O câncer de pênis é uma doença de baixa incidência e sua manifestação está associada a fatores intrínsecos e extrínsecos, e sua principal forma de tratamento é a penectomia. Devido à doença ocorrer no órgão genital masculino busquei conhecer como os homens adoecidos lidam com suas masculinidades na situação do adoecimento. Dessa forma, propus a tese de que a cultura influencia na forma como os homens sobreviventes do câncer de pênis lidam com suas masculinidades. Elaborei o objetivo de interpretar os significados atribuídos à experiência com o câncer de pênis e seus tratamentos pelos homens adoecidos. O referencial teórico adotado foi o da antropologia médica e das masculinidades, pois ambas consideram a cultura como um elemento importante no mundo social. Para conhecer a cultura do outro é necessário vivenciá-la de perto, por este motivo optei por desenvolver a etnografia narrativa. Esse método propõe ao pesquisador o uso de técnicas como a observação participante, múltiplas entrevistas, uso do diário de campo, análise temática e a apresentação dos resultados na estrutura de narrativas que contenham a estória das vivências dos participantes. Ressalto que a narrativa tem como principal objetivo mostrar as transformações vividas pelos depoentes, considerando os aspectos comuns e divergentes dos entrevistados. Foram selecionados 18 homens com o diagnóstico de câncer de pênis no ambulatório de uro- oncologia de um hospital do interior paulista. As características sociais e clínicas dos entrevistados são semelhantes aos dados nacionais e internacionais em relação à baixa incidência da doença, faixa etária e os tratamentos empregados. Diante do processo de análise foi possível construir oito sínteses temáticas: O câncer de pênis e seu itinerário; O corpo após a doença e seus tratamentos; O câncer e suas repercussões sociais: o trabalho, o lazer e as relações sociais; Por trás do visível: a confidencialidade da doença; A sexualidade pós- tratamento; Um homem inteiro ou meio homem: a ressignificação das masculinidades; Recursos de apoio social; O hoje e as expectativas para o futuro. Por meio das sínteses narrativas é possível conhecer os sentidos que os homens empregaram ao adoecimento e como a doença afetou sua masculinidade. Estes achados permitiram alcançar o significado de ser homem sobrevivente do câncer de pênis e seus tratamentos, que pode ser compreendido pela expressão \"ser meio homem\". Desde o início do diagnóstico até a vida no pós- tratamento, os homens negociam suas masculinidades com o mundo social, e percebem que algumas características adquiridas durante o adoecimento os tornam diferente dos demais homens, tais como se assumir doente, a extirpação total ou parcial do pênis, redução da força física, impossibilidade de trabalhar e alterações na prática sexual. Comprovo, então, que a cultura tem influência na forma que os homens lidam com suas masculinidades, uma vez que os adoecidos constantemente revisitam seus padrões culturais de masculinidade para obedecê- lo ou ressignificá-lo. Os enfermeiros podem utilizar os achados deste estudo para refletir sua prática de cuidado aos homens com câncer e para desenvolverem outras pesquisas que o complementem / Penile cancer is a disease of low incidence, and its manifestation is associated with intrinsic and extrinsic factors, and its main form of treatment is the penectomy. Due to the fact that the disease occurs in the male genital organ, I sought to know how the ill men deal with their masculinities in the disease situation. Thus, I proposed the thesis that culture influences in the way as the penile cancer survivors deal with their masculinities. The aim of this study is to interpret the meanings attributed to the experience with penile cancer and its treatments by the ill men. The theoretical framework adopted was medical anthropology and masculinities, since both considered culture as an important element in the social world. In order to understand the culture of the other people is necessary to experience it closely, for this reason I chose to develop the narrative ethnography. This method proposes to the researcher the use of techniques such as participant observation, mult iple interviews, the use of field diary, thematic analysis and the presentation of results in the structure of narratives that contain the story of participants\' experiences. I emphasize that the narrative has as main objective to show the transformations lived by the deponents, considering the common and divergent aspects of the interviewees. We selected 18 men with the diagnosis of penile cancer in the uro-oncology clinic of a hospital in the interior of São Paulo. The social and clinical characteristics of the interviewees are similar to the national and international data regarding the low incidence of the