The Politics of Fertility: Population and Pronatalism in Ladakh

In India’s northwestern region of Ladakh, the linkage between reproduction, politics, and fertility is both complicated and contested, evident in increasing population discourses and the re-emergence of a Buddhist pronatalist movement. This paper examines the impacts of population discourses and pronatalism on women’s reproductive decision-making, as well as on the delivery of healthcare throughout Ladakh. Population discourses currently circulating produce two reproductive subjects—the “hyper-fertile Muslim woman” and the “vulnerable Buddhist”—both of which have been central in revitalizing Buddhist pronatalism. Data collected through a hospital-based survey and interviews shows that fertility behavior is shaped by religious interpretations, political mobilization, and pressure to be culturally loyal. Fertility decisions are not simply about one’s reproductive choices and desires—but are instead situated in a contested context where Ladakhis are worried about culture loss. While these cultural pressures differently impact Muslim and Buddhist women, the growing politicization of reproduction results in continued ethnic/religious conflict that has far-ranging impacts throughout the region

Uncomfortable yet Necessary: The Impact of PPE on Communication in Emergency Medicine

Background: The efficacy of pre-hospital emergency services is heavily dependent on the effective communication of care providers. This effective communication occurs between providers as part of a team, but also among providers interacting with family members and patients. The COVID-19 pandemic introduced a number of communication challenges to emergency care, which are primarily linked to the increased use of PPE. Methods: We sought to analyze the impacts of the Covid-19 pandemic on Emergency Medical Service (EMS) workers and pre-hospital care delivery. We conducted focus groups and one-on-one interviews with fire-EMS first responders between Sept 2021 and 2022. Interviews included questions about job related stress, EMS skills, work experiences and changes during Covid-19. Interviews were recorded, independently dual coded, and analyzed for themes. Results: 223 first responders participated in 40 focus groups and 40 lead paramedics participated in individual interviews. We found that additional use of personal protective-equipment (PPE) was reported to have significantly impaired efficiency and perceptions of quality of care—among EMS team members and also between EMS workers and patients. EMS personnel also experienced on scene hostility on arrival (from both families and other agencies). Use of extensive PPE muffles voices, obscures facial expressions, and can cause team members to have difficulty recognizing and communicating with one another and can be a barrier to showing empathy and connecting with patients. Creative solutions such as putting a hand on someone’s shoulder, wearing name tags on suits, and explaining rationale for perceived delays were mentioned as methods to transcend these barriers. The appearance of providers in heavy PPE can be unsettling and create barriers to human connection, particularly for pediatric patients. Conclusion: Human connection is an important element of health care delivery and healing. These findings shed light on new skills that are needed to initiate and maintain human connection in these times of PPE use, especially full body PPE. Awareness of the communication and empathy barriers posed by PPE is the first step to improving provider-patient interactions in pre-hospital EMS. Additionally, ‘communication-friendly’ adaptations of PPE equipment may be an important area for future research and development in manufacturing and the healthcare industry

Book Review of, Pushing for Midwives: Homebirth Mothers and the Reproductive Rights Movement

Reviews the book Pushing for Midwives: Homebirth Mothers and the Reproductive Rights Movement by Christa Crave

The Politics of Fertility: Population and Pronatalism in Ladakh

In India’s northwestern region of Ladakh, the linkage between reproduction, politics, and fertility is both complicated and contested, evident in increasing population discourses and the re-emergence of a Buddhist pronatalist movement. This paper examines the impacts of population discourses and pronatalism on women’s reproductive decision-making, as well as on the delivery of healthcare throughout Ladakh. Population discourses currently circulating produce two reproductive subjects—the “hyper-fertile Muslim woman” and the “vulnerable Buddhist”—both of which have been central in revitalizing Buddhist pronatalism. Data collected through a hospital-based survey and interviews shows that fertility behavior is shaped by religious interpretations, political mobilization, and pressure to be culturally loyal. Fertility decisions are not simply about one’s reproductive choices and desires—but are instead situated in a contested context where Ladakhis are worried about culture loss. While these cultural pressures differently impact Muslim and Buddhist women, the growing politicization of reproduction results in continued ethnic/religious conflict that has far-ranging impacts throughout the region

Book Review of, \u3ci\u3eSpeak: The Graphic Novel\u3c/i\u3e

Book Review: Speak: The Graphic Novel, Laurie Halse Anderson (Author), Emily Caroll (Illustrator) (Eds.), 2018. Farrar, Straus and Giroux, New York. 384 pages

