Numbers of caesarean sections, epidurals, and other forms of medical interventions for birthing are rising in the United States healthcare industry. One possible reason is the medicalization of birthing and labor techniques. Another potential reason is the increasing distinction between laboring in a hospital versus laboring in the home or an independent birthing center. The dominance of the medical model of birthing has led to social constructions of birthing that divide women by diagnosis, into either high-risk or low-risk prenatal categories, further perpetuating the medical model’s power to marginalize the midwifery model. Forty percent of U.S. births are financed by Medicaid insurance. Because Medicaid insurance is based on the technocratic medical model, birthing providers that accept Medicaid insurance may be pressured, directly and indirectly, to adopt the medical model as the most appropriate birthing option, decentering the midwifery model. Inevitably, this potentially shifts birthing options and experiences for low-income women in the U.S. In order to understand how low-income women experience birthing in U.S birthing institutions, we first need to take a closer look at how birthing facilities socially construct birthing. Among many areas of influence for the social construction of birthing, website content has been neglected as a form of primary data. Using content analysis, this study investigates how web content aids in the social stock of knowledge on labor and delivery. Analyzing the websites of three birthing centers and two public hospitals that accept Medicaid insurance in Miami, Florida, this study’s findings indicate that the language used on birthing center websites aligns with the midwifery model, but reverts to the medical model used by hospitals, in language and policy, when discussing cases of emergency birthing. The public hospital websites, meanwhile, appropriate the language and procedures of the midwifery model without providing the practical benefits of natural birthing. Findings in this study also capture a snapshot of birthing models used by providers in Miami, Florida ahead of its 2016 transition from the Florida Medicaid system to the Federally-Funded Marketplace, as per the Affordable Care Act of 2009. By assessing how birthing providers socially construct birthing, we could reduce the underrepresentation of natural birthing, exposing low-income women to more balanced depictions of both the medical and midwifery models of birthing, possibly reducing negative socio-emotional outcomes during birthing, postpartum depression and maternity-mortality rates among the poor.

Not available / text

Not available / text

In the United States, concern about breast cancer has generated policies and programs aimed at increasing screening mammography and treatment access for the uninsured and underinsured. Oriented toward the importance of early detection and the state's responsibility to ensure health care access to its citizens, these policies and programs reflect and reinforce a moral economy of disease management that shapes the ethical behavior of patients, providers, and advocates. In contrast, the moral economy of market-based health care generates norms and assumptions about individual responsibility for health and limits expectations of the state in providing access to health care. Using breast cancer care for structurally vulnerable women as a focal point, this dissertation examines the social effects of intersecting moral economies of breast cancer management and market-based health care. It describes the relationships between public policies, social and economic marginalization, and gaps in health care access. Based on 18 months of ethnographic field work in Southern Arizona, I report findings from interviews with physicians, nurses, advocates, clinic office staff, and community health workers; from recurring discussions with women undergoing treatment for breast cancer; and from participant-observation in cancer-focused events and activities. This dissertation explores how policies that extend low-cost or free health care to broad populations also reproduce social exclusion and complicate what it means to be uninsured in America. I describe how everyday practices of health care, including determinations of eligibility for public insurance, reflect and reinforce social inequities based on citizenship status, gender, and occupational status. I conclude that the organization of cancer care for structurally vulnerable women effectively directs the focus away from the state's responsibility to provide health care access and instead privatizes that responsibility so that it resides with structurally vulnerable clinics and non-licensed health care staff. Furthermore, a charity approach to managing cancer care for unauthorized U.S. residents diverts public responsibility for their social exclusion to private entities. Finally, the findings of this dissertation contribute to debates about health reform efforts, such as the Affordable Care Act, by outlining the relationship between moral worth and government entitlements.

After the forced sterilizations of low-income and minority women were exposed in the 1970’s, new Medicaid policies were put into place in order to protect vulnerable populations. The revised policy included a mandatory consent form and a waiting period of 30 days between consent and procedure, as well as a presentation of the form at time of procedure. Although these policies were enacted to protect vulnerable populations, research has shown they are ineffective and act as barrier to women receiving the post-partum tubal sterilization that they desire. The policy has been shown to have a disproportionate detrimental impact on minority populations, and it has created a two-tiered health care system in terms of sterilization. The unfulfilled requests lead to many inadvertent consequences, including higher rates of unintended pregnancies, abortions, loss of self-efficacy, and higher costs for the Medicaid system. In order to ensure equitable treatment of Medicaid patients in regards to tubal sterilization, the 30-day waiting period should be rescinded. Additionally, to confirm that patients are fully knowledgeable of the implications of the tubal sterilization, the form and any ensuing consent should be rewritten to meet literacy standards for the target demographic. This analysis will include a history of the issue, an examination of relevant research, a policy analysis and recommendations to enhance healthcare equity.

Thesis (Ph. D.)--University of Texas at Austin, 2008. / Vita. Includes bibliographical references.

Thesis (Ph. D.)--UCLA, 2007. / Vita. Includes bibliographical references (leaves 131-137).

Thesis (Ph. D.)--University of Missouri-Columbia, 2002. / Typescript. Vita. Includes bibliographical references (leaves 74-78). Also available on the Internet.

Thesis (Ph. D.)--University of Missouri-Columbia, 2002. / Typescript. Vita. Includes bibliographical references (leaves 74-78). Also available on the Internet.

Thesis (Ph. D.)--University of Washington, 1996. / Vita. Includes bibliographical references (p. [55]-60).