Adrienne Strong

Medical anthropology, hospital ethnography, theories of care, pain care practices, and maternal mortality

Gainesville, FL, 32603 United States

I am a medical anthropologist and Associate Professor of Anthropology at the University of Florida and affiliate faculty with the Center for African Studies and the Center for Gender, Sexualities, and Women’s Studies Research, with a joint Ph.D. from Washington University in St. Louis, USA and the Universiteit van Amsterdam in the Netherlands. I have long studied maternal mortality and women's health in Tanzania, focusing on theories of care for pregnant women. In my new NSF funded research (2022-2025), I am examining the meanings and formation of pain care practices in Tanzania across multiple levels in two regions, including the national Ocean Road Cancer Institute and Tosamaganga District Hospital. The common threads between all of my projects are interests in theories of care, everyday ethics, hospital ethnography, bio bureaucracy and the expansion of biomedical care and power, and patient-provider interactions. I supervise Ph.D. students interested in maternal and reproductive health, hospital ethnography, and the anthropology of biomedicine in a variety of geographic locations. I will be on parental leave until the end of October 2023. If you are interested in applying to UF to work with me, please send me an email.

Before my current position, I was 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 and a Fellow at the Columbia Population Research Center.

My first book, winner of the 2021 Eileen Basker Memorial Prize from the Society for Medical Anthropology (SMA), Documenting Death: Maternal Mortality and the Ethics of Care in Tanzania, available from University of California Press November 3, 2020, focuses on the inner workings of a government regional referral hospital in Tanzania, 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 focuses 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 the first ethnography to examine the issue of maternal mortality in a low resource setting from this perspective and in the setting of a biomedical facility, complementing the existing work of anthropologists of reproduction who have worked at the community level.

I worked in the Rukwa Region for my PhD 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. For my postdoctoral research in 2017 and 2018 I conducted a project examining a birth companion pilot program in the Kigoma region of Tanzania, which focused on how companions impact the social dynamics of health center maternity wards and the care provided in those settings. This project also included an 80-question cultural consensus survey and analysis around the cultural domain of care and support for pregnant women.

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

Leah M. Ashe Prize for the Anthropology of Medically Induced Harm Honorable Mention 2022

Eileen Basker Memorial Prize 2021

ReproNetwork Adele E. Clarke Book Award Honorable Mention 2021

Paper Prize

Publications

Welcome to my publications page. This includes citations of my works that have been accepted for publication, as well as brief mention of those in the pipeline i.e. in preparation or currently under review. When possible, I have provided links to the full work or the pertinent website for more information. 

Published works

  • Strong, A. 2020. Documenting Death: Maternal Mortality and the Ethics of Care in Tanzania. Berkeley, CA: University of California Press (available for open access free download) https://www.ucpress.edu/book/9780520310704/documenting-death

    • Documenting Death is a gripping ethnographic account of the deaths of pregnant women in a hospital in a low-resource setting in Tanzania. Through an exploration of everyday ethics and care practices on a local maternity ward, anthropologist Adrienne E. Strong untangles the reasons Tanzania has achieved so little sustainable success in reducing maternal mortality rates, despite global development support. Growing administrative pressures to document good care serve to preclude good care in practice while placing frontline healthcare workers in moral and ethical peril. Maternal health emergencies expose the precarity of hospital social relations and accountability systems, which, together, continue to lead to the deaths of pregnant women.

      “This powerful and compelling analysis of maternal mortality in rural Tanzania is a groundbreaking addition to scholarship on Africa and its public health challenges. Adrienne E. Strong presents a rich ethnography of hospital function and dysfunction, to which the voices of patients and staff add poignant detail. The ways in which state and global health policy shape maternal health and well-being frame individual narratives in a memorable testimony.” Carolyn Sargent, Professor of Anthropology, Washington University in St. Louis

