‘I really tried’: Management of normative issues in accounts of responses to infertility

Kok, Bregje Christina de; Widdicombe, Sue

doi:10.1016/j.socscimed.2008.05.007

Cited by 18 publications

(11 citation statements)

References 27 publications

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“…Despite being time-and resource-intensive, the narrative approach is particularly appropriate to examine issues of access. Individual explanations of health-seeking behaviours 'perform social functions rather than being neutral reflections' (de Kok & Widdicombe, 2008) and allow for an examination of social contexts on people's behaviours, and vice versa.…”

Section: Discussionmentioning

confidence: 99%

‘Maybe It Was Her Fate and Maybe She Ran Out of Blood’: Final Caregivers' Perspectives on Access to Care in Obstetric Emergencies in Rural Indonesia

2009

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Maternal mortality persists in low-income settings despite preventability with skilled birth attendance and emergency obstetric care. Poor access limits the effectiveness of life-saving interventions and is typical of maternal health care in low-income settings. This paper examines access to care in obstetric emergencies from the perspectives of service users, using established and contemporary theoretical frameworks of access and a routine health surveillance method. The implications for health planning are also considered. The final caregivers of 104 women who died during pregnancy or childbirth were interviewed in two rural districts in Indonesia using an adapted verbal autopsy. Qualitative analysis revealed social and economic barriers to access and barriers that arose from the health system itself. Health insurance for the poor was highly problematic. For providers, incomplete reimbursements, and low public pay, acted as disincentives to treat the poor. For users, the schemes were poorly socialized and understood, complicated to use and led to lower quality care. Services, staff, transport, equipment and supplies were also generally unavailable or unaffordable. The multiple barriers to access conferred a cumulative disadvantage that culminated in exclusion. This was reflected in expressions of powerlessness and fatalism regarding the deaths. The analysis suggests that conceiving of access as a structurally determined, complex and dynamic process, and as a reciprocally maintained phenomenon of disadvantaged groups, may provide useful explanatory concepts for health planning. Health planning from this perspective may help to avoid perpetuating exclusion on social and economic grounds, by health systems and services, and help foster a sense of control at the micro-level, among peoples' feelings and behaviours regarding their health. Verbal autopsy surveys provide an opportunity to routinely collect information on the exclusory mechanisms of health systems, important information for equitable health planning.

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Section: Discussionmentioning

confidence: 99%

‘Maybe It Was Her Fate and Maybe She Ran Out of Blood’: Final Caregivers' Perspectives on Access to Care in Obstetric Emergencies in Rural Indonesia

2009

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“…On the one hand, such an analysis helps articulate how the project of having children relates to the organisation of power and privilege along gender and generational lines in north Malawi, where bridewealth ( chuma ) remains an important and respectable means of validating marriage and husband's rights to children. And why, as earlier research in Malawi has implied, childlessness in marriage is perceived to be one of the more severe forms of gendered and social disempowerment accompanied by intensive and enduring treatment seeking, infidelity, divorce or polygyny (Barden-O’Fallon 2005 ; de Kok and Widdicombe 2008 ; de Kok 2009 ). On the other hand, such a framework does little to orientate attention to the transformative practices, shaping the way in which male reproductive impairment is recognised and embodied, or to the diversity of contemporary and historical influences on the experience of marriage and fertility.…”

Section: Theorising Masculinity and The Gender Effects Of Semen Analymentioning

confidence: 99%

‘At the hospital I learnt the truth’: diagnosing male infertility in rural Malawi

Parrott

2014

Anthropology & Medicine

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This paper examines how men's reproductive bodies are problematised in rural northern Malawi as access to biomedically defined diagnoses of the health of men's sperm contribute to the visibility of male infertility. Ethnographic research with infertile and fertile men explored pathways into the sexual health and fertility services offered in district hospitals, men's clinical engagements and masculine imaginaries. The research suggested that men's willingness to be referred for semen analysis is an extension of intensive and persistent help-seeking for childlessness instigated by couples and encouraged by families. Within the laboratory, acceptable social arrangements for semen sample collection are negotiated between male clients and laboratory staff, which emphasise heterosexual and marital virility. Following diagnosis, counselling by clinical officers, without any significant therapeutic interventions, focuses on compassion in marriage. This paper considers: what is the role of semen analysis within public health facilities and why do men participate? How do men experience an infertility diagnosis and what do they and their partners do with this knowledge? In addition, how do these practices shape gendered relationships in families and communities? The analysis builds on Inhorn's (2012) concept of ‘emergent masculinities’ to better understand the connections between male subjectivities, medical technologies and the globalisation of male reproductive health, as they relate to men's lives in rural Malawi.

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“…men marrying multiple wives) [9, 22–24]. The experience of polygyny has not been discussed at length but is often mentioned as one of the hardships women with infertility endure [9, 11, 12, 21–25].…”

Section: Introductionmentioning

confidence: 99%

Women with infertility complying with and resisting polygyny: an explorative qualitative study in urban Gambia

et al. 2019

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Background In many low-and middle-income countries women with infertility are often in polygynous marriages. From a human and women’s rights perspective, the practice of polygyny is commonly understood as harmful. Studies indicate that polygyny aggravates negative life circumstances of women with infertility with respect to their health and social well-being. The purpose of this qualitative study is to explore how women with infertility experience polygyny and to understand their decision-making regarding these marriages. Methods An explorative qualitative study was conducted among women with infertility in the urban communities of the West Coast region of The Gambia using in-depth interviews (30). Data analysis involved an emergent and partially inductive thematic framework and was carried out using NVivo 11. Results With the exception of some women with infertility who described positive experiences within polygynous marriages, most women emphasised conflicts that exist within polygynous households and reported financial and emotional difficulties. Thematic analysis identified several strategies of women with infertility to cope with and resist polygynous marriages, including overcoming childlessness, addressing conflict, spending time outside the compound, looking for social support, kanyaleng kafoolu , living separately and initiating divorce. Moreover, the experiences and decision-making power of women with infertility when it comes to polygynous marriages was found to be closely related to their socio-demographic background. Conclusion This work highlights how women with infertility in polygynous marriages are in a precarious situation in urban Gambia. Women utilize a mix of compliance, coping and resistance strategies to navigate the challenges of polygynous marriages in a structurally constraining context.

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‘I really tried’: Management of normative issues in accounts of responses to infertility

Cited by 18 publications

References 27 publications

‘Maybe It Was Her Fate and Maybe She Ran Out of Blood’: Final Caregivers' Perspectives on Access to Care in Obstetric Emergencies in Rural Indonesia

‘Maybe It Was Her Fate and Maybe She Ran Out of Blood’: Final Caregivers' Perspectives on Access to Care in Obstetric Emergencies in Rural Indonesia

‘At the hospital I learnt the truth’: diagnosing male infertility in rural Malawi

Women with infertility complying with and resisting polygyny: an explorative qualitative study in urban Gambia

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