Adrienne Strong

Medical anthropology, maternal mortality, hospital ethnography, and dignity in women's health care

I am a medical anthropologist with a joint Ph.D. from Washington University in St. Louis, USA and the Universiteit van Amsterdam in the Netherlands. I study maternal mortality and women's health in Tanzania, currently in the Kigoma region on a birth companionship program and the notions of ideal comfort, care, and support for pregnant women in labor. I am a National Science Foundation Postdoctoral Research Fellow with Columbia University's Mailman School of Health, in the Averting Maternal Death and Disability (AMDD) Program in the Heilbrunn Department of Population and Family Health. 

I worked in the Rukwa Region for my dissertation fieldwork, which I conducted from January 2014- August 2015. From September 2010 through July 2011, I conducted research on access to healthcare services during pregnancy, birth, and the postpartum period in the Singida Region of Tanzania. My doctoral dissertation project focused on the inner workings of a government regional referral hospital, examining how institutional structures related to hierarchy, bureaucracy, historical precedents, communication and other factors, may influence the capacity of the institution to provide effective maternal healthcare during times of obstetric crisis. My research focused on biomedical healthcare providers and administrators, groups that are often overlooked in the context of medical anthropology in sub-Saharan Africa. I contextualize the hospital ethnography with interviews, participant observation, and focus group discussions in communities throughout the region, as well as through the use of primary archival sources from the colonial and post-independence eras. 

This is my personal website, which includes updates on my research, collaborations, conference presentations and papers, publications, teaching, and critical responses to current events related to women's health and reproduction.  

Mentions and Public Anthropology

Paper Prize

Washington University Feature

Feature on Anthropology Department Website

Research Report on Global Health Hub

Photoessay on SAPIENS.org 

Mention on Anthrodendum

Mention on Anthrodendum for fieldwork blog

 

MISCELLANEOUS

I don't quite know where to start but I feel like I have to write something. There are some many thoughts and questions and ideas buzzing around in my head that I think I just need to dump some of them somewhere. I've been thinking a lot recently about where I'd like my career to go in the future, what kind of role I'd like to take on and in what ways I might be able to apply my research interests and training. I am someone who is used to being a leader, used to having some modicum of control over my environment and here, because of the nature of doing this fieldwork, I really have neither of those things. I feel like being away from an academic environment dulls my analytic capabilities and I feel myself to be haphazardly theorizing about things without all the pieces. I like to speak from a position of knowledge and information but I also am really trying to own my growing status as some kind of "expert" on the issues I am researching. After all, if you get a PhD in something and don't feel like you're an expert yet, then who is? I was reading the book The Confidence Code and I think it's true what the authors write about a lot of women, in particular, thinking they must have all the information before speaking up and offering their insights. This can cause me, in particular and people in general, to forgo speaking up. I am trying to own my experience, which is becoming fairly significant at this point, and speak up when I think I need to. Being a researcher whose presence was not asked for, even if not unwanted, means that my professional opinion is rarely elicited and while I can make suggestions all I want, rarely, if ever, are they implemented. This just makes it even more frustrating to watch as the hospital continues to struggle with things it need not struggle with. 

A good example is what happened during our last maternal death audit meeting in the middle of December. The assembled group was discussing the action plan for one of the deaths and trying to settle on a suitable outcome indicator. They were trying to figure out a way to measure improvement in counseling and education during the prenatal period at antenatal clinics. One of the participants suggested a decrease in maternal mortality as the suitable outcome indicator. I mentioned that clearly this cannot be used because there is no one-to-one connection; maternal death is a complex problem and certainly is not only caused by a lack of health education in communities and village dispensaries. I suggested later in the discussion that we should speak with women about what they know about pregnancy-related problems and about making a personal birth preparedness plan, as a way of gauging the information and counseling being done by the dispensaries. I was told, "Well, we already wrote the other thing so we can't change it now. Maybe at our next audit meeting," which I found to be a rather distressing and lazy answer. I also tried to push back about the quality of information women get in dispensaries and was basically told I didn't know what I was talking about, despite the fact that I've spent ample time in dispensaries watching first-hand prenatal care visits and I know women rarely get to ask questions and rarely get information delivered in a way that is easy for them to remember and own. I think I'm getting more brazen and next time I won't let them push me around when I feel like what I say could actually make a difference. There is a real resistance to constructive criticism and new ideas and perspectives that makes it feel incredibly challenging to contribute and work for change. I'm sure I have more to say but I think this will suffice for the moment. I'm hoping to do some interviews this week and to finalize a social network questionnaire. I can already hear the complaining from the nurses when I try to explain that one… keep your fingers crossed that I can convince them of the questionnaire's worth.

 

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