Unethical ethics? Reflections on intercultural research practices.

The notion that there is a universal ethics is commonly supposed, but less often explicitly discussed, in protocols for ethical procedures in research. In this article, the authors reflect on their action-research with women farmers in a Bolivian highland province. Their project aims to propose ways in which local health services could better serve these women's expressed sexual and reproductive health needs. A series of field experiences led the authors to question the adequacy of pre-established institutional protocols for informed consent. Cultural understandings in this context made for situations where supposedly ethical procedures led to unethical effects. While recognising the value of precautionary measures to avoid abuse of research subjects, the authors challenge the assumption of subjects' essential vulnerability in fieldwork relations. They found that they too, as researchers and outsiders to the community, could be assigned less than adult status by research subjects seeking empowerment in their own terms. The paper concludes that consent protocols, rather than relying on standardised procedures, should provide flexible alternatives to facilitate negotiation with subjects about whether and how they will participate at different stages of a research project.

Misinformation, mistrust, and mistreatment: family planning among Bolivian market women.

Results of an ethnographic study suggest that, despite stereotypes to the contrary, urban Aymara women in Bolivia want to regulate their fertility, and sociocultural norms support fertility regulation. However, the norms also make such regulation difficult to achieve. One barrier is a deep suspicion of modern medicine and medical practitioners, who are not seen as reliable sources of information. This suspicion is reinforced when the quality of health services is inadequate. Among urban Aymara, the level of acceptability of most modern methods of contraception is low. Many would prefer to use traditional methods, even when use of these methods entails considerable sacrifice and risk of conflict with their partners, unwanted pregnancies, and recourse to unsafe abortion.

PIP: Ethnographic data were used to examine fertility control in 1993 among Aymara urban women in Bolivia. Data were gathered from in-depth interviews on family planning (FP) with 30 women, from similar interviews with eight men, from 38 other household interviews, and from FP service clients. Most of the Bolivian population is composed of members of the Aymara or Quechua indigenous groups. About 50% of total population is urban. Interview responses indicated that most women wanted to control their fertility so that they could improve their economic situation by selling items in the market. Cultural norms and beliefs were compatible with fertility control and women's work. Women were expected to control reproduction through rhythm or a form of abstinence. Barriers to fertility control included a lack of communication about sexual and contraceptive matters with friends, family, or spouses. This pattern of silence was handed down from their mothers. Almost 66% of the 30 women had never received information on menstruation or reproduction when growing up. The message was that sexuality was dangerous and shameful. Almost 33% engaged in a living arrangement with a sexual partner at the age of 14-16 years, and the remaining had done so by 17-20 years. Marriage occurred accidentally or by force (25%). Voluntary cohabitation occurred in about 50% of cases. After sexual contact occurred, parents strongly urged marriage. Women eventually learned about contraception through women's clubs, clinics, church groups, husbands, or friends. When fertility control failed, women resorted to extreme abstinence, abortion, infanticide, or modern methods. Modern methods were viewed as dangerous and with harmful side effects; modern medicine was viewed similarly. Contraceptive use could be associated with promiscuity. Women feared being touched by health personnel. Although abortion was illegal, women conveyed a desire to end an unwanted pregnancy or acted with systematic neglect to end an unwanted birth. Recommendations were made for providing culturally sensitive services which involved men.

Post-abortion services in Bolivia.

PIP: Third World women with complications from an illegally induced abortion tend to postpone seeking medical treatment, because of both a lack of knowledge about the signs of infection or hemorrhage and a fear of moral and legal sanctions. At admission, hospital policies require that women be questioned repeatedly until they acknowledge whether their symptoms are a result of induced or spontaneous abortion. In Bolivia, women hospitalized for abortion-related complications also face financial sanctions. They are charged 450 Bs (US$105) for dilatation and curettage); social security coverage is denied as is eligibility for sliding scale fees based on ability to pay. Interviews with 12 patients and 14 staff members at 4 Bolivian hospitals revealed substantial variation in the postabortion care women receive. Care seemed to be more dependent on the personal ethics of staff members than definite policies. In general, however, these women did not receive the moral support needed to help them overcome their feelings of ambivalence, guilt, and depression. Rather, a double standard prevails, where women alone bear responsibility for the pregnancy and then are blamed for seeking termination under illegal conditions.^ieng