A formative evaluation and critical analysis of an alcohol and pregnancy intervention in the Eastern Cape of South Africa
- Authors: Graham, Nicola Susan Jearey
- Date: 2023-10-13
- Subjects: Fetal alcohol spectrum disorders South Africa Eastern Cape , Foucauldian discourse analysis , Conversation analysis , Women Social conditions South Africa Eastern Cape , Sex role South Africa Eastern Cape , Cultural hegemony
- Language: English
- Type: Academic theses , Doctoral theses , text
- Identifier: http://hdl.handle.net/10962/432541 , vital:72879 , DOI 10.21504/10962/432541
- Description: Some communities in South Africa have the highest documented rates of Foetal Alcohol Spectrum Disorders (FASD) in the world. Interventions to reduce alcohol consumption during pregnancy are crucial, but evaluations of such interventions are sparse. Formative evaluations are indicated to assist in the development of interventions. Harmful alcohol consumption during pregnancy is undergirded by a range of social injustices, including those imposed by colonisation and patriarchy; a feminist, decolonial approach to evaluations is, therefore, important. A research project, consisting of three arms, examined alcohol use during pregnancy in an under-resourced urban area of the Eastern Cape, and this research was one of those arms. An intervention was being rolled out in this area and I gathered a range of data from it. I engaged in a formative evaluation of it, and I reflect on the difficulties that I encountered in this endeavour. In the bulk of this thesis, I examine the power apparatuses and technologies that were used during the intervention to discursively position pregnant women. My analysis was guided by Foucauldian and post-Foucauldian theories, using Foucauldian Discourse Analysis and simplified Conversation Analysis (CA). Power apparatuses of coloniality, patriarchy, and pastoral power were used in the intervention to construct positions for pregnant women who drink alcohol as ignorant children, sinners, criminals, or “Mommies”. The foetus was constructed as a precious, vulnerable baby, while the person with FASD was constructed as the defiled Other, responsible for societal dissolution. The intervention used various disciplinary techniques to exhort women to follow their dictates. Women were generally compliant with being positioned as ignorant children, which absolved them from any blame for pre-natal drinking. However, some resistance was evident. I then introduce an ethics of care and justice, and I argue that pregnant/newly parenting women need to be positioned within such an ethics, which acknowledges both the universal resources that they require for reproductive freedoms, as well as their particular care needs. I highlight the few times when women were positioned in this way in the data, and I look at how the common positions could be altered or expanded to promote such an ethics. I conclude by arguing that alcohol use during pregnancy cannot be separated from the larger context of the cultural hegemony of alcohol use in some communities, and the social injustices that potentiate this use. I provide suggestions for country-wide policies and interventions, as well as specific FASD prevention programmes, and I argue that a feminist decolonising approach, within an ethics of care and justice, should guide interventions at all levels. , Thesis (PhD) -- Faculty of Humanities, Psychology, 2023
- Full Text:
- Authors: Graham, Nicola Susan Jearey
- Date: 2023-10-13
- Subjects: Fetal alcohol spectrum disorders South Africa Eastern Cape , Foucauldian discourse analysis , Conversation analysis , Women Social conditions South Africa Eastern Cape , Sex role South Africa Eastern Cape , Cultural hegemony
- Language: English
- Type: Academic theses , Doctoral theses , text
- Identifier: http://hdl.handle.net/10962/432541 , vital:72879 , DOI 10.21504/10962/432541
- Description: Some communities in South Africa have the highest documented rates of Foetal Alcohol Spectrum Disorders (FASD) in the world. Interventions to reduce alcohol consumption during pregnancy are crucial, but evaluations of such interventions are sparse. Formative evaluations are indicated to assist in the development of interventions. Harmful alcohol consumption during pregnancy is undergirded by a range of social injustices, including those imposed by colonisation and patriarchy; a feminist, decolonial approach to evaluations is, therefore, important. A research project, consisting of three arms, examined alcohol use during pregnancy in an under-resourced urban area of the Eastern Cape, and this research was one of those arms. An intervention was being rolled out in this area and I gathered a range of data from it. I engaged in a formative evaluation of it, and I reflect on the difficulties that I encountered in this endeavour. In the bulk of this thesis, I examine the power apparatuses and technologies that were used during the intervention to discursively position pregnant women. My analysis was guided by Foucauldian and post-Foucauldian theories, using Foucauldian Discourse Analysis and simplified Conversation Analysis (CA). Power apparatuses of coloniality, patriarchy, and pastoral power were used in the intervention to construct positions for pregnant women who drink alcohol as ignorant children, sinners, criminals, or “Mommies”. The foetus was constructed as a precious, vulnerable baby, while the person with FASD was constructed as the defiled Other, responsible for societal dissolution. The intervention used various disciplinary techniques to exhort women to follow their dictates. Women were generally compliant with being positioned as ignorant children, which absolved them from any blame for pre-natal drinking. However, some resistance was evident. I then introduce an ethics of care and justice, and I argue that pregnant/newly parenting women need to be positioned within such an ethics, which acknowledges both the universal resources that they require for reproductive freedoms, as well as their particular care needs. I highlight the few times when women were positioned in this way in the data, and I look at how the common positions could be altered or expanded to promote such an ethics. I conclude by arguing that alcohol use during pregnancy cannot be separated from the larger context of the cultural hegemony of alcohol use in some communities, and the social injustices that potentiate this use. I provide suggestions for country-wide policies and interventions, as well as specific FASD prevention programmes, and I argue that a feminist decolonising approach, within an ethics of care and justice, should guide interventions at all levels. , Thesis (PhD) -- Faculty of Humanities, Psychology, 2023
