Thesis (Ph. D.)--University of Texas at Dallas, 2007. / Includes vita. Includes bibliographical references (leaves 150-167)

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Thesis (Ph.D.)--University of Nebraska-Lincoln, 2008. / Title from title screen (site viewed Jan. 13, 2009). PDF text: vii, 292 p. : ill. (some col.), maps (some col.) ; 6 Mb. UMI publication number: AAT 3315886. Includes bibliographical references. Also available in microfilm and microfiche formats.

Addressing modifiable factors in perinatal mortality is a key priority for commissioners and service providers, aiming to improve birth outcomes and reduce preventable deaths (Department of Health, 2016; National Maternity Review, 2016). Luton, a town with a plural population, experiences higher rates of perinatal mortality than the national average (CDOP, 2015). Figures show an ethnic variation; Pakistani and Bangladeshi mothers experience higher rates of perinatal mortality in England compared with White British mothers, and the reasons for this are unclear. Much of the existing literature approaches the problem by examining individual risk factors quantitatively or exploring South Asian women’s experiences qualitatively. There is little research considering how Pakistani, Bangladeshi and White British women’s health beliefs impact on their health behaviour through the maternity care pathway, in Luton, and how this might contribute to perinatal mortality. This study takes an intersectional approach, using a convergent mixed-methods research design, reviewing retrospective secondary data (2008-2013) from the Luton and Dunstable Hospital NHS Foundation Trust’s Circona Maternity information System, to identify risk factors for perinatal mortality in Luton. Additionally, focus groups were conducted with lay women (aged over 16, living in LU1-LU4, who had experienced a live birth, at 37 weeks of gestation in the previous 6-24 months), and face-to-face interviews were held with bereaved mothers (aged over 16, who suffered an infant bereavement in the preceding 6-24 months, living in LU1-LU4). Health care professionals working on the maternity care pathway also took part in focus groups or interviews, providing their views on the service needs of Pakistani, Bangladeshi and White British women. The results/findings showed that risk factors varied according to ethnicity. Pakistani mothers had a greatest number of risk factors i.e. birthweight, diabetes, gestational diabetes, BMI < 18kg/m2, parity two, three and four and later booking (> 12 weeks). Deprivation featured in 81% of all deaths in 2014. The findings with the mothers revealed mostly similarities among women, regardless of their ethnicity; the majority of women wanted more pregnancy-related information, especially in respect of stillbirth and adverse outcomes. Similarly, bereaved mothers regardless of their ethnicity also reported mostly similarities, which included experiencing intuition when things were not right with the pregnancy. A few differences according to ethnicity were also identified, which focused on cultural or religious needs, such as cultural therapies (mostly dietary restrictions) undertaken by Pakistani and Bangladeshi women. The intersectional approach allowed simultaneous and aggregated factors (i.e. heritable, socio-economic status, structural factors and health beliefs and health behaviours) to be exposed; staff believed Pakistani and Bangladeshi women were not proactive in seeking pregnancy-related information, relying on verbal information and staff assumed mothers were literate and understood health messages. The intersected findings also revealed that few women took folic acid preconception, and many women co-slept with their baby. This study contributes new knowledge to the understanding of how Pakistani, Bangladeshi and White British women’s health beliefs influence their health behaviour, and contributes to perinatal mortality in Luton.

This thesis offers an analytical discussion of contemporary fictional and autobiographical narratives by migrants who write in a language other than their mother tongue and/or grew up in a bilingual environment. While not all literature by ethnic minority writers is necessarily concerned with the experience of growing up in or living between cultures, the present study deals with those writers whose texts self-reflexively and counter-discursively seek to define and express individual identity at the interface of two or more cultures. The writers discussed not only move spatially between places but also shift emotionally and intellectually between different languages and cultures as well as literary texts from these cultures. The focus is on language and the literary text itself as it becomes the site for an interaction of cultural codes. The methodology adopted draws eclectically on theories which explore the space between" from anthropological, linguistic, post-colonial and feminist perspectives. The thesis examines different textual paradigms of countering dominant discourses as found in ten representative texts from Australia, Canada, Germany and the United States which have been chosen to cover a range of cultural experience. The texts discussed are: Angelika Fremd's Heartland and Josef Vondra's Paul Zwillinq; Caterina Edwards' The Lion's Mouth, Henry Kreisel's The Betrayal and Rachna Mara's Of Customs and Excise; Franco Biondi's Abschied der zerschellten Jahre: Novelle and Akif Pirincci's Tranen sind immer das Ende: Roman; Sandra Cisneros' The House on Mango Street, Eva Hoffman's Lost in Translation: A Life in a New Language and Richard Rodriguez' Hunger of Memory: The Education of Richard Rodriguez. It is shown that self-reflexive negotiation of Self and Other in the text takes different forms depending on the writer's ethnic and racial background, his/her gender and the adopted country's social and political attitudes toward the newcomer. Re-writing, however, which is understood as an intentional, political dialogue with specific texts, is a recurrent counter-discursive strategy in the texts discussed. Finally, the thesis argues that the re-writing of traditional literary genres, such as Novelle, short story cycle, autobiography, Bildungs roman and quest novel, rather than of a particular text, as in other post-colonial contexts, is the most prevalent form of "writing back" in migrant literature. Texts written by migrants not only creatively revise literary conventions, challenge the concept of “national literature" and undermine canonically established categories, but also defeat attempts to approach a text with a single "appropriate" theory to reveal the strategies and the effects of cultural hybridity. / Arts, Faculty of / English, Department of / Graduate

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