disease, age group and the treatments used. From the process of analysis it was possible to construct eight thematic syntheses: Penile cancer and its itinerary; The body after disease and its treatments; Cancer and its social repercussions: work, leisure and social relations; Behind the visible: the confidentiality of the disease; The sexuality post-treatment; The whole man or half man: resignification of masculinities; Social support resources; The today and expectations for the future. Through narrative syntheses it was possible to comprehend the meaning attributed by the patients, what they assigned to illness and how that disease affected their masculinity. These findings allowed us to achieve the meaning of being a man penile cancer survivor and its treatments, which can be understood by the expression \"being half man\". From the onset of diagnosis up to life post-treatment, men negotiate their masculinities with the social world, and realize that some characteristics acquired during illness make them different from other men, such as, to assume themselves as sickness, the fact that they have total or partial penile extirpation, reduction of physical strength, impossibility of working and changes in sexual practice. I then show that culture influences the way men deal with their masculinities, since the ill men are constantly revisiting their cultural patterns of masculinity to obey or re-signify it. Nurses can use the findings of this study to reflect their practice of caring for men with cancer and to develop further researches that complements this one

A questão do aborto provocado no Brasil envolve discursos de diversas ordens, definindo um contexto marcado por disputas políticas em debates polêmicos. Por um lado, a problemática do aborto pressupõe um recorte de gênero específico, pois remete imediatamente ao corpo da mulher. Por outro, refere-se a um conjunto de relações mais amplas, centrado especialmente no(s) sentido(s) de família, como dimensão fundamental a ser investigada com vistas ao entendimento dos contextos de gravidez. A partir de uma metodologia qualitativa de orientação etnográfica foi desenvolvido trabalho de campo com dois grupos. Em um deles, foram realizadas entrevistas semi-estruturadas com treze mulheres da região de Porto Alegre/ RS que interromperam a gestação em condições ilegais. No outro, foram feitas entrevistas com diversas pessoas que estiveram envolvidas em um caso de indiciamento judicial de uma Clínica de Planejamento Familiar em Campo Grande/MS. Também foram analisados materiais veiculados na mídia sobre os debates que envolvem a prática de aborto. Foi possível perceber que o caso do indiciamento abrange aspectos sociais e políticos, que não a restrita punição das mulheres que interromperam a gestação. Além disso, procurou-se demonstrar a rede familiar e o contexto na qual a gravidez não planejada está inserida, além das formas de punição corporificadas para as mulheres que abortam. O conjunto de dados mostra, tanto a desconexão dos discursos legais, dos movimentos sociais e da realidade das pesquisadas, como a interpenetração das esferas públicas e privadas no corpo das mulheres. Os resultados apontam para a necessidade de uma abordagem que assuma como central a experiência das mulheres, já que a questão do aborto é encoberta por ambivalências próprias do âmbito legal e moral. / The issue of indeced abortion in Brazil is comprised by multiple discourses, creating a context of political disputes and polemic debates. On the one hand, the problem of abortion presupposes targeting one specific gender, centering on the women's body. On the other hand, abortion is related to a wide set of relationships with an emphasis on the meaning of family, as a central dimension to be investigated in order to illuminate the contexts of pregnancy. The ethnographic work was conducted with two different social groups. Semistructured interviews were collected with 13 women from Porto Alegre/RS, who performed illegal abortion. The other case that I discuss is the indictment of a Family Planning clinic in Campo Grande/MS. In other to analyze the case, I use qualitative data gathered from newspapers and the Internet. The case of the Family Planning clinic involves social and political aspects, given that it was not restricted to the women who performed abortion. Moreover, I intent to demonstrate the kinship networks and the context in which pregnancy took place. The analysis of data demonstrates, beyond the disconnect of legal, political and the experiential discourses concerning abortion, the intertwining of the private and public spheres. The results point to the necessity of a women's experience-centered approach, because the problem of abortion is often covered by ambiguities that are recurrent in the legal and moral spheres.

