The Social Production of Reproductive Health Disparities Open Access

Abstract

This dissertation study was driven by the research question: "Are reproductive health beliefs and behaviors shaped by categories of race and/or class?" In this work, I put into practice methods from both anthropology and epidemiology, ranging from cultural consensus analysis and QAP regression analysis to ethnographic observations. I found that neither race nor class were culturally distinct categories in the domain of healthy pregnancy behaviors and beliefs. What did matter in influencing patterns of belief were close relationships.

I conducted this study on a sample of women between the ages of 18-35 in Atlanta, GA. Among this sample, having a bad relationship with one's father influenced the cultural model of health a woman holds. Having a good relationship with one's mother predicted one's ability to do what they think is important during pregnancy. Feeling connected with one's community and not being obese going into pregnancy also predicted this. Having a good relationship with one's mother also predicted the amount of stressors one encountered during pregnancy. Having a good relationship with one's partner also predicted this. Finally, all of these associations exist even when compared against a number of demographic, physical, and behavioral context factors including race. I hope to use these findings to further support the inclusion of social and anthropological theory into the development of complex epidemiological models in order to better understand disparities in health behaviors, beliefs, and outcomes.

Table of Contents

CHAPTER 1. 1
Introduction. 1
Objective 1. 1
Hypothesis 1. 2
Hypothesis 2. 2
Background. 3
What is Biological Embedding?. 23
What are the Candidate Mechanisms of Biological Embedding?. 27
HPA-axis. 27
Autonomic Nervous System.. 29
The Immune System.. 30
Social Affiliation System.. 31
Compounding Factors. 32
Figures and Table. 50
CHAPTER 2. 55
Birth, Sex, and the Body of Black Women: A Short History. 55
Defining "Choice" Among Black Women. 58
The Woman-as-Person Push and the Public/Private Split 67
Evolving Anthropological Views on Pregnancy and Reproductive Health. 71
What About Motherhood?. 75
How Do You Counter Decentralization?. 79
CHAPTER 3. 95
Overall Study Methods. 95
Study Overview.. 95
Study Design Characteristics. 96
Setting and Recruitment 96
Phases 1 and 2. 96
Procedures. 97
Phase 1. 97
Free Listing. 97
Details of the Free List. 98
Phase 1 Analysis. 99
Phase 2. 99
Questionnaire on Healthy Pregnancy Beliefs and Objective Pregnancy Behaviors. 99
Phase 2 Sample. 100
Phase 2 Analysis. 100
Works Cited. 102
CHAPTER 4. 103
Cultural Consensus Models of Pregnancy Behaviors and Beliefs. 103
Background. 105
Methods. 108
Setting, Recruitment, and Sampling. 108
Free List and Cultural Consensus Modeling. 108
Between versus Within Group Sharing. 109
Context Factors. 110
QAP Analysis. 110
Binary Logistic Regression Analyses. 111
Qualitative Assessment 111
Results. 111
Sample Description. 111
Free List 112
Cultural Consensus Modeling Analysis. 113
QAP Regression and Subgroup Analysis. 114
Binary Regression Analysis. 115
Qualitative Assessment 116
Discussion. 117
Limitation. 119
Works Cited. 121
Figures and Tables. 125
CHAPTER 5. 133
Is there a Cultural Burden of Race that Makes Pregnancy More Risky for Black Women? 133
Introduction. 133
Tension 1: Race-as-Risk Factor versus Health Disparities Observations. 137
Tension 2: Race as Culture versus Blackness as a Part of American Culture. 141
The Study. 146
Race, Class and Barriers to Pregnancy Health. 149
Feeling connected with community. 151
Maternal Relationship. 152
Pre-Pregnancy Obesity and Age. 153
Relationships, Health Beliefs, and Health Behaviors. 154
Works Cited. 157
Figures and Tables. 171
CHAPTER 6. 177
Integrating Biological Embedding and Social Production Theory. 177
The Intersection of Social Production Theory and Biological Embedding. 177
Relevance Beyond this Work. 184
Figures and Tables. 204
CHAPTER 7. 213
Birthing Black Mothers: How Race Shapes Childbirth as a Rite of Passage 213
Works Cited. 230
CHAPTER 8. 233
Conclusions and Future Directions. 233
Chapter 1: Concluding Point 233
Chapter 2: Concluding Point 233
Chapter 3: Concluding Points. 234
Chapter 4: Concluding Points. 234
Chapter 5: Concluding Points. 236
Chapter 6: Concluding Point 237
Chapter 7: Concluding Points. 237

List of Figures
Figure 1.1. The Social Environment.................................................................................. 50
Figure 1.2. The Behavioral Risk Environment................................................................... 51
Figure 1.3. Individual Perceptions..................................................................................... 52
Figure 1.4. Decentralized Bodies...................................................................................... 53
Figure 1.5. The Social Loop............................................................................................... 54
Figure 1.6. What is Race.................................................................................................... 54
Figure 6.1. Social Production Theory.............................................................................. 208
Figure 6.2. The Environment of Health Production........................................................ 209
Figure 6.3. Individual Perceptions................................................................................... 210
Figure 6.4. Relationships Matter...................................................................................... 211
Figure 6.5. Relationships and Effects on the Child......................................................... 212
List of Tables

Table 4.1. Sample Characteristics.................................................................................... 125
Table 4.2. Domain Response .......................................................................................... 126
Table 4.3. Domain Response with Class.......................................................................... 127
Table 4.4. Between vs. Within......................................................................................... 128
Table 4.5. Quadratic Assignment Procedure (QAP)....................................................... 129
Table 4.6. Sharing Based on Relationship....................................................................... 130
Table 4.7. Qualitative Assessment of Father's Relationship........................................... 131
Table 5.1. Description of Context Categories................................................................. 171
Table 5.2. Proportions...................................................................................................... 172
Table 5.3. Proportion Responding "Important"............................................................... 174
Table 5.4. Regression Analysis........................................................................................ 175
Table 5.5. Predicting Level of Cultural Competence...................................................... 175
Table 5.6. Qualitative Assessment of Mother's Relationship ......................................... 176
Table 6.1. Quadratic Assignment Procedure (QAP)....................................................... 204
Table 6.2. Stress............................................................................................................... 205
Table 6.3. Race, Class, and Stress................................................................................... 206
Table 6.4. Stress and Context.......................................................................................... 207
Table 6.5. Key Stressors.................................................................................................. 207

About this Dissertation

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• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Laney Graduate School
Department	Anthropology
Degree	PhD
Submission	Dissertation
Language	English
Research Field	Anthropology, Medical and Forensic Biology, General Psychology, Cognitive
Keyword	Cultural Modeling Reproductive Health Racial Disparities
Committee Chair / Thesis Advisor	Worthman, Carol, Emory University
Committee Members	Hogue, Carol J, Emory University Hadley, Craig, Emory University

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