Female sexuality, social reproduction, and the politics of medical intervention in Niger: Kel Ewey Tuareg perspectives

Patient Assessment and Chronic Pain Self-Management in Ethnomedicine: Seasonal and Ecosystemic Embodiment in Ayurvedic Patient-Centered Care

Background: Ayurveda’s preventive focus complements its strength with the interventionist approach of the biomedical in chronic pain self-management. Patient-centered care (PCC) using ethnomedicine promises greater patient self-management; however, few studies have examined environmental relationships and PCC in self-management of chronic pain through Ayurveda. Objective: To examine how Ayurveda’s philosophical focus on whole system frameworks describes the integration of the individual and the ecological in tailoring an integrative patient-centered diagnostic and prognostic approach to chronic pain management. Methods: This qualitative case study conducted in-depth semi-structured interviews of Ayurvedic physicians from India (N = 10) and a qualitative inductive content analytic approach. Findings: The diagnostic and interpretational framework of the doshas supports the integration of the individual and the ecological through (a) the circadian and seasonal cycles relating mind-body awareness with diet, lifestyle (e.g., yoga), and breath (e.g., pranayama), and (b) biogeographical and ecosystemic regions relating the biogeographical and the ecological (e.g., desh) with the regulatory principle of pain and its physiological and anatomical perception (vata) in an approach that goes beyond treating pain etiology to a whole person PCC approach. Conclusions: The study highlights how circadian and seasonal cycles and evolutionary spatial-temporal factors of biogeographical and ecological regions are employed in patient assessment and self-management to support patient involvement. Recommendations for PCC in integrative chronic pain management include supporting patient ownership of their care through the dosha framework that relates the individual and the ecological in the patient’s own life-context and supports co-creation of a collaborative plan of care using an ethnomedical framework.

Creating the next steps to care: Maternal heath, improvisation, and Fulani women in Niamey, Niger

On paper, Niger's maternal healthcare system is extensively outlined by policies which assure access to certain services and create hierarchical referral chains. In practice it remains intensely improvisational: actors in the system must frequently make up the next steps to giving and receiving care, often outside the existing policies and procedures. Although population health in Niger has improved since the recently enacted gratuité des soins policy (which guarantees free access to certain material and child health services), care on the ground is still dictated by difficult circumstances and scarce resources. Health workers often lack the required medications and supplies; nevertheless, they must find ways to deliver services. Patients seeking maternal health services are frequently dissatisfied with the care they receive and so move forward of their own volition, by negotiating with health workers or by looking for services elsewhere. This research builds on recent scholarly work on improvisation, and asks us to further look at the ways that improvisation can be informed by the identity of the actors. Examining case studies of women from the Fulani ethnic group illustrates how particular cultural differences can inform improvisation. Analysing improvisation can also have policy implications; identifying typical points of departure from the official maternal health care system can reveal points where Niger can bolster its commitment to a universally high quality of care.

Comparing the attitudes of urban and rural Iranian women toward menopause

OBJECTIVES

This study was designed to compare the attitudes of urban and rural Iranian women toward menopause. The socio-cultural context of urban Tehranian women is considerably more westernized than that of rural Semiromian women. Our original hypothesis was that urban Tehranian women would have a more negative outlook on menopause than rural women. This hypothesis was drawn from previous work implicating the youth-oriented culture of the west as responsible for the negative attitude of western women toward menopause.

METHODS

A questionnaire with eight questions regarding major psychosocial issues that are of importance to menopausal women was prepared and administered to a group of 70 Tehranian and 49 Semiromian women.

RESULTS

In contrast to the initial hypothesis, analysis revealed that rural Iranian women have a more negative attitude towards menopause than urban Iranian women.

CONCLUSION

The more negative attitude of the rural women toward menopause in large part reflected the higher priority they placed on fertility than did their urban counterparts. Further, cross-cultural studies will illuminate exactly which social and cultural factors play a role in both the physical and psychological aspects of menopause.

From childbearers to culture-bearers: transition to postchildbearing among Tuareg women

This essay presents an analysis of women's lived experience of the transition from childbearing to postchildbearing among a division of the Tuareg in Niger, West Africa. The analysis suggests that biological realities associated with the end of fertility are interwined with local notions of qualities of ritual and social elderhood among women. It shows how changes in ritual and social roles, associated with increasing devotion to Islam and becoming a mother-in-law, are salient criteria for assuming the role and status of post-menopausal woman. The implication of this is very significant for biocultural reasons: menstruation and its cessation are not always literally the most important markers in female aging, in cross-cultural perspective.