A fate worse than death : pregnancy weight gain and the thinness ideal

This Master's thesis, entitled "A fate worse than death: Pregnancy weight gain and the thinness ideal," interrogates scientific discourse on pregnancy weight gain, focusing on medical literature published between 1990 and 2009. In 1990, the Institute of Medicine changed their official gestational weight gain recommendations out of fears that women were not gaining enough weight in pregnancy, resulting in low birth weights. More recently, a fervour surrounding the so-called childhood obesity epidemic has fueled much scientific debate about the possibility that women are gaining too much weight. Thus it is now being suggested that women's weight gain should be restricted to alleviate society's obesity. Although the experts' position on pregnancy weight gain shifts over time, consistent across the dataset (1990-2009) is an understanding of women's bodies as the origin of childhood health. I argue that medical discourse on weight gain in pregnancy has historically created an embodied ideal as a requirement of motherhood and femininity; more recently this ideal has necessarily been linked not only to dominant discourses of obesity, which is seen as costly, burdensome, and undesirable, but also to dominant notions of good motherhood. Building on Foucault's genealogical approach, this thesis examines the medical/scientific discourse, and its claims to truth that have the effect of responsibilising and normalising pregnant women, both in terms of the feminine and motherhood itself

Under the Skin and Into the Social: Examining the Neuroscience of Social Problems and Inequality

This dissertation examines how and why neuroscience has entered the field of social problems research. A subset of neuroscientists I studied is now doing research with the explicit purpose of addressing poverty, adversity, and inequality. Their foundational claim is that experiences in the world and interactions with other people – an “environment of relationships” – are integral in shaping brain development. I investigate how neuroscientists and policymakers produce scientific knowledge about the developing brain, and put forward a new sociotechnical vision for governance. Those involved in this project understand themselves as using science to advocate for a more just society that takes responsibility for the health and well being of its most vulnerable and disadvantaged citizens. Despite these good intentions, my neuroscientist interviewees found themselves at the center of controversy during their early careers. Critics from within the scientific community were worried that the research was based upon eugenicist and racist assumptions. The neuroscience community eventually accepted the work, and the controversy subsided. More recently, however, the studies have gotten wider coverage, and a similar strand of criticism, albeit from outside of the scientific community, has resurfaced. Through ethnographic methods, I studied the knowledge production and policymaking practices of this group, as well as the controversy that ensued and how my participants react to it. I pay close attention to the science-policy relationship, and show that building neuroscience-based policy requires extensive negotiation amongst actors, where they must contend with both social and scientific concerns. The production of a new narrative called the “Brain Story” exemplifies this process. I found that neuroscience brings new attention to age-old problems, and positions itself as a powerful new voice in the arena of early childhood development by pulling together discourses of science, economics, and our moral responsibility to children. I argue that the research is at once a reflection and repudiation of biomedical modes of analysis. Though this approach values biomedical evidence about the individual, scientists I interviewed believe that the best way to solve social problems is by intervening at the level of the social. Though well-intentioned, the research may produce unintended consequences

Understanding the Patient Experience of Receiving Clinically Actionable Genetic Results from the MyCode Community Health Initiative, a Population-Based Genomic Screening Initiative

Understanding unselected individuals’ experiences receiving genetic results through population genomic screening is critical to advancing clinical utility and improving population health. We conducted qualitative interviews with individuals who received clinically actionable genetic results via the MyCode© Genomic Screening and Counseling program. We purposively sampled cohorts to seek diversity in result-related disease risk (e.g., cancer or cardiovascular) and in personal or family history of related diseases. Transcripts were analyzed using a two-step inductive coding process of broad thematic analysis followed by in-depth coding of each theme. Four thematic domains identified across all cohorts were examined: process assessment, psychosocial response, behavioral change due to the genetic result, and family communication. Coding of 63 interviews among 60 participants revealed that participants were satisfied with the results disclosure process, initially experienced a range of positive, neutral, and negative psychological reactions to results, adjusted positively to results over time, undertook clinically indicated actions in response to results, and communicated results with relatives to whom they felt emotionally close. Our findings of generally favorable responses to receiving clinically actionable genetic results via a genomic screening program may assuage fear of patient distress in such programs and guide additional biobanks, genomic screening programs, and research studies