OBJECTIVES. The purpose of this study was to determine whether women's sociodemographic characteristics are independently associated with cesarean delivery. METHODS. A retrospective review was conducted of hospital discharge data for singleton first births in California in 1991. RESULTS. After insurance and personal, community, medical, and hospital characteristics had been controlled, Blacks were 24% more likely to undergo cesarean delivery than Whites; only among low-birthweight and county hospital births were Blacks not at a significantly elevated risk. Among women who resided in substantially non-English-speaking communities, who delivered high-birthweight babies, or who gave birth at for-profit hospitals, cesarean delivery appeared to be more likely among non-Whites and was over 40% more likely among Blacks than among Whites. CONCLUSIONS. The findings cannot establish causation, but the significant racial/ethnic disparities in delivery mode, despite adjustment for social, economic, medical, and hospital factors, suggest inappropriate influences on clinical decision making that would not be addressed by changes in reimbursement. If practice variations among providers are involved, de facto racial differences in access to optimal care may be indicated. The role of provider and patient attitudes and expectations in the observed racial/ethnic differentials should also be explored.
Evans-Pritchard"THE NUER" ACQUIRED JUST FAME as one of the paradigmatic ethnographies that apparently solved urgent theoretical problems of the time. With the model of "segmentary lineage system," Evans-Pritchard thus accounted for the manner in which a society "without government" could exist through a process of "ordered anarchy" because this system served to "regulate political relations between territorial segments" (Fortes and EvansPritchard 1940:6). Ironically enough, Evans-Pritchards earlier writings about the Nuer (from 1933 to 1938) did not make any mention of a segmentary lineage system. It suddenly surfaced in 1940, certainly a convenient analytical tool, but perhaps not a most faithful representation of Nuer society, as later exegetists were to suggest (Glickman 1971; Holy 1979a).The segmentary lineage model's appeal extended far and wide, accounting for the social organization of various polities, such as the Tallensi or Tiv. But problems soon arose. To take but one instance, the "regulation between territorial groups" exerted by the segmentary lineage system seemed to vary significantly between the Nuer, on the one hand, and the Tallensi, on the other. The more inclusive territorial segments among the Nuer emerged in action only, and lacked permanence or reality except in opposition to segments of coordinate status. Fortes also read the same relativity in Tallensi lineage segments but, in reality, every level of segmentation among the Tallensi is clearly identified at all times. Every segment has a permanent representative who acceeds to a position according to clear rules and criteria of eligibility. The segment head is also entitled to perform certain political or ritual activities on behalf of the group, or to convene a subgroup for the performance of these activities. The problem was solved by claiming that the Tallensi lineage segments were corporate, whereas the Nuer ones were not. This distinction, however, only introduced a basic contradiction. Since corporateness implied perpetuity, corporate groups were by definition endowed with the attributes of permanence (a name, a representative, recurrent activities, and so forth). If the groups formed through the merging of lower groups (the lineage segments) were essentially relative, gaining substance in complementary opposition only, they could therefore not be corporate at the same time. Thus, either lineages could never be corporate (because of their essential relativity) or they could never be segmentary (because of their corporateness). Unfortunately, this contradiction was tolerated to save the category.As a first step toward a solution, we could thus rid ourselves from the notion of corporateness, but this would be far from sufficient. The very notion of lineage (or descent group) came indeed to subsume a number of disparate phenomena and, to clarify matters, we must define our concepts in a way that is mutually exclusive. The problem has been tackled from a purely theoretical point of view elsewhere (Verdon 1980a(Verdon , b, c, 1981 but...
Opening ParagraphThe Abutia Ewe form one of what the British colonial administrators dubbed the ‘traditional areas’, over one hundred of which are said to compose the Ewe people or Eweland. These Ewe traditional areas lie in the southern half of the Volta Region (in Ghana) and in southern Togo. Although much has been written about the Ewe, little is known about the political organisation of the inland areas, north of the coastal savanna. In fact, most authors have treated the Ewe as if they were thoroughly homogeneous and could be analysed as one ethnic group or one society, only acknowledging variations between the north and south, not considered significant enough to make them completely different groups (Spieth 1906; 1911; Westermann 1935; Ward 1949; Manoukian 1952; Nukunya 1969; Friedländer 1962; Asamoa 1971 amongst many others). And yet I contend that the northern areas are as distinct from the southern ones as they are from the Akan populations. As a result, none of the present available literature is particularly useful as a paradigmatic model of the northern areas' political organisation.
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