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1.
Med Anthropol Q ; 2023 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-37874945

RESUMO

In the context of a steadily decreasing Indigenous population, active military occupation, and a documented history of human rights abuses perpetrated by Indonesian state security forces, Black Indigenous Papuans have uttered phrases like extinction, and we will be gone in public and private spaces. These utterances often follow an indictment of Indonesia's national family planning program as a key node of state apparatuses of domination and, by extension, genocide. Amid Indonesia's global health success story of a historically lauded national family planning model, I examine the emergence of a local pronatalist program in which health workers are both providers and deniers of access to birth control. Through highlighting this story of Indigenous refusal and racial survival in the terrain of women's reproduction the stakes of a necropolitical environment marked by occupation, population control, and fears of genocide are brought into high relief.

2.
Contraception ; 120: 109956, 2023 04.
Artigo em Inglês | MEDLINE | ID: mdl-36634729

RESUMO

OBJECTIVES: Pregnant people have traveled across state and national borders for the purpose of abortion since at least the 1960s. Scholarship has robustly documented the financial and logistical costs associated with travel, but less work has examined the emotional costs of abortion travel. We investigate whether abortion travel has emotional costs and, if so, how they come about. STUDY DESIGN: We conducted in-depth interviews with 30 women who had to travel across state borders in the United States for abortion care because of their gestation. We analyzed findings thematically. RESULTS: Interviewees described having to travel to obtain abortion care as emotionally burdensome, causing distress, stress, anxiety, and shame. Because they had to travel, they were compelled to disclose their abortion to others and obtain care in an unfamiliar place and away from usual networks of support, which engendered emotional costs. Additionally, travel induced feelings of shame and exclusion because it stemmed from a law-based denial of in-state abortion care, which some experienced as marking them as deviant or abnormal. CONCLUSIONS: People who have to travel for abortion care experience emotional costs alongside financial and logistical costs. The circumstances of that travel-specifically, being forced to travel because of legal restriction and service unavailability-are foundational to the ensuing emotional burdens. Findings add to the emerging literature on how laws and other structures produce the stigmatization of abortion at interpersonal and individual levels. IMPLICATIONS: With abortion bans following the overturning of the right to abortion and existing gestational limits in the US, more people will have to travel for abortion care. Attention to the emotional costs of abortion travel can help providers understand what their patients may be experiencing when they present for care.


Assuntos
Aborto Induzido , Acessibilidade aos Serviços de Saúde , Gravidez , Estados Unidos , Feminino , Humanos , Aborto Induzido/psicologia , Ansiedade , Viagem/psicologia , Aborto Legal
3.
Med Anthropol Q ; 36(1): 44-63, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-34762740

RESUMO

As medicine integrates social and structural determinants into health care, some health workers redefine housing as medical treatment. This article discusses how health workers in two U.S. urban safety-net hospitals worked with patients without stable housing. We observed ethnographically how health workers helped patients seek housing in a sharply stratified housing economy. Analyzing in-depth interviews and observations, we show how health workers: (1) understood housing as health care and navigated limits of individual care in a structurally produced housing crisis; and (2) developed and enacted practices of biomedical and sociopolitical stabilization, including eligibilizing and data-tracking work. We discuss how health workers bridged individually focused techniques of clinical care with structural critiques of stratified housing economies despite contradictions in this approach. Finally, we analyze the implications of providers' extension of medical stabilization into social, economic, and political realms, even as they remained caught in the structural dynamics they sought to address.


Assuntos
Habitação , Pessoas Mal Alojadas , Antropologia Médica , Pessoal de Saúde , Humanos , Provedores de Redes de Segurança
4.
Soc Sci Med ; 220: 49-55, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30391641

RESUMO

Our paper explores how legal status stratification shapes the health and health care of low-income patients with chronic illnesses in the U.S. healthcare safety net. Drawing on data from over two years of ethnographic fieldwork at urban safety-net clinics, we examine efforts by Complex Care Management (CCM) teams to stabilize patients with uncontrolled chronic illnesses through primary care-integrated support. We show that stratified citizenship and geographic variability correspond to different possibilities for health care. We suggest an approach to immigration as a structural determinant of health that accounts for the complex, stratified, and changing nature of citizenship status. We also highlight how geographical differences and interactions among local, state, and federal policies support the notion that citizenship is stratified across multiple tiers with distinctive possibilities and constraints for health. While county-based health plans at each of the study sites include residents with varying legal status, lack of formal legal status remains a substantial obstacle to care. Many immigrants are unable to take full advantage of primary and specialty care, resulting in unnecessary morbidity and mortality. In some cases, patients have returned to their country of origin to die. While CCM teams provide an impressive level of support to assist immigrant patients in navigating healthcare and immigration bureaucracies, legal and geographic stratification limit their ability to address broader aspects of these patients' social context.


Assuntos
Atenção à Saúde , Emigrantes e Imigrantes/legislação & jurisprudência , Emigração e Imigração , Provedores de Redes de Segurança/legislação & jurisprudência , Determinantes Sociais da Saúde , Adulto , Antropologia Cultural , Doença Crônica/terapia , Feminino , Hispânico ou Latino/legislação & jurisprudência , Humanos , Masculino , Pessoa de Meia-Idade , Pobreza , Estados Unidos
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