O diagnóstico de câncer e a necessidade de passar por vários tratamentos geram impactos e transformações na vida da pessoa. A reação individual para lidar com o itinerário da doença sofre influência do contexto sociocultural e repercute no modo de lidar com os sentimentos existenciais da experiência. Esses sentimentos podem ser expressos por termos diversos, entre eles, a depressão. O objetivo deste estudo foi interpretar os significados da depressão atribuídos pelos pacientes com câncer de bexiga em seguimento terapêutico, construídos com base em dados narrativos. Empregou-se a abordagem metodológica qualitativa, embasado pelo referencial teórico-metodológico da antropologia médica e do método da narrativa. Após aprovação ética para a pesquisa e consentimento das chefias da instituição coparticipante, foram convidados 12 participantes com câncer de bexiga, sem diagnóstico de depressão, em seguimento terapêutico no Ambulatório de Urologia Oncológica de um serviço de saúde de alta complexidade do interior do Estado de São Paulo, para participar do estudo. A coleta de dados ocorreu no período de janeiro 2014 a fevereiro de 2015, por meio de entrevistas semiestruturadas gravadas, observação direta e registros no diário de imersão, realizadas nos domicílios dos participantes e no serviço de saúde. Obteve-se uma amostra representativa do grupo, não intencional, homogênea quanto ao sexo, sendo a maioria acima de 60 anos, casados, com mais de sete anos de estudos e aposentados. Para tratamento, todos realizaram RTU com associação da BCG para a maioria, e houve três cistectomizados. A análise dos dados narrativos apoiou-se nos pressupostos da análise temática pelo processo indutivo. Identificaram-se as categorias com as quais elaboramos as unidades de sentidos do processo vivido com o câncer de bexiga e a depressão, compondo os modelos explanatórios dos pacientes. As unidades de sentidos serviram de guia para a construção de duas sínteses narrativas e seus significados: \"O paradoxo da vida com câncer de bexiga\" e \"A depressão como emoção no câncer de bexiga em seguimento terapêutico\". A primeira síntese aborda as dificuldades com o processo da doença e tratamento enquanto rupturas na vida, futuro incerto pela possibilidade de recidiva da doença, necessidade de continuidade do tratamento para o controle da doença e a lógica compensatória de controle emocional, relacionando-se com as ponderações contraditórias da vida atual. Assim, o significado desta síntese narrativa é de paradoxo. A segunda síntese aborda a incorporação do termo depressão ao senso comum, o qual revela a dimensão sociocultural da condição de ser sobrevivente oncológico em seguimento terapêutico. O seu significado revela a depressão no câncer como prática social e expressão de subjetividade, por meio da emoção de tristeza. Esta investigação permitiu-nos interpretar os significados da depressão atribuídos pelos adoecidos com câncer de bexiga segundo suas experiências. Como considerações finais, destacamos a importância dos enfermeiros em darem atenção à saúde mental do adoecido pelo câncer, pela escuta das suas subjetividades para promoveram intervenções adequadas, objetivando a integralidade do cuidado / The diagnosis of cancer and the need to undergo several treatments cause impact and change in the people\'s life. The personal reaction in coping with the itinerary of the disease suffers influence of the sociocultural context affecting the way of dealing with existential feelings from experience. These feelings can be related through different terms, among them, depression. The aim of study was to interpret the meanings of the depression attributed by patients with bladder cancer under therapeutic follow-up, based on their narratives. It was used the qualitative methodological approach, supported by theoretical-methodological referential of medical anthropology and narrative method. After ethical approval for the research and agreement of the heads of institutions, as coparticipants, 12 individuals were invited to participate of the study, they all with bladder cancer, without depression diagnosis, under therapeutic follow-up at the Oncological Urology Clinic that provide health service of high complexity in the countryside of São Paulo state . The data collection occurred from January 2014 to February 2015, through recorded semi-structured interviews, direct observations and it were registered in the immersion diary. These activities were held at the patients´ residences and in the health service. It was obtained a representative sample of the group, non-intentional, homogeneous regard to sex, being the most part of the patients over 60 years old, married, with more seven years of schooling and retired. For treatment, they all were submitted to TUR, with BCG association for the greater part and three of them by cystectomy. The analysis of narratives data was supported