My research interests coalesce around maternal death in healthcare facilities. This has come to include scholarly interests in respectful maternity care, gendered dynamics in the nursing profession and care provision in biomedical settings, health system financing in ethnographic perspective, stillbirth and accountability, as well as the contemporary role of bridewealth, and men’s sexual and reproductive health in rural East Africa. Theoretical orientations include critical medical anthropological and feminist approaches to the study of bureaucracy, institutions, hospital ethnography, and concepts of risk, uncertainty, and care. My research interests sit at the nexus of anthropology, gender studies, science and technology studies, and history. For my postdoctoral research fellowship, funded by the National Science Foundation, I collaborated with Columbia University's Averting Maternal Death and Disability group in the Mailman School of Public Health's Department of Population and Family Health. For this project, I followed a birth companion program and investigated the ways in which such programs seek to re-stituate birth within hospitals as a social process after many years of de-socializing birth in these biomedical facilities. The project also uses an innovative qualitative, mixed-methods approach to understanding local conceptions of choice, care, obstetric violence, and the local meanings of birth within and beyond the walls of health facilities in Kigoma, Tanzania.
For more on my professional development please see Washington University's feature article on my work: https://source.wustl.edu/2016/08/washington-people-adrienne-strong/
Tanzania: The first thing people usually ask me about my research is why Tanzania? Tanzania was the first country in Africa that I was able to visit back in 2007. I was struck by the people and the country, intrigued by the language, as well as the country's natural beauty. I initially traveled to Tanzania as part of a service-learning program. In 2008, I began studying Kiswahili and have returned to the country in various capacities every year since. I began reading voraciously about the country, its history, and its varied ethnic groups and have since come to see it as a theoretically interesting site for my research, not simply a place that has become dear to my heart. In 2010 and 2011 I was able to return to the Singida region to conduct a year-long original research project on access to maternal health care funded by a Fulbright Student Research Grant through the U.S. Department of State and the Institute for International Education. I am invested in helping to improve health care in the country through the unique routes provided by an anthropological lens. I chose to remain in Tanzania for my second major fieldwork project for the PhD, which I completed in August 2015, obtaining a joint PhD from Washington University in St. Louis and the Universiteit van Amsterdam in April 2017.
Maternal Mortality and the Biomedical Setting
I first came in contact with maternal death during my second visit to Tanzania in 2008. I was shadowing doctors and nurses at the Singida Regional Hospital with two other American college students. One of the doctors who consistently allowed us to shadow him and learn from him worked in obstetrics and gynecology. One morning, he asked us if we would like to watch an autopsy. It turned out to be the autopsy of a pregnant woman who had died during labor. The baby was full term and had also died, still in her uterus. I was 19 years old at the time and watching that autopsy motivated me to begin asking questions about the global distribution of resources, particularly those that could have saved the life of the woman on the autopsy table in front of me. Since then, I have continued to strive to gain further insight into how access to medical care (both biomedical and other forms) contributes to maternal health or lack thereof. I have explored the perspectives of women, community members, and healthcare providers and administrators.
While it is undeniable that access to certain drugs and procedures can save a woman's life, my research in biomedical health facilities seeks to problematize the events that occur in that setting and interrogate an underlying policy assumption that suggests if only women could reach a hospital, they would receive the life-saving care they need. My research proposes that institutional and social dynamics of the maternity ward, the hospital more generally, and the overall health care system sometimes work against a woman and contribute to the deterioration of her condition and her subsequent death. Though many countries worldwide have seen success in reducing maternal mortality over the course of the Millennium Development Goals initiative, Tanzania has made slow progress. The PhD project has already resulted in a number of conference talks, as well as several manuscripts currently under review. See the CV and Publications pages for more information.