Anthropological research on post-socialism points to the need for informal relations when navigating social and health care systems, while feminist research on childbirth points out the negative consequences of the dominant medicalized model of childbirth on women?s experience. This paper combines these two types of research and points to the role of informal relations in negotiating childbirth in Serbia and the role of peoples social positioning influencing the possibilities of using these relations. Based on eighteen months of ethnographic fieldwork on the practices of providing maternal health care in Serbia, the aim of this paper is to show how a woman's social position affects her ability to establish a relationship within the state health care system, and to reconsider the claim that informal relationships can protect women from interventionism during childbirth in Serbia. Using informal relations (veze) in order to have your doctor during childbirth is a key concern for women in Serbia. Informal relations transform women from (no)bodies into somebodies, someone?s patient. Women of poorer economic status, women from rural areas, and often women of Roma ethnic origin have limited opportunities to establish informal relations in state maternity hospitals. Informal relations do not fully protect women from interventions but affect the type and timing of interventions.
Social practices, such as connections (veze) and gift giving, are often labelled as socialist legacies that lead to corruption and are contrary to the establishment of market practices in postsocialist societies. This paper investigates the effects of the selective opening of aspects of maternal care to market practices on patient–provider relationships. Ethnographic research indicates that doctors are navigating between the constraints and opportunities afforded by both sectors, private and public, to negotiate their daily interactions with patients. In the attempt to maintain both authority and trust with their patients in a very precarious economic and social context, doctors have to be both medical experts and entrepreneurs. This practice points towards the conclusion that it may not be the legacies of socialism that have created the need for finding new ways of forging connections between medical providers and their patients, but rather the unbundling of socialist healthcare into the market.
The WHO and UNICEF launched The Baby-Friendly Hospital Initiative (BFHI) in 1991 with the goal of promoting breastfeeding. Four years later, this initiative was adopted in Serbia (then Yugoslavia). Although Serbia has officially been a part of the BFHI for over 26 years, less than 13% of children are currently exclusively breastfed for the first 6 months of life. Drawing on interviews, observations and document review, this chapter offers ethnographic insight into why the BFHI in Serbia has met with little success. I argue that the principles and practices of the initiative to promote breastfeeding have been both thinly learned and thinly applied by healthcare workers and therefore have had little positive impact on women’s empowerment to breastfeed or the rates of breastfeeding in the country. I show how the global Baby-Friendly Hospital Initiative implemented in Serbia in the early 1990s and the national level policies which renewed it in 2018 were severely constrained by social, political and economic conditions that hindered the uptake of the program by frontline health workers – namely the devastating effects of the civil war and international sanctions in the 1990s, and the deleterious effects of IMF policies on the Serbian healthcare system since the 2000s. The pressure of time due to high workloads, and understaffed hospitals, in combination with unsustainable national funds for implementation may contribute to the reality of the thin implementation of BFHI.
Background For pregnant and birthing women, maintaining a relationship with the same health care practitioner is critical to establishing a sense of safety. In postsocialist Serbia, where care is fragmented and depersonalized, this continuity is often missing. Patients are frequently handed over to new practitioners, sometimes without even knowing the name of the person overseeing their care. In response, many women turn to the private sector to keep the same practitioner across their prenatal period and their birth by establishing a personal “connection” within the hospital that they believe will shield them from mistreatment during childbirth. Methods Data presented in this paper were collected through participant observation in one public maternity hospital and one public primary care center in Serbia; semistructured interviews with 14 physicians; and semistructured interviews with 80 women who had given birth in one public maternity hospital in Serbia. Results Public maternity hospital physicians who supplement their income working in the private sector have the power to blur the distinctions between favors and services. They offer continuity of personalized care to their private clients/patients once they enter the public system, and they themselves obtain social and economic security unavailable to those working in only one sector. At the same time, there is evidence that personalized continuity of care does not actually shield women from mistreatment in hospitals. Conclusions The private sector is reshaping existing informal strategies and blurring the lines between formal and informal payments. In the postsocialist context, consumer practices are not separate from, but entangled with, informality. Neoliberalism has not brought about empowerment and eliminated informality, but has instead further exacerbated existing inequalities in maternity care in Eastern Europe.
The aim of this review was to systematically identify, analyze, and summarize research involving interventions based on sensory integration and activities that promote sensory integration in children with ASD. Based on the selection criteria ten out of thirty studies were selected and described in terms of: a) participant characteristics, b) assessments used in the studies, c) intervention procedures, d) study goals, e) intervention outcomes and whether or not there was improvement in behavior or clinical conditions. The results of the analyzed studies indicate a remarkable heterogeneity profile of sensory function in children with ASD, which affect the applicability of different forms of treatment. Based on the results of these studies, we can conclude that treatments based on SI theory can reduce stereotypical, aggressive, auto-aggressive, irritable, and hyperactive behavior, as well as improve self-regulation of behavior.
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