on the assumptions of thematic analysis by inductive process. The categories were identified and used to elaborate the units of senses of the experienced process by bladder cancer and depression as well as built the explanatory models of the patients. These units of senses served as guide for construction of two narratives syntheses and their meanings: \"The paradox of life with bladder cancer\" and \"The depression as emotion with bladder cancer under therapeutic follow-up\". The first synthesis addresses the difficulties with disease process and treatment as rupture of life, an uncertain future on the possibility of recurrence of the disease, the need of continuous treatment to control the disease and compensatory logic of the emotional control relating to contradictories considerations of the current life. Thus, the meaning of this narrative synthesis is paradox. The second synthesis approaches the incorporation of the depression term to common sense, which exposes the sociocultural dimension of the condition of being cancer survivor under therapeutic follow-up; its meaning reveals depression in cancer as social practice and subjectivity expression through emotion of sadness. This research allowed us to interpret the meanings of depression attributed by patients with bladder cancer according to their experiences. As final consideration, we emphasize the importance of the nurses to give attention to the mental health of the patients with cancer, by listening to their subjectivities to promote appropriate interventions, aiming care completeness

Este trabalho é fruto de uma investigação que buscou elucidar a relação estabelecida entre os serviços de saúde e os seus usuários. Com esse objetivo, utilizou-se uma abordagem antropológica que teve como referência a experiência empírica ligada à Unidade Conceição do Serviço de Saúde Comunitária do Grupo Hospitalar Conceição, em Porto Alegre, RS. Funcionando nas dependências do Hospital Nossa Senhora Conceição, a Unidade Conceição é um posto de saúde vinculado ao Sistema Único de Saúde (SUS) em que médicos gerais comunitários e outros profissionais vêm prestando atendimento de saúde, há cerca de 15 anos, aos moradores da sua vizinhança, calculados atualmente em mais de 20 mil pessoas. Tendo como pano de fundo as influências da cultura no comportamento humano e na prestação de atendimento de saúde, os desdobramentos principais da relação entre a Unidade e os seus usuários foram analisados sob diversos eixos: a história da Unidade, seus conflitos com a instituição e outras especialidades médicas; a relação da Unidade com a área geográfica sob sua responsabilidade; a questão da participação popular nos serviços de saúde, mais especificamente a experiência do seu Conselho Gestor Local; e, por fim, a avaliação dos serviços de saúde, principalmente no que concerne à perspectiva dos pacientes. Sempre que possível, a análise feita procurou fazer uma ligação com as mudanças ocorridas no sistema de saúde brasileiro nos últimos anos. Resgatar os aspectos culturais como elemento essencial para o estabelecimento de uma comunicação efetiva entre os indivíduos e os serviços formais de saúde mostrou-se fundamental para permitir o aprofundamento desse tipo de análise e para qualificar as ações desenvolvidas pelos serviços de saúde. / This dissertation is the result of a research that aimed at clarifying the relationship between health services and their users under an anthropological point of view. The research was based on the practical experience carried out at Unidade Conceição do Serviço de Saúde Comunitária do Grupo Hospitalar Conceição, in Porto Alegre, RS. This Unit, a health care center associated to Sistema Único de Saúde (SUS), has been developing its activities inside Hospital Nossa Senhora Conceição for the last 15 years, counting on family doctors and other professionals to provide health attention to around twenty thousand people living in this neighborhood. Having culture influences on human behavior as well as on health care practice as background, the main aspects of the relationship between health center and its users were analyzed under different lines of thought: Unit history, Unit conflicts related to the institution and other medical specialties; the relationship between the Unit and the geographical area under its responsibility; popular participation on health services, more specifically the experience of the Unit health council; and, finally, the evaluation of health care, mainly related to the patient’s perspective. Whenever possible, this analysis was referred to changes occurred in the Brazilian health system in the last few years. Reclaiming cultural aspects as an essential element to establish effective communication between formal health services and their users showed to be of utmost importance to deepen this kind of analysis and to qualify the health care practice.

