I argue that colonialism and capitalism have utilized a specific narrative of reproduction to devalue reproducers and produce and maintain control over their bodies and lives. This builds on the work of other reproductive justice and feminist scholars and activists which seek to challenge this “dominant” discourse and destabilize the notion that there is one correct way to reproduce and birth. This podcast study uses key-word-in-context and critical discourse analyses methods to compare the ways different care providers (e.g., doctors, midwives, doulas) in the US currently situate authority and power regarding individuals (e.g., birthing people and care providers) and decision-making (e.g., knowledge, choices). I selected two podcasts, both interested in “women’s rights/health,” representative of two different approaches: holistic reproductive health (Birthful) and obstetric/gynecologic perspectives (The Ob/Gyn Podcast). Frequency count data and critical discourse analysis, drawing on 20 randomly selected episode transcripts from each podcast, revealed four main themes: worth and importance, provider roles in birthing spaces, integral actors in reproduction and birthing decision-making, and shaping legitimacy. Findings elucidate (1) key differences in the ways podcast speakers ascribe meaning and value to certain types of knowledge and individuals regarding decision-making and (2) subtle and overt ways in which care providers reify or challenge the narrative that positions the birthing person as a passive agent to whom birth happens at the hands of more capable experts. Acknowledging and challenging the presumed role of authority and power in reproduction and birthing has real-world implications for birthing people and their mental health, reproductive justice, and ethics of care.
The measles, mumps, and rubella (MMR) vaccination has been the subject of many disinformation campaigns claiming that it is associated with the development of autism. Somali immigrants and refugees have been particularly targeted by such campaigns and, as a result, are hesitant to accept the MMR vaccine. However, these campaigns are not the sole reason for vaccine hesitancy within this population. This dissertation is concerned with the social and political context of vaccine decision making within a Somali population in Southern California. I also examine an organization attempting to counter disinformation. I consider the context within which vaccine decision making occurs for a marginalized population using a social ecological model, allowing for a multi-level analysis of factors associated with vaccination decisions. This analysis has significant implications for health interventions. Additionally, I explore the development of a vaccine promotion intervention that was co-designed with the Somali community using virtual reality. In my study of this intervention, I explore epistemological negotiations and shifting priorities that shaped intervention design, highlighting how non-profits engage neoliberal ideologies such as “social enterprise” while attempting to simultaneously meet community needs. I also deconstruct how community co-design of the intervention takes place in practice and examine the role it plays in improving the intervention.
This dissertation is written at the intersection of medical anthropology and public health. I contribute to the literature on vaccine hesitancy by demonstrating that vaccine decision making in the Somali community is a highly complex negotiation of beliefs and values that take place at many different levels of social interaction. In my examination of the intervention, I argue that while social enterprise models are, in theory, supposed to be designed to place the community’s needs at the heart of the enterprise, this project shows that it is not always the case that the community remains at the center of profit driven models. Finally, I demonstrate the value of community co-design in the development of a vaccine promotion intervention that makes use of technological approaches. I argue that community co-design is necessary to ensure that technological public health campaigns avoid inequitable top-down approaches.
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