Authors:Arantza Meñaca (Centre for Int. Health Research (CRESIB - Hospital Clínic - Univ. de Barcelona))
Robert Pool (University of Amsterdam)
Paper short abstract:
This paper explores the meanings of uncertainty for the different actors involved in the development, change and use of malaria in pregnancy strategies, and the role given to trust in the context of the asymmetric power relations between researchers, policy makers, health professionals and pregnant women
Paper long abstract:
The rapid development of global health programs for different infectious diseases and other risks in pregnancy have increased the complexity and variability of the medical encounter in ANC clinics in Africa. In malaria in pregnancy, the program analysed in this paper, during the last twenty years, there have been frequent changes in biomedical drugs and treatment / prevention strategies.
With data of a multicenter anthropological study in Ghana and Malawi this paper shows the different models of understanding of malaria in pregnancy and its related uncertainties for the different actors involved in the programs: researchers, policy makers, health professionals and pregnant women. It also explores their reactions to the different changes in treatment and prevention, and the enactment of trust associated to these changes in an arena of asymmetric relationships between the different actors.
Whereas in western/central countries the emphasis on trust appears linked to the discourse on patients' autonomy and choice which has been found not to be enough to explain the complexity and best practices in doctors-patients relationship (Mol 2008, Calnan and Rowe 2008); in international health trust is understood in an unquestioned context of hierarchical relationships. The unidirectional enactment of trust that this models involves, leaves very little space for a shared management of malaria in pregnancy uncertainties.
Uncertainty and trust in medicines and therapeutic techniques