Publics, technologies and interventions in reproduction and early life in South Africa

Abstract

Despite successful clinical interventions and maternal and child health monitoring for over a century, low and middle-income countries, including South Africa, continue to experience the quadruple burden of disease of high maternal mortality rates and poor infant and child health, non-communicable diseases, infectious diseases, and violence and injury. In this article, we focus on how different kinds of technologies in South Africa are implemented in the 'first 1000 days' from conception to early childhood. Some of these interventions, as we discuss, are lifesaving; others are conceptualised as preventing early and longer-term health problems, including cardiometabolic conditions into adulthood and in future generations. Here, we consider the use of routine and specialist technologies in reproduction and early life: scanning and monitoring in pregnancy, caesarean section, extracorporeal membrane oxygenation (ECMO) for very low birth weight infants, and the Road to Health Booklet. Through this focus, we illustrate how 'publics' are constituted such that foetal and infant health outcomes are privileged over women's health, reproductive rights, and public health safety.

Cancer and the Politics of Care

“…People with lower incomes and low levels of education are less likely than wealthier, better-educated people to seek medical care or recognise cancer symptoms and are more likely to have negative beliefs about cancer treatment (Hvidberg et al 2015). While these studies are sensitive to how local actors embody meaningmaking and engage with the healthcare system, more recently, clinical ethnographers have advanced the hypothesis that biomedical knowledge is 'biased', not in the sense that it is 'wrong', but in the sense that it is partial knowledge constructed from prevailing understandings of the body and society (Manderson and Ross 2020;Nguyen and Peschard 2003). For instance, if biological norms and diagnostic tests are standardised on middle-class, white populations, they may not perform accurately in groups that differ biologically or in the way they articulate and embody changes.…”

“…For instance, if biological norms and diagnostic tests are standardised on middle-class, white populations, they may not perform accurately in groups that differ biologically or in the way they articulate and embody changes. Dominant forms of knowledge of the body, and the care politics (Tronto 2012) and therapeutic practices through which the body is made visible or attended to, are central to our understandings of social inequalities in health (Manderson and Ross 2020). In some ways, by virtue of its efficacy, medicine has 'become an unwitting accomplice to biological inscription of social hierarchies', as noted by Nguyen and Peschard (2003: 457).…”