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Paper short abstract:

This paper addresses perceptions of high-risk pregnancies and their medical management, focusing on the impact of scientific advances on risk awareness and reproductive expectations. Ethnographic findings reveal the vulnerabilities of high-risk pregnant people, especially in marginalized populations

Paper long abstract:

This paper addresses the cultural perceptions surrounding high-risk pregnancies and their management in medical settings, with a focus on the intersection between medical decisions and reproductive desires. The results of ethnographic research in a regional maternity hospital support an analysis of risk assessment and probability as the foundation of contemporary pregnancy care, and its connection with the medicalization of reproductive experiences, highlighting the importance of sociocultural factors, such as the experience and beliefs of pregnant people, often disregarded in favor of biomedical considerations. This study, centered on the relationships between healthcare providers and pregnant individuals screened at high obstetric risk, emphasizes the influence of contemporary technoscientific advances on the awareness of reproductive uncertainties, while recognizing the growing tendency for individuals to move away from discourses based exclusively on medical authority.

The construction of pregnancy as a hazardous event is under negotiation between professionals and patients. Ongoing negotiations for decision-making power in obstetric care are built on a binary of “normal” and “pathological”. The study reveals inequalities in access to the knowledge that legitimizes decision-making in a highly hierarchical health care setting, as well as a specific set of vulnerabilities of pregnant people at high obstetric risk, especially in marginalized populations. This work aims to raise questions about the implications of making and managing uncertainty in reproductive processes, as well as the impact of emerging new areas of uncertainty on our understandings of the beginning and end of life, reproductive rights, and expectations around parenthood in a medicalized setting.

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Paper short abstract:

This paper explores the methodological complexities and ethical challenges encountered during fieldwork within the context of a fertility clinic in Zagreb, Croatia. The emphasis is placed on the relationships and power dynamics between anthropologists, health workers and patients.

Paper long abstract:

This paper explores encountered during fieldwork within the context of a fertility clinic. Fertility clinics serve as sites for understanding the lived experiences of individuals struggling with reproduction. However, the process of conducting fieldwork in these clinics presents numerous methodological and ethical dilemmas. This presentation seeks to identify and analyze the key challenges encountered by anthropologists in this specific research setting. One primary challenge lies in gaining access to the clinic and establishing dialogue with patients, medical staff, and healthcare providers. The highly private and emotionally charged nature of fertility treatments requires sensitivity and trust-building, as anthropologists must navigate delicate boundaries and ethical considerations. Additionally, ethical concerns surrounding confidentiality, privacy, and informed consent further complicate the fieldwork process. Furthermore, the dynamic nature of the clinic environment poses practical challenges. Anthropologists may face limited timeframes, strict protocols, and access restrictions due to the clinical priorities and patient confidentiality. Balancing the needs of the research with the demands and constraints of the clinic environment necessitates careful negotiation and adaptability. This presentation critically reflects on the implications of power dynamics between anthropologists, health workers and patients within the fertility clinic context. Anthropologists must be mindful of their positionality and the potential for exploitation or harm, striving to maintain an ethical and equitable research process. By highlighting these challenges, this presentation contributes to a broader conversation of the complexities involved in conducting fieldwork within fertility clinics and encourages a balanced and patient-centered approach to research.

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Paper short abstract:

This paper explores the perceptions of healthcare professionals on sharing reproductive decisions with patients in high-risk contexts. It suggests that gynaecologists and midwives approach pregnancy and childbirth differently, as they have different understandings of what ‘risk’ means.

Paper long abstract:

Within the biomedical model of attention, pregnant people undergo a screening process to determine the risks they may present during their pregnancy, with an aim to select those who will receive preventive interventions to mitigate possible future complications. This article explores health professionals’ perspectives on the appropriate level participation for “at-risk” pregnant patients in decision-making processes related to pregnancy, follow-up, and delivery. Drawing on 8 months of ethnographic fieldwork in the obstetrics area of a hospital in Barcelona and semi-structured interviews with 24 professionals (15 gynaecologists and 9 midwives), this study shows the rationalities of health professionals in determining the role of patients as active agents within risk circuits of attention. The findings reveal that sharing decisions is a challenge not only in relation to patients, but also between the different professionals attending births, gynaecologists and midwives, who understand and define risk in different ways. The findings suggest that the growing demand from patients for more information and participation in their reproductive processes is perceived by doctors as conflicting with their moral and legal responsibilities. As midwives often find themselves in visions that are more aligned with patients' requests, tensions between professionals emerge, generating a context of friction that does not go unnoticed by the patients.

