normal, overweight, mildly obese, and obese. Mixed-effects models were used to compare attribution scores for figures relative to the clinically normal silhouette. RESULTS: Silhouettes deviating from the clinically defined normal BMI category on both sides are stigmatized to varying degrees. Food insecurity exacerbates the degree of stigma, while also relatively preferencing overweight bodies. CONCLUSIONS: In this pilot study, women exhibit a preference for body sizes that fall within the clinical normal and overweight categories and stigmatize bodies outside this range, but in distinct ways. We suggest the attachment of stigma to small and large bodies are not mirror processes, and require more detailed testing to untangle the likely complex ecological and social explanations.

Reaching women in the Peruvian Andes through cervical cancer screening campaigns: assessing attitudes of stakeholders and patients.

BACKGROUND: Peru is characterized by high cervical cancer incidence and mortality rates. The country also experiences significant gaps in quality cervical cancer screening coverage for the population. OBJECTIVE: This descriptive mixed methods study conducted in Cusco, Peru, aimed to assess the attitudes and perceptions of medical staff, health care workers, and patients toward a cervical cancer screening program that included both clinic-based and community outreach services conducted by a nongovernmental organization clinic (CerviCusco). The study also explored patient knowledge and attitudes around cervical cancer and about the human papillomavirus (HPV) to inform patient education efforts. METHODS: The study employed structured interviews with key informants (n=16) primarily from CerviCusco, which provides cervical cancer prevention, screening, diagnosis and treatment services, and surveys with a sample of patients (n=30) receiving services at the clinic and at screening campaigns. RESULTS: The majority of key informant medical staff participants felt that the general public had a very negative view of government health services. One theme running throughout the interviews was the perception that the general population lacked a culture of preventive health care and would wait until symptoms were severe before seeking treatment. Regarding services that were received by patients at CerviCusco, the participants responded that the prices were reasonable and more affordable than some private clinics. Patients attending the rural health campaigns liked that the services were free and of good quality. CONCLUSION: CerviCusco has demonstrated its capacity to provide screening outreach campaigns to populations who had not previously had access to liquid-based cytology services. The finding that patients had generally low levels of knowledge about cervical cancer and the HPV vaccine prompted the development of culturally and linguistically appropriate educational and promotional materials to improve the educational component of the periodic campaigns conducted primarily in rural areas of Andean Peru.

Cultural beliefs and understandings of cervical cancer among Mexican immigrant women in Southeast Georgia.

Rural Mexican immigrant women in the U.S. are infrequently screened and experience health disparities from cervical cancer. We explored cancer-related cultural beliefs in this population. We administered a cross-sectional survey to 39 Mexican immigrant women due for screening. We conducted univariate and bivariate analyses of participants' characteristics, Pap test history, cancer-related knowledge and beliefs, and cultural consensus analysis about causes of cervical cancer and barriers to screening. For all the cultural consensus tasks, there was consensus (Eigenratios >3:1) among survey participants. Comparing the rankings of risk factor clusters, clusters related to sexual behaviors were ranked more severely than clusters related to genetic or other behavioral factors. There was agreement on ideas of cervical cancer causation and barriers to screening among these women. Hence, improved methods of disseminating important health information and greater access to care are needed, particularly in relationship to stigma about sex and birth control practices.

Assessing the accuracy of two proxy measures for BMI in a semi-rural, low-resource setting in Guatemala.

BACKGROUND: Validation studies of self-reported BMI are limited to populations in high-income countries or urban settings. Here, we assess the accuracy of two proxy measures of measured height, weight and BMI - self-reported values and the Stunkard figure scale - in a semi-rural population in Guatemala. METHODS: Self-reported values and Stunkard figure selection were elicited prior to biometric measurements from a total of 175 non-pregnant women recruited based on a stratified random sample of households, with 92 women providing full data for validation across measures. RESULTS: 86.3% of participants self-reported weight and 62.3% height. Among those responding, self-reported weight is highly accurate though lower relationships for height contribute to error in reported BMI. The Stunkard scale has a higher response rate (97.1%) and while less accurate in predicting BMI values, more accurately predicts BMI categories. CONCLUSIONS: Self-reported measures are more accurate than the Stunkard scale in estimating BMI values, while the latter is more accurate in estimating BMI categories. High non-response rates and lower correlations between reported and measured height caution against using self-reported biometric data other than raw weight in low-resource settings.

Gendered experiences of migration and conceptual knowledge of illness.

Migration is a gendered process which may differentially alter conceptual models of illness as variation and change within specific sub-domains reflect unique experiences and interactions. Forty Mexican migrants completed a questionnaire consisting of 30 true/false questions regarding the symptoms, causes, and treatments of 19 illnesses (570 total questions). Results were analyzed using the Cultural Consensus Model and residual agreement analyses to measure patterns of inter-informant agreement. While men and women share overall agreement, they differ significantly in conceptions of treatment. In general, men over-extend the efficacy of treatment options while women restrict the abilities of folk healers and emphasize dietary changes in treating many illnesses. Variations reflect different social roles and interactions as migration patterns and living conditions reinforce gendered roles in medical decision-making. Women have greater experience with illnesses and interactions with biomedical services, which causes them to approximate biomedical providers' model of treatment.

Remaking the Guatemalan midwife: health care reform and midwifery training programs in Highland Guatemala.

Midwifery practice and identity in Guatemala is constantly being transformed because midwives must negotiate their practices in response to changing international and national health care agendas and processes. Recently, the Guatemalan government implemented the Sistema Integral de Atención en Salud (SIAS). Framed by neoliberal processes and global reproductive health paradigms, SIAS is designed to attain the reproductive health goals outlined in the 1996 Peace Accords by reducing maternal and infant mortality rates. As the primary birthing specialists in rural areas, midwives are essential to this task. A central focus of SIAS is incorporating midwives into the national health care system through midwifery training programs. Drawing on observations of midwifery training programs and interviews with midwives in the municipality of San Martín Jilotepeque, I argue that the incorporation of midwives into SIAS is redefining the position by establishing a new model of recruitment to the role, education, and practice and authority.