Since the 1970s, governments in many high-income countries have implemented a series of reforms in their health care systems to improve efficiency and effectiveness. Many of these reforms have been of a market-oriented character, involving the deregulation of key services, the creation of competitive markets, and the privatization of health and social care. Some scholars have argued that these “neoliberal” reforms have unseated the historical structural embeddedness of medicine, and in some cases even resulted in the proletarianisation of physicians. Other scholars have challenged this view, maintaining that medical hegemony continues to shape health care provision in most high-income countries. In this paper we examine how policy reforms may have altered medical dominance over maternity care in two comparatively similar countries – Canada and Australia. Our findings indicate that neoliberal reforms in these two countries have not substantially changed the historically hegemonic role medicine has played in maternity care provision. We discuss the implications of this outcome for the increased medicalisation of human reproduction.
Cet article compare les portraits médiatiques de personnes qui travaillent dans l'industrie du sexe avec les représentations de soi de ces travailleurs, représentations qui incluent leurs origines personnelles et leurs expériences vécues au quotidien. Notre objectif est de jauger la distance empirique entre les descriptions médiatiques et la réalité vécue de ces travailleurs puis de comprendre comment les médias contribuent à cons‐truire, reproduire et approfondir les stigmates sociaux associés au travail dans l'industrie du sexe. Nous avangons que le fait de distinguer la variabilité historique et spatiale de ces stigmates ainsi que le fait d'expli‐quer leurs racines dans les activités de sens et de pratiques des auteurs et autorités médiatiques représentent une avancée cruciale pour la compréhension de leur construction sociale. This paper compares media portrayals of people who work in the sex industry with these workers' self‐reports of their personal backgrounds and experiences of what they do for a living. Our aim is to first, gauge the empirical distance between media depictions and workers' lived reality, and second, to understand how the media contributes to constructing, reproducing and deepening the social stigmas associated with working in the sex industry. We argue that pulling apart the historical and spatial variability of these stigmas and explicating their roots in the meaning‐making activities of media authors and authorities is a crucial step towards understanding their social construction.
This article examines the mutability of symbolic sanctionsor stigmas-applied to sex industry work by examining newspaper narratives in one medium-sized Canadian city over two time periods: 1870-1910 and 1980-2004. The article's purpose is first to get a sense of what the authors call the ecology of stigmas-their relation to the temporal and spatial contexts in which they are produced-and second to give needed historical context to them and the representational tropes that currently dominate media, policy, and academic discussions about prostitution. This article finds significant continuities and discontinuities between media representations during the two study periods. In particular, prostitution stigmas are constituted out of cross-articulations of narratives around containment, culpability, and contagion across the twentieth century, but the ideational contents and empirical referents of these narratives reflect the intersection of sex industry contexts with historically specific concerns around gender, sexuality, race, and social status. Stigmas of the sex industry, rather than being constant, reveal themselves to be both deeply ecological and accommodating to a range of concerns about female sexuality and normative behavior that are sensitive to historical time.
Courtesy stigma, also referred to as 'stigma by association', involves public disapproval evoked as a consequence of associating with a stigmatised individual or group. While a small number of sociological studies have shown how courtesy stigma limits the social support and social opportunities available to family members of stigmatised individuals, there is a paucity of research examining courtesy stigma among the large network of people who provide health and social services to stigmatised groups. This article presents results from a mixed methods study of the workplace experiences of a purposive sample of workers in a nonprofit organisation providing services to sex workers in Canada. The findings demonstrate that courtesy stigma plays a role in workplace health as it shapes both the workplace environment, including the range of resources made available to staff to carry out their work activities, as well as staff perceptions of others' support. At the same time, it was evident that some workers were more vulnerable to courtesy stigma than others depending on their social location. We discuss these results in light of the existing literature on courtesy stigma and conclude that it is an under-studied determinant of workplace health among care providers serving socially denigrated groups.
The research literature indicates that problematic substance use as a form of health behaviour is poorly understood, being sometimes viewed as deviance, at other times as a disease, and most often as a combination of these states. The use of substances by women who are pregnant or new parents is often conceptualised within an individualised framework. Yet drinking alcohol and using other drugs during pregnancy and early parenthood cuts across social divisions and is shaped by socio-structural contexts including health care. There is a growing body of literature that critically examines public health interventions that are aimed at implementing harm reduction and health promotion techniques in service delivery to help pregnant and early parenting women who are identified as problem substance users. We examine qualitative data from representatives of a recent harm reduction intervention, focusing, in particular, on providers' individual conceptualisations of the problematic behaviour. Our results show that most study participants regard any substance use during pregnancy, birth and the postpartum period as fundamentally unacceptable. This framing of problematic substance use is accomplished via gendered responsibilisation of women as foetal incubators and primary caregivers of infants. We discuss our results in light of the current literature and suggest policy implications.
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