Keywords: Female reproductive health; patient agency; shared-decision making; risk; preeclampsia.

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Paper short abstract:

The interaction between humans and machines is multisensorial. In hospitals, audio interaction is omnipresent. This research discusses a longitudinal fieldwork conducted on the audio ethnographic experiences of sonic relations in a gynaecological service in a major public Catalan hospital.

Paper long abstract:

The study of sounds in hospitals contributes to the mainstream anthropological literature on organisational human-machine relations but specifically to the social-sonic relations. Indeed, the interaction between humans and machines in hospitals is complex and multisensorial. However, audio interaction has been minimised as a research object, even if the anthropological perspective of sounds in hospitals is an emerging area of interest within the field. The study of sounds in hospital environments involves active listening, minimisation of participation, to be embedded with the soundscape, and an extreme sensitivity to what could be referred as sound and sonic everyday organising (Rice et al., 2021). This approach aligns with the call for anthropology to incorporate the social and cultural sounded organisational world more fully (Samuels et al., 2010). This perspective allows for the consideration of the Anthropocene interpretations of silence, noise, and dissonance within hospital soundscapes. Based on the experience of producing research based on audio ethnographies and ethnographies in hospitals in UK and Spain, this research discussed a longitudinal fieldwork conducted on the audio ethnographic organisational experiences of sonic relations in a gynaecological service in a major public Catalan hospital.

References

Rice, T. (2003). Soundselves: an acoustemology of sound and self in the Edinburgh royal infirmary. Anthropology Today, 19(4), 4-9.

Samuels, D., Meintjes, L., Ochoa, A., & Porcello, T. (2010). Soundscapes: toward a sounded anthropology. Annual Review of Anthropology, 39(1), 329-345.

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Paper short abstract:

This paper addresses the challenges encountered by pregnant women and their partners when talking about their experiences with early pregnancy loss with health professionals, focusing on language and the comprehensive assessment of the impact of the loss on people’s lives beyond the medical aspects.

Paper long abstract:

Currently, in Spain, gestational losses represent about 25% of pregnancies, and despite their high prevalence, they remain hidden. The existence of a gap in the field of anthropology and qualitative studies in general about the people who have gone through gestational losses (

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Paper short abstract:

The paper investigates the experience of breast cancer transit and the place that risk inaugurates as a frame of decisions regarding the use of oncological treatments and fertility care. It delves into this experience in the lives of women with the diagnosis as the place (non)desire of motherhood.

Paper long abstract:

This paper reflects on the experience of going through breast cancer by focusing on a particular moment that tends to affect women of reproductive age, in which a series of decisions regarding fertility care come into play. Here the place of risk assumes a preponderant place, given that the recommended oncological treatments can affect fertility. It is also often a turning point for women, which was not necessarily present or even a desire-driven concern, and which most often requires short-term decisions in the face of the emergency of diagnosis and the need to initiate treatments. Thus, faced with the disruptive nature of the communication of the diagnosis, a certain paradox arises in which, on the one hand, there is an incentive to start the indicated treatments as early as possible, while at the same time there is the added complexity of deciding on the care of fertility, in a context in which risk appears as a determining condition and a framework of uncertainty. We are interested in exploring how risk is understood and experienced, its impact on women's decision-making processes and daily lives, on the course of treatment and the experience of illness, on interaction with medical teams and also on family relationships. To this end, we use and analyse interviews with women who are going through breast cancer.

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Paper short abstract:

My fieldwork in an obstetrics hospital in Shanghai in 2023 revealed that the label and risks of “perinatal depression” diagnosed by certain medical scales and popularized by the “psycho-boom” in urban China may not align with the everyday experiences and understandings of the women being researched.

Paper long abstract:

About 20% of women who initiated prenatal care in an obstetrics hospital in Shanghai, China in June 2023 screened positive for depression or anxiety, or had a mental illness history, showing the risks of perinatal depression. However, my preliminary ethnographic fieldnotes, interviews, and informal conversations with perinatal women, their families, and hospital staff found that these women felt optimistic about these risks - “I do not have these problems” or “it’s within my control,” and they and their families held little knowledge about what perinatal depression meant for their everyday lives. The hospital staff needed to inform perinatal women of these risks and refer them to the psychological counseling clinic. But merely a few of them followed the psychological nurse’s suggestions. This phenomenon is embedded in complicated Chinese sociocultural circumstances, such as stigma toward mental illness, focus on physical rather than mental health, attention to the fetus or newborn not the perinatal woman, the misleading name of “postpartum” depression, and a lack of education on mental illness. These labels and related risks diagnosed by certain medical scales like the Edinburgh Postnatal Depression Scale (EPDS), General Anxiety Scale-7 (GAS-7), and Self-rating Anxiety Scale (SAS) and popularized by the recent “psycho-boom” in urban China may not align with the everyday needs, experiences, and understandings of the women being researched.