O diagnóstico de câncer e a necessidade de passar por vários tratamentos geram impactos e transformações na vida da pessoa. A reação individual para lidar com o itinerário da doença sofre influência do contexto sociocultural e repercute no modo de lidar com os sentimentos existenciais da experiência. Esses sentimentos podem ser expressos por termos diversos, entre eles, a depressão. O objetivo deste estudo foi interpretar os significados da depressão atribuídos pelos pacientes com câncer de bexiga em seguimento terapêutico, construídos com base em dados narrativos. Empregou-se a abordagem metodológica qualitativa, embasado pelo referencial teórico-metodológico da antropologia médica e do método da narrativa. Após aprovação ética para a pesquisa e consentimento das chefias da instituição coparticipante, foram convidados 12 participantes com câncer de bexiga, sem diagnóstico de depressão, em seguimento terapêutico no Ambulatório de Urologia Oncológica de um serviço de saúde de alta complexidade do interior do Estado de São Paulo, para participar do estudo. A coleta de dados ocorreu no período de janeiro 2014 a fevereiro de 2015, por meio de entrevistas semiestruturadas gravadas, observação direta e registros no diário de imersão, realizadas nos domicílios dos participantes e no serviço de saúde. Obteve-se uma amostra representativa do grupo, não intencional, homogênea quanto ao sexo, sendo a maioria acima de 60 anos, casados, com mais de sete anos de estudos e aposentados. Para tratamento, todos realizaram RTU com associação da BCG para a maioria, e houve três cistectomizados. A análise dos dados narrativos apoiou-se nos pressupostos da análise temática pelo processo indutivo. Identificaram-se as categorias com as quais elaboramos as unidades de sentidos do processo vivido com o câncer de bexiga e a depressão, compondo os modelos explanatórios dos pacientes. As unidades de sentidos serviram de guia para a construção de duas sínteses narrativas e seus significados: \"O paradoxo da vida com câncer de bexiga\" e \"A depressão como emoção no câncer de bexiga em seguimento terapêutico\". A primeira síntese aborda as dificuldades com o processo da doença e tratamento enquanto rupturas na vida, futuro incerto pela possibilidade de recidiva da doença, necessidade de continuidade do tratamento para o controle da doença e a lógica compensatória de controle emocional, relacionando-se com as ponderações contraditórias da vida atual. Assim, o significado desta síntese narrativa é de paradoxo. A segunda síntese aborda a incorporação do termo depressão ao senso comum, o qual revela a dimensão sociocultural da condição de ser sobrevivente oncológico em seguimento terapêutico. O seu significado revela a depressão no câncer como prática social e expressão de subjetividade, por meio da emoção de tristeza. Esta investigação permitiu-nos interpretar os significados da depressão atribuídos pelos adoecidos com câncer de bexiga segundo suas experiências. Como considerações finais, destacamos a importância dos enfermeiros em darem atenção à saúde mental do adoecido pelo câncer, pela escuta das suas subjetividades para promoveram intervenções adequadas, objetivando a integralidade do cuidado / The diagnosis of cancer and the need to undergo several treatments cause impact and change in the people\'s life. The personal reaction in coping with the itinerary of the disease suffers influence of the sociocultural context affecting the way of dealing with existential feelings from experience. These feelings can be related through different terms, among them, depression. The aim of study was to interpret the meanings of the depression attributed by patients with bladder cancer under therapeutic follow-up, based on their narratives. It was used the qualitative methodological approach, supported by theoretical-methodological referential of medical anthropology and narrative method. After ethical approval for the research and agreement of the heads of institutions, as coparticipants, 12 individuals were invited to participate of the study, they all with bladder cancer, without depression diagnosis, under therapeutic follow-up at the Oncological Urology Clinic that provide health service of high complexity in the countryside of São Paulo state . The data collection occurred from January 2014 to February 2015, through recorded semi-structured interviews, direct observations and it were registered in the immersion diary. These activities were held at the patients´ residences and in the health service. It was obtained a representative sample of the group, non-intentional, homogeneous regard to sex, being the most part of the patients over 60 years old, married, with more seven years of schooling and retired. For treatment, they all were submitted to TUR, with BCG association for the greater part and three of them by cystectomy. The analysis of narratives data was supported on the assumptions of thematic analysis by inductive process. The categories were identified and used to elaborate the units of senses of the experienced process by bladder cancer and depression as well as built the explanatory models of the patients. These units of senses served as guide for construction of two narratives syntheses and their meanings: \"The paradox of life with bladder cancer\" and \"The depression as emotion with bladder cancer under therapeutic follow-up\". The first synthesis addresses the difficulties with disease process and treatment as rupture of life, an uncertain future on the possibility of recurrence of the disease, the need of continuous treatment to control the disease and compensatory logic of the emotional control relating to contradictories considerations of the current life. Thus, the meaning of this narrative synthesis is paradox. The second synthesis approaches the incorporation of the depression term to common sense, which exposes the sociocultural dimension of the condition of being cancer survivor under therapeutic follow-up; its meaning reveals depression in cancer as social practice and subjectivity expression through emotion of sadness. This research allowed us to interpret the meanings of depression attributed by patients with bladder cancer according to their experiences. As final consideration, we emphasize the importance of the nurses to give attention to the mental health of the patients with cancer, by listening to their subjectivities to promote appropriate interventions, aiming care completeness

Thesis (M.A.)--State University of New York at Binghamton, Department of Anthropology, 2006. / Includes bibliographical references.

The United States population continues to increase and diversify. The cultural composition within the United States embodies a multitude of people from a variety of belief systems, religious backgrounds, and ethnicities. Within current biomedical practice, many of these differences are often marginalized, leaving populations with unsatisfactory experiences in seeking health care. Cultural competency attempts to address those differences in health care delivery. Many health care institutions are striving to become more culturally competent yet there is not a common understanding of what cultural competency means. In addition, there are many obstacles that limit the implementation of cultural competency in health care delivery. This thesis examines the need for cultural competency in health care, addressing the lack of understanding between institutions regarding cultural competency and assessing its understanding at one particular institution. Recent research at Oregon Health & Science University in Portland, Oregon has provided new insight to the discussion of cultural competency and how uniquely it can be defined in a single institution. Qualitative interviews were conducted with medical students, physicians/physicians-in-training, administrators and nurses/CMA in order to uncover how cultural competency is defined as well as the issues that are involved when delivering culturally competent health care. By being aware of an institution's cultural composition and understanding of cultural competency can help that institution enact health programs and policies that have a better chance of representing and respecting the populations they serve. / Graduation date: 2003

Because infants are the most vulnerable members of a community, their deaths – and the resulting infant mortality rate (IMR) – are said to signal more fundamental problems that are likely to affect the general health of a community. However, a focus on proximate- and intermediate-level risk factors in epidemiological analyses presents a decontextualized picture and ignores the role of larger forces on health, disease, and illness. In response to this trend, this project will contribute to a revitalization of the use of infant mortality as an index of larger social problems by tempering statistical analyses with critical reflection regarding the effects of the liminal position of Malta within the British imperial system, prior to the Second World War. In addition, by bringing together several analytic approaches which often proceed in parallel, rather than in dialogue – historical epidemiology, social history, and the analysis of colonial discourse – this dissertation highlights the problematics of knowledge production at both the theoretical and methodological level. As a result, my work is not just about Malta, one moment in history, the calculation of infant mortality rates, or the disentanglement of various determinants of infant mortality in this context; it is about the dynamics and repercussions of power differentials and of social, economic, and political inequalities, as they define and structure health outcomes and experiences. Specifically, I will show that fluctuations in international tensions affected Malta’s population on a number of levels because of the island’s importance as a British military and naval base and its location in the middle of the Mediterranean. I will demonstrate how Malta’s “strategic position” restricted political and economic development in the island and articulated with colonial perceptions of the Maltese as “Other” and Malta as “overpopulated.” Finally, I will argue that international tensions, Malta’s location within Empire, and perceptions of the island and its inhabitants in the early twentieth century affected the ways in which infant deaths were explained and understood and the strategies of intervention initiated in the island to curtail infant mortality – all of which had a tremendous impact on the rates at which infants in Malta died.