- Full Text:
“How do you feel about the abortion?”: pre-termination of pregnancy counselling in the public health sector in the Eastern Cape
- Authors: Du Toit, Ryan Rudolph
- Date: 2023-10-13
- Subjects: Abortion counseling South Africa Eastern Cape , Conversation analysis , Discursive psychology , Public health South Africa , Reproductive justice , Abortion Psychological aspects
- Language: English
- Type: Academic theses , Doctoral theses , text
- Identifier: http://hdl.handle.net/10962/437238 , vital:73355 , DOI 10.21504/10962/437239
- Description: Pre-abortion counselling, as an aspect of abortion provision, has received growing research interest in various contexts. Much of the research has primarily focused on whether abortion counselling takes place, the experiences of women and/or counsellors (usually through retrospective interviews and surveys), and the content discussed during the counselling session (often policy regulated). Such research has proven vital to addressing the various reproductive issues facing women seeking an abortion worldwide. However, little research has focused on how pre-abortion counselling as an everyday institutional practice is conducted at a conversational level in the medical setting. By drawing on both conversation analysis and discursive psychology, this study explored how pre-abortion counselling was conducted in the public health sector in South Africa. The study involved recording the conversation during pre-abortion counselling and analysing it in terms of its content, in particular, the discourses drawn on by all parties involved, and its structure and delivery. The data were collected from three public hospitals in the Eastern Cape of South Africa and involved the audio recording of pre-abortion counselling sessions as part of abortion services. In total, 28 counselling sessions were recorded: 21 were individual sessions, and 7 were group counselling sessions. At two of the sites, counselling was conducted by registered midwives who worked at the hospital. At one site, an external Christian organisation volunteered trained counsellors to counsel women at the hospital free of charge. Using conversation analysis, counselling sessions were analysed in terms of the main projects. Seven key projects were identified: (1) Context setting, (2) History taking, (3) Establishing reason for abortion, (4) Presenting options, (5) Providing procedural information, (6) Obtaining verbal informed consent, and (7) Discussion of family planning. Each project is explored in terms of what discourses and subject positions featured when speakers were orienting to a specific project. This process highlighted how the conversational projects and their respective goals enable the deployment of certain problematic discourses and interactive/reflexive positionings. Discourse analysis revealed a clustering of discourses around two central themes. In the first clustering, the discourses were primarily used to discuss the (1) medically related issues underpinning the abortion procedure [medical discourse, responsibilization discourse, risk discourse, and discourse of support]. Talk using these discourses positioned women as patients needing medical intervention, responsibilised women for conceiving, playing an active role in their termination, and navigating all the psychological and physical risks “associated” with abortion. The discourse of support illustrates how support was spoken about in the interaction whereby patients were constructed as subjects who required support and nurses/counsellors as the ones who offered the support. In the second clustering, the discourses (2) focused on women and the foetus. These discourses [reproductive choice, religious, pronatalist, and foetal personhood discourses] positioned women as being responsible for making a choice regarding their pregnancy and the consequences that may result. In addition, a religious discourse coupled with a pronatalist discourse was used to construct the pregnancy and motherhood as desirable and part of “God’s plan”, whereas the foetus was spoken about as a “gift from God”. The foetal personhood discourse was used to construct the foetus as a living and functional human. This research provides evidence of how abortion counselling is problematic at various levels. At a practical level, there is a lack of standardisation in the delivery of abortion counselling (e.g., variation in key projects, where the counselling is mandated, time taken, nurse/counsellor training, content and format – group vs. individual counselling). At a discursive level, the use of certain discourses works to render the counselling directive through : (1) awfulizing abortion by providing misinformation about the abortion procedure, foetus and post-abortion psychological distress, (2) chastising and responsibilising women for conceiving, (3) constructing abortion as immoral, the ending of life and not in line with God’s plan, (4) constructing parenthood as the preferred choice, (5) delegitimising abortion as a resolution for pregnancy when compared to the other options (e.g., parenting or adoption), and finally (6) providing counselling that does not take into account the broader socio-political contexts. Recommendations for future research are put forward, and a call to move to a reparative justice framework is made by highlighting how it can be used to identify and understand reproductive injustices as they occur along four intersecting dimensions: (1) Individual material, (2) Collective material, (3) Individual symbolic, and (4) Collective symbolic. , Thesis (PhD) -- Faculty of Humanities, Psychology, 2023