Conceptualizing Risk and Effectiveness: A Qualitative Study of Women’s and Providers’ Perceptions of Nonsurgical Female Permanent Contraception

Objective: Novel approaches to nonsurgical permanent contraception (NSPC) for women that are low cost and require no incision or hysteroscope/surgical equipment could improve access to, and the acceptability of permanent contraception (PC). To better understand opportunities and limitations for NSPC approaches, we examined women\u27s and OB/GYN providers\u27 perceptions of NSPC in Portland, OR. Study Design: Semi-structured, qualitative interviews were conducted with 40 women recruited from outpatient clinics with purposive sampling, and a focus group was conducted with 9 OB/GYNs in academic and community practice. Transcripts were coded and inductively analyzed with a grounded theory approach. Results: The majority of women identified as white (67%) or Latina (25%). They had a median age of 31.5, and median number of children was one. Perspectives on NSPC were closely aligned with women\u27s general attitudes towards PC; over half were considering PC for themselves or partners in the future. Most respondents valued multiple aspects of a nonsurgical approach, with themes of minimizing recovery time, invasiveness, risk, and avoiding hormonal contraception. Many assumed NSPC would be less effective than surgery, however, and felt a confirmation test would be necessary regardless of the failure rate. Providers welcomed efforts to expand contraceptive choice with NSPC, but would require long-term safety and efficacy data before recommending, and voiced concerns that NSPC\u27s potential relative ease of administration could undermine the inherent seriousness of choosing PC. Conclusions: Women’s and providers’ perceptions of NSPC hinged on the ways in which they conceptualized risk and effectiveness. While perceptions were generally favorable, confirmation of safety and effectiveness would be required for a new approach to be accepted. Implications: This hypothesis-generating study elucidates women’s and provider’s perspectives on new methods of NSPC, and contributes to understanding their perceptions of various types of risk. A technique to verify tubal occlusion would be needed for women and providers to accept NSPC

Interest in Nonsurgical Female Permanent Contraception Among Men in Portland, Oregon and Eastern Maharashtra, India

Objective: We examined the men’s attitudes and perceptions toward the concept of nonsurgical female permanent contraception (NSPC), or novel approaches to permanent contraception (PC) that do not require incisions or surgical equipment/hysteroscope. Study design: Cross-sectional survey of married/partnered men in Portland, OR and rural eastern Maharashtra, India. Descriptive analysis was performed. Results: In India (N=150), most men (80%) anticipated their partners would undergo PC in the future, compared to 30% in Portland (N=170). About a third (39.6% in India, 82% in Portland) reported being uncomfortable with PC for partners due to the need for surgery. Most men (85% in India, 82% in Portland) expressed a preference for a hypothetical new method of female NSPC over surgery, if safe and effective. Conclusion: Most men sampled in two diverse settings expressed interest in NSPC for women. Implications: Men’s perceptions of new female contraceptive methods are important to the contraceptive development process. Men may find a safe and effective nonsurgical method of permanent female contraception more acceptable than surgical PC

Perceptions of nonsurgical permanent contraception among potential users, providers, and influencers in Wardha district and New Delhi, India: Exploratory research

Background: New permanent contraceptive methods are in development, including nonsurgical permanent contraception (NSPC). Objective: In the present study, perceptions of NSPC in India among married women, married men, mothers-in-law, providers, and health advocates in Eastern Maharashtra (Wardha district) and New Delhi were examined. Methods: We conducted semi-structured interviews with 40 married women and 20 mothers-in-law; surveys with 150 married men; and focus group discussions with obstetrics/gynecology providers and advocates. Transcripts were coded and analyzed using a grounded theory approach, where emerging themes are analyzed during the data collection period. Results: The majority of female respondents expressed support of permanent contraception and interest in NSPC, stating the importance of avoiding surgery and minimizing recovery time. They expressed concerns about safety and efficacy; many felt that a confirmation test would be necessary regardless of the failure rate. Most male respondents were supportive of female permanent contraception (PC) and preferred NSPC to a surgical method, as long as it was safe and effective. Providers were interested in NSPC yet had specific concerns about safety, efficacy, cost, uptake, and government pressure. They also had concerns that a nonsurgical approach could undermine the inherent seriousness of choosing PC. Advocates were interested in NSPC but had concerns about safety and potential misuse in the Indian context. Conclusion: Although perceptions of NSPC were varied, all study populations indicated interest in NSPC. Concerns about safety, efficacy, appropriate patient counseling, and ethics emerged from the present study and should be considered as NSPC methods continue to be developed