Because infants are the most vulnerable members of a community, their deaths – and the resulting infant mortality rate (IMR) – are said to signal more fundamental problems that are likely to affect the general health of a community. However, a focus on proximate- and intermediate-level risk factors in epidemiological analyses presents a decontextualized picture and ignores the role of larger forces on health, disease, and illness. In response to this trend, this project will contribute to a revitalization of the use of infant mortality as an index of larger social problems by tempering statistical analyses with critical reflection regarding the effects of the liminal position of Malta within the British imperial system, prior to the Second World War. In addition, by bringing together several analytic approaches which often proceed in parallel, rather than in dialogue – historical epidemiology, social history, and the analysis of colonial discourse – this dissertation highlights the problematics of knowledge production at both the theoretical and methodological level. As a result, my work is not just about Malta, one moment in history, the calculation of infant mortality rates, or the disentanglement of various determinants of infant mortality in this context; it is about the dynamics and repercussions of power differentials and of social, economic, and political inequalities, as they define and structure health outcomes and experiences. Specifically, I will show that fluctuations in international tensions affected Malta’s population on a number of levels because of the island’s importance as a British military and naval base and its location in the middle of the Mediterranean. I will demonstrate how Malta’s “strategic position” restricted political and economic development in the island and articulated with colonial perceptions of the Maltese as “Other” and Malta as “overpopulated.” Finally, I will argue that international tensions, Malta’s location within Empire, and perceptions of the island and its inhabitants in the early twentieth century affected the ways in which infant deaths were explained and understood and the strategies of intervention initiated in the island to curtail infant mortality – all of which had a tremendous impact on the rates at which infants in Malta died.

This thesis examines maternal decision-making regarding prenatal care and childbirth in the rural, north-central Andes in the province of Carhuaz. Semi-structured interviews (n=30) and participatory action research workshops (n=7) were conducted with local women to elucidate how they conceptualize, experience, and negotiate the shifting landscape of prenatal care and childbirth practices and providers. Semi-structured interviews with obstetricians, midwives, and social workers (n=9) were also conducted to compare perspectives and identify disconnects in knowledge and practices existing between these two groups in order to facilitate an open conversation on how to jointly improve the maternal experience and reduce maternal mortality and morbidity in rural Peru, where these risks are significantly higher than in urbanized, coastal areas. In the face of changing practices and the influx of biomedical ideologies, women are faced with competing and conflicting bodies of knowledge as well as varying concrete and symbolic values and consequences of their decisions, which they must navigate and evaluate in a dynamic environment. Issues of ethnic and gender discrimination and financial and social coercion arose as prominent forces structuring risks and constraining maternal agency. However, women also found ways to both resist and accommodate these challenges, demonstrating the intricate and on-going negotiations that occur throughout gestation and the maternal experience. The results of this investigation illustrate the various and nuanced ways in which macro-level maternal health policies are manifesting on the local level and impacting the lived realities of rural, Andean women.