Adrienne Strong

Medical anthropology, maternal mortality, hospital ethnography, and dignity in women's health care

I am a medical anthropologist and Assistant Professor of Anthropology at the University of Florida with a joint Ph.D. from Washington University in St. Louis, USA and the Universiteit van Amsterdam in the Netherlands. I study maternal mortality and women's health in Tanzania, currently in the Kigoma region on a birth companionship program and the notions of ideal comfort, care, and support for pregnant women in labor. Before my current position, I was a National Science Foundation Postdoctoral Research Fellow with Columbia University's Mailman School of Health, in the Averting Maternal Death and Disability (AMDD) Program in the Heilbrunn Department of Population and Family Health and a Fellow at the Columbia Population Research Center.

My current book project, Documenting Death: Maternal Mortality and the Ethics of Care in Tanzania, under contract with University of California Press, focuses on the inner workings of a government regional referral hospital in Tanzania, examining how institutional structures related to hierarchy, bureaucracy, historical precedents, communication and other factors, may influence the capacity of the institution to provide effective maternal healthcare during times of obstetric crisis. My research focuses on biomedical healthcare providers and administrators, groups that are often overlooked in the context of medical anthropology in sub-Saharan Africa. I contextualize the hospital ethnography with interviews, participant observation, and focus group discussions in communities throughout the region, as well as through the use of primary archival sources from the colonial and post-independence eras. This is the first ethnography to examine the issue of maternal mortality in a low resource setting from this perspective and in the setting of a biomedical facility, complementing the existing work of anthropologists of reproduction who have worked at the community level.

I worked in the Rukwa Region for my PhD fieldwork, which I conducted from January 2014- August 2015. From September 2010 through July 2011, I conducted research on access to healthcare services during pregnancy, birth, and the postpartum period in the Singida Region of Tanzania. My most recent project was about a birth companion pilot program in the Kigoma region of Tanzania from January through December 2018, which focused on the ways in which companions impact the social dynamics of health center maternity wards and the care provided in those settings. This project also included an 80-question cultural consensus survey and analysis around the cultural domain of care and support for pregnant women.

This is my personal website, which includes updates on my research, collaborations, conference presentations and papers, publications, teaching, and critical responses to current events related to women's health and reproduction.

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Mention on Anthrodendum for fieldwork blog

"Are your hands pregnant?"

My research assistant and I arrived in village 1 on Monday this past week. On the drive there (an adventure in and of itself the first time), I was expressing my concern about how we might be perceived and what kind of reception we might expect. Being the first village, I had nothing to compare it to and wasn't about to blame anyone for being suspicious of me. However, we pulled up to a small cluster of people and asked them if we had reached the right village and where we might find the village leaders. They pointed us to a cluster of people trickling out of one of the primary school classrooms, saying the village leaders were just not getting out of a community meeting. The second person we met was the Village Chairman. I began to explain to him what we were here to do and what I study. I told him we were there to learn about life in their community, the challenges they face, and how they view the quality of their health care services. He was extremely receptive and, in fact, very happy to hear that I had chosen them as a site for my research and the first village, at that. 

He took us over to the village dispensary and we went on a brief tour of the village. I explained how we would like to go about things and asked for his help in arranging some meetings. On Day 1, we met with members of the village's Community Health Committee and interviewed the two health providers who were present. For Day 2, we set up a group discussion with the community leaders in the morning and then a men's focus group discussion in the afternoon. On Day 3, we did a women's focus group discussion in the morning and a group discussion with older women, particularly those who, in the past, had been working as community ("traditional") birth attendants. 

I loved the conversations we had and the exchanges that took place. I learned a great deal and I hope I was able to help them at least a little bit with some health education and some answers about the ways in which the health care system operates. I was also able to help the health care providers assemble and start using some of the equipment they had been given several months earlier. One of my objectives with the providers was simply to listen to them about the challenges they face and the difficulties they have in their work in the community. They seemed grateful to simply have someone interested in listening to their problems. They told me "inatia moyo," basically it was encouraging. There is also a Swahili saying that when the visitor arrives, the local benefits. They were saying it, but I hope it was true, at least a bit!

Unsurprisingly, the opinions we heard from the men and the women were pretty opposing, in some instances. We asked a general question about the responsibilities of men and the responsibilities of women. Women told us stories about the hard work they do, telling us things like "You'll see a woman going to the field. In one hand she has her hoe, on her back a young child, on her head firewood, and she's probably even pregnant." They also told us that many women continue with this hard work even while they are pregnant and if they don't, if they ask for a rest or tell their husband they were too tired to finish all the work at home, their husbands will ask them, "Why can't you work? What, are you hands pregnant?" This can be dangerous for women and can, in some cases, even lead to pregnancy complications and possible miscarriage. The women told us that the men like to drink and some even get drunk in the mid morning. They do this instead of contributing more to the family, but the men are the ones who make the plans for the family and women are simply the receivers; on this account both the men and women agreed. 

On the topic of men's participation in reproductive health care, the women told us their husbands will accompany them to the dispensary if they are in labor, but only at night when they know no one else will see them doing this. Men said they thought it was important to accompany their wives to the prenatal clinic but, when the chips were down, only three of about twelve participants said they'd actually ever gone with their wives and out of nearly fifteen women, only three said their husbands had ever gone with them. There was also an issue, brought up by the women, of the men not believing their wives when they told them what they had learned at the prenatal clinic. Everyone generally agreed that this idea of men participating in women's health was a new thing and hadn't yet really caught on. 

We also learned about how the poor corn prices and the poor market last year had effectively stalled the community's effort to build a new, larger dispensary building specifically for reproductive and child health issues. We heard about bureaucratic difficulties, poor communication, and poor support from the district. We heard stories about past witchcraft and the difficulties women had giving birth in the community before the presence of the dispensary. We heard about how this thing called "human rights" had made children the children of the state and not their parents. Men perceived the concept of human rights as detrimental to their ability to effectively discipline their children, it has "taken away the strength of parents." 

Some of these issues are already well known and some of them are specific to this community, but I can already tell that this work in the villages will add necessary and beautiful background color to the work I've been doing in the regional hospital. I already had questions for the communities based on my time in the hospital and I have returned to the hospital with more questions for them based on what I've heard in the village. I think this iterative process is going to be very fruitful and will highlight further issues related to the health care system and how everyday people interact with it in times of crisis.  

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