      “Documenting Death is an arresting tale of life and death on a busy maternity ward in rural Tanzania. Drawing on a remarkable period of ethnographic fieldwork, Strong evocatively details the predicament of nurse midwives caught in the ‘biobureaucracy’ of global health projects and their audit trails. A significant contribution to medical anthropology and critical global health scholarship.” Margaret MacDonald, Associate Professor of Anthropology, York University

  • Strong, A. and T.L. White, 2019. Using paired cultural modeling and cultural consensus analysis to maximize program suitability in local contexts, Health Policy and Planning https://doi.org/10.1093/heapol/czz096

    • Abstract: Cultural consensus analysis (CCA) is a quantitative method for determining cohesion in a specified cultural domain and cultural modelling (CM) is a method for designing and testing connections within a cultural domain based on qualitative data collection. After a description of the methods, and examples of their application, we provide a description of three main points in the programme planning, implementation and evaluation cycle at which the method can best be utilized to plan, contextualize or evaluate programmes and policies. In addition, the use of CCA and CM is not constrained to one point in time though, in order to maximize its ability to help with programme design or evaluation, it ought to be done as early as possible in the process. Through examples from research, and a broader description of the methods of CM and analysis, we provide another tool for global public health practitioners, planners and policymakers. We argue these tools can be used to great effect in a short period of time to maximize the local suitability, acceptability and quality of proposed and implemented interventions, building on existing local strengths, not just in maternal health but, more broadly.

  • Strong, A. 2018. Causes and effects of occupational risk for healthcare workers on the maternity ward of a Tanzanian hospital. Accepted, Human Organization. Winner in the Peter K. New Student Research Paper Prize competition.

    • Abstract: In this paper, the author introduces the concept of “institutional care” as a key component of mitigating healthcare workers’ occupational risk from their exposure to bodily fluids. In the Rukwa region of Tanzania, healthcare providers often work in very low resource environments that lack equipment and the tools needed for patient care. Additionally, resources for protecting the healthcare workers from occupational exposure to infectious diseases is also often lacking. Against the background of the 2014-2015 Ebola outbreak in West Africa and continued resource scarcity in the Mawingu Regional Hospital, healthcare workers explained the effects of a lack of certainty about women’s HIV status and a lack of personal protective equipment. On the maternity ward, the nurse-midwives worked in an environment that was high risk but also nearly entirely outside their control. When health administrators at the institutional level did not demonstrate care for their employees—what I term institutional care—the nurses reported higher levels of concern and fatalism regarding their potential to contract HIV or Hepatitis. The article concludes with recommendations for how to operationalize institutional care to mitigate occupational risk in this environment to care for hospital staff members so they can most effectively care for patients and minimize abusive interactions.

  • Strong, A., M. Cogburn, and S. Wood. 2018. A Facility Birth for All?: Homebirth, Hospital Birth, and Birth Registration in Tanzania in Birth in 8 Cultures, Robbie Davis-Floyd, Melissa Cheyney, and Carolyn Sargent, eds. https://www.amazon.com/Birth-Eight-Cultures-Robbie-Davis-Floyd/dp/1478637900/ref=sr_1_1?crid=34KU00MKEXGZA&keywords=birth+in+8+cultures&qid=1575562224&sprefix=birth+in+%2Caps%2C169&sr=8-1

  • Strong, A. and D.A. Schwartz. 2017. "Effects of the Ebola epidemic on health care of pregnant women- Stigmatization with and without infection" in Pregnant in the Time of Ebola, D.A. Schwartz, S. Abramowitz, J. Anoko, Eds.

