Medical Anthropology Quarterly: Vol. 18, No. 2 (june 2004)
editorial
Forward
Marcia C. Inhorn
articles
Stigma, Community, Ethnography: Joan Ablon's Contribution to the Anthropology of Impairment-Disability
Russell P. Shuttleworth, Devva Kasnitz
Joan Ablon has helped establish the anthropology of impairment-disability and significantly contributed to the role of anthropology in disability studies. In this article, we review the development of and situate Ablon's ethnographic research in the anthropology of impairment-disability. We then address various methodological issues in her work including her ethnographic approach, her grounding in action anthropology and her support for the development of the academic study of disability in anthropology and the careers of disabled anthropologists. The next section of the article examines Ablon's use of the notion of stigma, her understanding of community, and her engagement with disability rights. As examples of themes important to disability studies, we present her discussion of the implications of the ideal of the body beautiful, and gender differences in negotiating intimacy for people with physical differences. We close with a discussion of the future of an anthropology of impairment-disability. [disability, impairment, Ablon, genetics, ethnography]
Middle Eastern Masculinities in the Age of New Reproductive Technologies: Male Infertility and Stigma in Egypt and Lebanon
Marcia C. Inhorn
Worldwide, male infertility contributes to more than half of all cases of childlessness; yet, it is a reproductive health problem that is poorly studied and understood. This article examines the problem of male infertility in two Middle Eastern locales, Cairo, Egypt, and Beirut, Lebanon, where men may be at increased risk of male infertility because of environmental and behavioral factors. It is argued that male infertility may be particularly problematic for Middle Eastern men in their pronatalist societies; there, both virility and fertility are typically tied to manhood. Thus, male infertility is a potentially emasculating condition, surrounded by secrecy and stigma. Furthermore, the new reproductive technology called intracytoplasmic sperm injection (ICSI), designed specifically to overcome male infertility, may paradoxically create additional layers of stigma and secrecy, due to the complex moral and marital dilemmas associated with Islamic restrictions on third-party donation of gametes. [male infertility, masculinity, new reproductive technologies, stigma, Egypt, Lebanon]
Sexuality, Color, and Stigma among Northeast Brazilian Women
L. A. Rebhun
Despite its international image as a sexually free-spirited country, local attitudes toward morality of sexual behavior remain complex throughout Brazil, especially in rural areas and the conservative Northeast region. In addition, notwithstanding its official ideology of nonracism, African ancestry as judged through personal appearance (color) constitutes a significant social and economic disadvantage. Using Goffman's idea of "spoiled identity" as a starting point, I show how locals use sexual behavior as a multivocal symbol of moral status in women, and how spoiled sexual reputation interacts with other stigmatized statuses, especially color. I also consider how the acquisition of sexually stigmatized status jeopardizes women's well-being and that of their children. [Brazil, color, gender, sexuality, stigma, women]
Multiple Chemical Sensitivities: Stigma and Social Experiences
Juliene G. Lipson
Multiple Chemical Sensitivity (MCS), an intolerance to everyday chemical and biological substances in amounts that do not bother other people, is a medically contested condition. In addition to symptoms and the ongoing difficulties of living with this condition, this hidden and stigmatized disability strongly impacts social relationships and daily life. Based on an ethnographic study, this article introduces the context of MCS in terms of cultural themes, the media, and the economic power of industries that manufacture the products that make people with MCS sick. Participants' experiences with family members and friends, in work and school settings, and with physicians exemplify the difficulties of living with MCS. I dedicate this article to Joan Ablon, my professor and mentor, whose work has always inspired my thinking and research topics. [multiple chemical sensitivities, environmental illness, stigma, hidden disabilities, medically contested diagnoses]
Childhood Asthma on the Northern Mexico Border
Norah Anita Schwartz
Children with asthma living on the northern Mexico border suffer not only from the physical aspects of this condition, but also from the lack of a clear biomedical definition and treatment plan for the illness. An ethnographic study involving participant observation and focused interviews in Tijuana, Mexico, sought to understand the intersection of diagnostic uncertainties surrounding childhood asthma on the part of parents, particularly mothers, living in acute poverty. Environmental factors such as dust and insects in impoverished homes probably acted as asthma triggers among many of the children in the study. Furthermore, management of children's asthma took place not only in biomedical clinics, but also in homes, traditional medical settings, and pharmacies, where mothers often sought remedies for their children's asthma attacks on an emergency basis. In all treatment settings, including biomedical ones, they often faced significant barriers to effective care, including the misuse of antibiotics. Thus, the role of pharmaceutical sales clerks, as well as pediatric asthma specialists, is explored in this article. [pediatric asthma, northern Mexico border, illness narratives, doctor-patient interaction, pharmaceuticals, poverty]
Free Markets and Dead Mothers: The Social Ecology of Maternal Mortality in Post-Socialist Mongolia
Craig R. Janes, Oyuntsetseg Chuluundorj
Beginning in 1990, Mongolia, a former client state of what was then the Soviet Union, undertook liberal economic reforms. These came as a great shock to Mongolia and Mongolians, and resulted in food shortages, reports of famine, widespread unemployment, and a collapse of public health and health care. Although economic conditions have stabilized in recent years, unemployment and poverty are still at disturbingly high levels. One important consequence of the transition has been the transformation of the rural, primarily pastoral, economy. With de-collectivization, herding households have been thrown into a highly insecure subsistence mode of production, and, as a consequence, have become vulnerable to local fluctuations in rainfall and availability and quality of forage, and many now lack access to traded staples and essential commodities. Household food insecurity, malnutrition, and migration of impoverished households to provincial centers and the capital of Ulaanbaatar are one result. Reductions to investments in the health sector have also eroded the quality of services in rural areas, and restricted access to those services still functioning. Evidence suggests that women are particularly vulnerable to these political-ecological changes, and that this vulnerability is manifested in increasing rates of poor reproductive health and maternal mortality. Drawing on case-study ethnographic and epidemiological data, this article explores the links between neoliberal economic reform and maternal mortality in Mongolia. [Mongolia, maternal mortality, neoliberal reform, post-socialist societies, political ecology of pastoralism]
Deadly Inequality in the Health Care "Safety Net": Uninsured Ethnic Minorities' Struggle to Live with Life-Threatening Illnesses
Gay Becker
Forty-three million Americans are uninsured. This article explores the difficulties people experience in seeking health care through the health care "safety net," which provides most of the health care that uninsured people receive, and critiques the gaps, inconsistencies, and failures of such care. In research with 176 African Americans and Latinos who had no health insurance, it was found that they delay seeking care because of cost, do without medications, have negative views of safety net health care, and experience discrimination. As a consequence of dissatisfaction with safety net care, avoidance of the health care system was commonplace. It is concluded that safety net health care facilitates the development of unhealthy practices, such as delays in seeking care. The inadequacy of safety net health care is thus injurious to people's health. [uninsured; ethnic minorities; chronic illness; safety net; structural inequality]
Afterword
Joan Ablon