In the United States, concerns about adolescent childbearing and its perceived corollaries – negative health outcomes for mother and child, the disintegration of the nuclear family, and “over-dependence” on public resources – began to circulate widely in policy spheres and popular media in the 1970’s, resulting in a proliferation of policies, programs, and services designed to address its prevention. Although national birth rates among adolescents are currently at their lowest since peaking in the early 1990’s, this decline masks persistent and significant disparities between groups of young people by race, ethnicity, geography, and poverty level. The concomitant existence of social and economic inequities that contribute to these differences is particularly striking in New York City; an urban center of vast extremes in health, wealth, and opportunity, but which boasts extensive reproductive health services for young people, including confidential care and availability of free or low-cost contraception. Within this setting, the promotion of hormonal and long-acting reversible contraceptive methods, specifically aimed at young women deemed at high risk of pregnancy and with less access to health care, has emerged as a key primary prevention strategy to reduce both overall adolescent pregnancy rates and disparities between adolescent groups. Using ethnographic methods, this research examined the promulgation and interpretation of this strategy by reproductive health leaders and healthcare workers as well as contextualized these perspectives with the reproductive decisions and fertility desires of female youth for whom this strategy is intended. As a result, this study elucidates broader political and socio-cultural contexts in which young women negotiate intimate relationships and contraceptive use. Recommendations are subsequently offered for clinical practices attuned to female youths’ lived experiences, educational programs for healthcare workers, and reproductive health policies reflective of the broader factors that influence contraceptive behaviors.

A wealth of research into medical and healing traditions of Maya communities has been conducted. Previous research has also explored unique conceptions of health and disorder held by Maya peoples. This study adds the voices of Q’eqchi’ Maya healers of southern Belize to this accruing research. Working from Indigenous research paradigms, a nine-month ethnographic study with six practicing members of the Q’eqchi’ Healers Association (QHA) of Belize occurred. The QHA is an endogenous grass-roots association formed in 1999 to preserve Maya medical knowledge and healing practices. In collaboration with the QHA members, this research focused on the healers’ conceptualizations and treatments of mental illness and disorders. During ethnographic research, 94 in-depth qualitative interviews with the six members of the QHA and 43 observations of healing encounters occurred. Twenty-six additional interviews were held with patients and participation in other healing ceremonies and cultural gatherings frequently took place. From the analysis of these data, there are 17 different mental illnesses and disorders recognized by the Q’eqchi’ healers that fall within one of four broad “narrative genres.” The main argument of the dissertation is that these “narrative genres” are epistemological structures that the healers use to “read” and “emplot” specific cases of illness to which they attend. Since narrative theory and research focuses largely on individual patient experiences, this study expands contemporary theory by looking at the Q’eqchi’ healers medical epistemology through a narrative lens. It is argued that a deeper understanding of Q’eqchi’ conceptions of mental illness and disorder can also aid dialogues between the “traditional” healers and biomedical practitioners working within the Belize Ministry of Health while also improving the treatment of Q’eqchi’ patients. This research adds to the areas of applied ethnography, narrative theory, Indigenous epistemology, cultural psychiatry, medical anthropology, and medical pluralism.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

This thesis focuses on the experiences of Vietnamese immigrants and refugees in accessing health care services in Saskatoon. Within Canada, terms such as immigrant and refugee are assigned to reflect the differing circumstances that “newcomers,” i.e. foreign-born residents, arrive under, who are typically classified as either temporary or permanent residents (Gushulak et al. 2011). Research has suggested that newcomers to Canada from non-European countries tend to under-utilize health services (Curtis and MacMinn 2008; Luu, Leung and Nash 2009; O’Mahony and Donnelly 2007; Whitley, Kirmayer and Groleau 2006), while language and cultural differences are cited as barriers to health care (Asanin and Wilson 2008; Gushulak et al. 2011; Kirmayer et al. 1996). Qualitative health research regarding Vietnamese immigrants and refugees in Saskatchewan is currently lacking. The purpose of this study was to elicit a deeper understanding of experiences in accessing health care services through open-ended interviews. A total of 14 interviews were conducted regarding the health care experiences of members of the Vietnamese community in Saskatoon. The aim was to examine the possible socio-cultural determinants affecting the experiences of this study’s participants, to explore whether or not these determinants resulted in health care under-utilization, and to determine areas for future research, particularly, in working to resolve barriers to care for immigrant and refugee groups. Participants iterated the challenges that newcomers face in accessing health care, such as language, cultural, geographical, and socio-economic differences, as identified within the literature. However, the most elaborate responses given by the Vietnamese-born participants in this study were built around references to Vietnam (their country of origin). In particular, they described their experiences in Saskatoon through comparisons of health care and larger socio-economic circumstances in Vietnam. While participants described both positive and negative experiences, the consensus was that health care is generally better in Canada than in Vietnam. This thesis illustrates the value of examining the participants’ descriptions of Vietnam in understanding their experiences with health care in Saskatoon. These findings contribute to a contextual understanding of the socio-cultural determinants affecting the experiences of immigrants and refugees. I follow previous research studies to suggest that the cross-cultural contexts of health and illness need to be continually explored in health research regarding immigrants and refugees.