    • Abstract: By now, after the end of the Ebola virus outbreak in West Africa, we have begun to see the lingering effects of stigma on Ebola survivors, as well as children orphaned by the disease. However, there has been little scholarly attention to stigma in relation to its particularities while the outbreak was still active. Therefore, in this chapter we explore the effects of stigmatization on the health care services pregnant women—with and without Ebola—were able to access and receive during the outbreak. We propose three primary ways in which stigma operated to reduce pregnant women’s access to health care services during the outbreak: 1) Women and their relatives were afraid to go to health facilities for fear of being infected with Ebola while there, i.e. stigmatization of healthcare facilities; 2) Healthcare workers frequently died due to their occupational exposure to EVD while caring for others, i.e. they were stigmatized as carriers or transmitters of Ebola; and 3) Pregnant women themselves were refused services at health facilities due to fears that they were infected with Ebola, i.e. the physiological processes of birth, which involve high levels of potential for exposure to bodily fluids, led to health care workers’ stigmatization of these women when they sought services during pregnancy or, particularly, at the time of giving birth. In several of the countries that experienced the worst of the outbreak, women already faced some of the world’s highest rates of pregnancy-related death. We argue that the high fatality rate for pregnant women with Ebola, the drastic effects of the epidemic on countries’ health care workforce, and the inherent messiness of birth, all coalesced to create heightened discrimination and stigma around seeking care during pregnancy and birth.

  • Strong, A. 2017. Working in Scarcity: Effects on social interactions and biomedical care in a Tanzanian hospital. Social Science & Medicine 172: 217-224. http://dx.doi.org/10.1016/j.socscimed.2017.02.010

    • Abstract: Based on mixed-methods, ethnographic research in government health facilities conducted in Rukwa, Tanzania over 23 months between 2012 and 2015, this paper explores the social implications of budget shortfalls in the healthcare system at the level of a regional hospital. Budget crises resulted from the late disbursal of funds and the failure of outside donors to meet aid commitments needed to subsidize healthcare at the national level. Healthcare administrators recounted specific donors who pulled out of commitments as a direct result of foreign government austerity measures enacted after the global financial crisis of 2008. In this environment of scarcity, partially due to years of reduced donor funds in the region, regional healthcare administrators circumvented bureaucratic fiscal procedures to ensure the continued functioning of facilities, and healthcare personnel struggled to provide pregnant women with high quality care in times of emergencies. Providers cited low morale and demotivation due to deteri- orating physical infrastructure, lack of supplies, and poor relations with the community as key factors inhibiting their ability to care for the women who came to their facilities.

  • Strong, A. and D.A. Schwartz. 2016. “Anthropological aspects of risk to pregnant women during the 2013-2015 multinational Ebola virus outbreak in West Africa.” Health Care for Women International

    • http://www.tandfonline.com/doi/abs/10.1080/07399332.2016.1167896?journalCode=uhcw20

    • Abstract: Researchers reflect on sociocultural aspects of the Ebola outbreak in West Africa and critically analyze the epidemic's effects on pregnant mothers and their babies. We address structural inequalities contributing to poor maternal health in lower-income countries, while reflecting on how the Ebola outbreak highlights the still-marginalized role of pregnant women. Drawing on prior research in West and East Africa, we discuss health care providers’ responses to risk of infection during maternity work under normal circumstances and in times of crisis. We end with recommendations for preventing such detrimental effects on the health of pregnant women in the case of another epidemic.

  • Strong, A. 2015. “The convergence of social and institutional dynamics resulting in maternal death in Rukwa, Tanzania” in Maternal Mortality: Risk Factors, Anthropological Perspectives, Prevalence in Developing Countries and Preventative Strategies for Pregnancy- Related Death. Ed. David Schwartz. Nova Science Publishers

    • https://www.novapublishers.com/catalog/product_info.php?products_id=54695&osCsid=

  • Marwa, S and A. Strong. 2015. “Three case studies and experiences of maternal death at a regional referral hospital in Rukwa, Tanzania” in Maternal Mortality: Risk Factors, Anthropological Perspectives, Prevalence in Developing Countries and Preventative Strategies for Pregnancy-Related Death. Ed. David Schwartz. Nova Science Publishers

    • https://www.novapublishers.com/catalog/product_info.php?products_id=54695&osCsid=

Works in Progress

  • Strong, A. "Jumping the Red Tape:" Administrative Workarounds, Improvisation, and the Social World of Rumors in a Tanzanian Hospital (in preparation for submission to Journal of the Royal Anthropological Institute)

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