- Full Text:
- Authors: Du Toit, Ryan Rudolph
- Date: 2023-10-13
- Subjects: Abortion counseling South Africa Eastern Cape , Conversation analysis , Discursive psychology , Public health South Africa , Reproductive justice , Abortion Psychological aspects
- Language: English
- Type: Academic theses , Doctoral theses , text
- Identifier: http://hdl.handle.net/10962/437238 , vital:73355 , DOI 10.21504/10962/437239
- Description: Pre-abortion counselling, as an aspect of abortion provision, has received growing research interest in various contexts. Much of the research has primarily focused on whether abortion counselling takes place, the experiences of women and/or counsellors (usually through retrospective interviews and surveys), and the content discussed during the counselling session (often policy regulated). Such research has proven vital to addressing the various reproductive issues facing women seeking an abortion worldwide. However, little research has focused on how pre-abortion counselling as an everyday institutional practice is conducted at a conversational level in the medical setting. By drawing on both conversation analysis and discursive psychology, this study explored how pre-abortion counselling was conducted in the public health sector in South Africa. The study involved recording the conversation during pre-abortion counselling and analysing it in terms of its content, in particular, the discourses drawn on by all parties involved, and its structure and delivery. The data were collected from three public hospitals in the Eastern Cape of South Africa and involved the audio recording of pre-abortion counselling sessions as part of abortion services. In total, 28 counselling sessions were recorded: 21 were individual sessions, and 7 were group counselling sessions. At two of the sites, counselling was conducted by registered midwives who worked at the hospital. At one site, an external Christian organisation volunteered trained counsellors to counsel women at the hospital free of charge. Using conversation analysis, counselling sessions were analysed in terms of the main projects. Seven key projects were identified: (1) Context setting, (2) History taking, (3) Establishing reason for abortion, (4) Presenting options, (5) Providing procedural information, (6) Obtaining verbal informed consent, and (7) Discussion of family planning. Each project is explored in terms of what discourses and subject positions featured when speakers were orienting to a specific project. This process highlighted how the conversational projects and their respective goals enable the deployment of certain problematic discourses and interactive/reflexive positionings. Discourse analysis revealed a clustering of discourses around two central themes. In the first clustering, the discourses were primarily used to discuss the (1) medically related issues underpinning the abortion procedure [medical discourse, responsibilization discourse, risk discourse, and discourse of support]. Talk using these discourses positioned women as patients needing medical intervention, responsibilised women for conceiving, playing an active role in their termination, and navigating all the psychological and physical risks “associated” with abortion. The discourse of support illustrates how support was spoken about in the interaction whereby patients were constructed as subjects who required support and nurses/counsellors as the ones who offered the support. In the second clustering, the discourses (2) focused on women and the foetus. These discourses [reproductive choice, religious, pronatalist, and foetal personhood discourses] positioned women as being responsible for making a choice regarding their pregnancy and the consequences that may result. In addition, a religious discourse coupled with a pronatalist discourse was used to construct the pregnancy and motherhood as desirable and part of “God’s plan”, whereas the foetus was spoken about as a “gift from God”. The foetal personhood discourse was used to construct the foetus as a living and functional human. This research provides evidence of how abortion counselling is problematic at various levels. At a practical level, there is a lack of standardisation in the delivery of abortion counselling (e.g., variation in key projects, where the counselling is mandated, time taken, nurse/counsellor training, content and format – group vs. individual counselling). At a discursive level, the use of certain discourses works to render the counselling directive through : (1) awfulizing abortion by providing misinformation about the abortion procedure, foetus and post-abortion psychological distress, (2) chastising and responsibilising women for conceiving, (3) constructing abortion as immoral, the ending of life and not in line with God’s plan, (4) constructing parenthood as the preferred choice, (5) delegitimising abortion as a resolution for pregnancy when compared to the other options (e.g., parenting or adoption), and finally (6) providing counselling that does not take into account the broader socio-political contexts. Recommendations for future research are put forward, and a call to move to a reparative justice framework is made by highlighting how it can be used to identify and understand reproductive injustices as they occur along four intersecting dimensions: (1) Individual material, (2) Collective material, (3) Individual symbolic, and (4) Collective symbolic. , Thesis (PhD) -- Faculty of Humanities, Psychology, 2023
- Full Text:
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