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Paper short abstract:

This proposal for an ethnographic approach, which relates the affective and the rational/economic, helps us to think about the conflictive and contradictory nature of the relationships and practices that make up care regarding sexual and reproductive health at the first level of care in Salta.

Paper long abstract:

This work is based on ethnographic research on sexual and reproductive health care, carried out at the first level of care in peripheral neighborhoods of the City of Salta, Argentina (Pérez Declercq, 2012, 2016, 2022). The native term cuidarse (take care), which refers to a repertoire of practices and knowledge that particularly includes the use of various contraceptive techniques, not only for women but also for men. A woman recounts the dialogue with the gynecologist: “Why don't you take care of yourself? If there are a lot of things to take care of yourself” (scolding tone) she, the gynecologist, tells you. And I tell him, “I can't take care with… , sometimes I use a condom, but not all the time because I want to have, well, I want to have a girl.” In the practices and relationships in health care, although a dimension of following cultural mandates is present, there is also the dimension of confrontation and resistance. This proposed approach, which relates the affective and the rational/economic, also helps us to think about the conflictive and contradictory nature of the relationships and practices that make up caring for oneself in the context of daily life.

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Paper short abstract:

This research aims to analyse therapeutic itineraries among women with endometriosis in Catalonia (Spain), based on cultural, political, and structural constructions around reproductive process of women’s bodies.

Paper long abstract:

Endometriosis consists of the growth of endometrial tissue outside the uterus and usually it manifests with symptoms such as severe pain as well as infertility, and a significant reduction in quality of life (Guidone, 2020). Diagnostic delay is estimated to take between 7 and 10 years from the onset of symptoms to the final diagnosis (Carmona, 2010). To date, there is no knowledge about the cause, an effective treatment and several controversies surrounding the diagnosis (Denny & Weckesser, 2019).

Critical studies have shown endometriosis as a construct that responds to the logics of cultural, political, and structural discourses about women’s bodies (Hudson, 2022; Jones, 2016; Seear, 2014).

Based on semi-structured interviews with 40 women and fieldwork in a specialized endometriosis care service in a public hospital, the current medical anthropological doctoral thesis, through qualitative research, aims to analyse therapeutic itineraries (Augé, 1986) among women with endometriosis, or with suspected diagnosis, in Catalonia (Spain) context. In this regard, it considers the different levels of care within the health care network of the territory for analysing some strategies women use to get medical treatment or shorten the time of diagnosis, inquiring into the medical discourse around those experiences.

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Paper short abstract:

Home Visitation Programs identify "at-risk" pregnant women and teach them to be "good" mothers. The “at-risk” designation fails to capture the complex socio-economic situations that Home Visitation clients live in and absolves the state of its role in perpetuating precarity for "at-risk" women.

Paper long abstract:

In Los Angeles, Home visitation programs (HVPs) identify pregnant racialized and marginalized mothers who are deemed “at-risk” and educate them to enact “good” American mothering behaviors. However, this “at-risk” designation fails to capture the complex socio-economic situations which many of the racialized and marginalized Home Visitation clients live in by centering the origin of their “risk” within the mothers themselves. In HVPs, “at-risk” signifies a mother who standardized assessments have indicated has one or more risk factors: a lack of formal education, stable home, stable income, food insecurity, history of postpartum depression, being Black, etc. Using ethnographic interview data, I discuss how the “at-risk” designation does not appear to attend to the multiple and interlocking precarities in Home Visitation clients’ lives which are the root cause for their “risk” factors. For example, structural racism, documentation status, language, lack of economic opportunities or community support, etc. To speak to this complexity, I shift the definition of “at-risk” motherhood towards an understanding of precarious motherhood. Through precarious motherhood, it becomes possible to see the unintended consequences of HVPs. Namely, the politics of deservingness that HVPs enact which leads to the performativity of “good mothering” when mothers are under surveillance during a home visit. Following this, I discuss how the focus on the mother’s risk factors re-center the onus for change into the mother herself through the neoliberal expectation of “resilience” and “self-sufficiency’. This absolves the state of its role in creating and perpetuating the precarious states in which many “at-risk” mothers live.