In this thesis I explore the effects of the recent introduction of posttraumatic stress disorder (PTSD) to the post-conflict and postsocialist discourse of Croatian psychiatry. In recent years Croatian psychiatrists have been faced with a significant increase in the number of reported cases of various types of war-related disorders. PTSD, in particular, is spreading among the population of veterans from Croatia’s Homeland War that lasted from 1991 to 1995. To explore the effects of the introduction of PTSD to the discourse of Croatian psychiatry I am raising the following questions: (1) how was the diagnostic category of PTSD introduced; (2) how are Croatian war veterans encouraged to communicate their traumatic experiences; (3) how are ideas about the effective treatment of PTSD reproduced, transformed, and resisted by individual medical practitioners? In the final analysis, I argue that PTSD in Croatian psychiatry is constituted in a way that makes it both a medically recognizable form of emotional suffering and an instrument in post-conflict governmentality.

'Alcohol', the strongest teratogen known to human-kind, is a commonly used legal drug which has the ability to cross the placenta and interfere with the development of the foetus resulting in a birth defect known as Fetal Alcohol Spectrum Disorder (FASD). This thesis looks at the historical knowledge base surrounding prenatal exposure to alcohol and presents the latest biomedical information available on FASD at the time of writing. The sub-discipline of medical anthropology, the associated methodology and it appropriateness for this kind of research is discussed. A historical look at the introduction and proliferation of alcohol in New Zealand from the macro-micro perspective, and James O'Connors' (1974) political modes of operation are presented, offering a broad analysis, of a dynamic political process involved with the lack of acknowledgement or action on the part of New Zealand governments. New Zealand specific research on women's drinking patterns, clinical practise and the experiences of those trying to obtain a diagnosis in regard to FASD within New Zealand are presented. Behavioural profiles pertaining to my participants' FASD charges are offered to the reader, all of which indicate serious repercussions for New Zealand society as a whole. Finally the labelling argument relating to the diagnostic terminology surrounding Fetal Alcohol Syndrome is discussed. The original contribution this thesis offers aside from being the first New Zealand anthropological PhD research on the subject of FASD surrounds education and action research. Knowledge creates empowerment and can facilitate individual change. My thesis has been a dialectical process whereby the more I learned from those care-giving for FASD individuals, the more I have been able to feed back to others and act in my capacity as a critical medical anthropologist, using action anthropology as a means to advocate for families affected by FASD, those whose voices of expertise by way of experience, are seldom if ever heard or listened too [sic].

This thesis explores South Korean healthcare politics based on a series of inter-generational conflicts that occurred in a medical community in 2012. The conflicts broke out among 'doctors of Korean medicine', a medical profession unique to Korea practicing a form of medicine of East Asian origin that has recently undergone significant 'bio-medicalization'. Doctors of Korean medicine have the same status as doctors of Western medicine in the country's mainstream healthcare system, although the purview of their practice is legally demarcated. Government policies aimed at the industrialization of pharmaceuticals and the promotion of health among Korea's elderly population were the source of the conflicts that escalated into a group of junior doctors leading to what could be considered a 'rebellion' against the community leaders. The thesis investigates first the socioeconomic and political backgrounds of the conflict. It proposes that elements of intra- and inter-professional politics and the aftermath of the country's re-democratization, economic shock and demographic transition were all important factors. Second, it explores the nature of the rebellion itself by focusing on the emergence of a set of norms and values and on the 'ritual-like' interactions observed during the event. The analysis reveals that during the conflicts the actors referenced certain values and ideologies underpinning their everyday lives and, in doing so, were effectively engaged in the strengthening, rather than the weakening, of existing social structures. This thesis contributes to the study of Korean medicine by revealing the features of its integration into the country's healthcare system and the effects of its bio-medicalization. By describing the process by which new online-based agents of a social movement emerged, it also contributes to the study of hyper-connectivity in Korean society. Finally, the ethnography contributes to the anthropological study of East Asian medicine by illustrating the importance of institutional factors such as politics and the economy in capturing the modes of its contemporary presence.

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.

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.

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.