As I have progressed through my education here at Allegheny, I
have changed completely in how I think and how I view the world. This continuous
process has not been easy, but it has defined who I am and it will determine
the impact I have on the world. From where I am now, I can look back on my past
and see how different I am. This allows me to be insightful and self-aware, but
it also means that I can see in the past the things I could or should have done
differently. We have discussed in class the many systems that work against
Native American women in this country, and I would like to examine these
systems and how they played out in a project that I worked on the summer after
my freshman year. While this project was valuable for the health initiative
that I worked with, I believe that the approach taken by the project managers and
myself did nothing to address the systemic barriers faced by Native people in
the United States, especially women.
The project I worked on was a review of
current public service messaging directed towards Native people in the Northern
Plains for the Safe Passage Study, which is run by the Prenatal Alcohol and
SIDS and Stillbirth (PASS) Network. I looked at published literatures and
public policy and recommendations by mostly federal level health organizations
(Some examples can be found here and here). The PASS Network focuses on two clinical sites; the Northern Plains of
North America (located in North and South Dakota), and South Africa. The
network uses "community-based studies to investigate the role of prenatal
exposure to alcohol in SIDS (Sudden Infant Death Syndrome) and FASDs (Fetal
Alcohol Spectrum Disorders)" (Dukes, et al., 2014). The Safe Passage
Study, run by the PASS network, seeks to determine the relationship between
prenatal alcohol exposure (PAE) and SIDS and stillbirth, the fetal and
placental mechanisms that contribute to these conditions, and the maternal,
environmental, and genetic factors that modify the development of the fetal and
infant face and brain.
 |
| Consumption of alcohol during pregnancy can have detrimental impacts on fetal development. |
While this is very valuable for medicine's understanding
of these conditions and relationships, I think that in order to truly address
the issue of Fetal Alcohol Syndrome (FAS) and SIDS in Native communities, so
much more must be considered. Using a justice lens to look critically at
my project and the greater study, I am hoping to create a better understanding
of the barriers facing Native women and the ways in which they are governed by
the State.
 |
| Using only a medical lens often prevents detection of other factors, discussed below, that create the conditions for certain populations to have systematically poor health outcomes. |
Looking back at this project now through
the justice lens I have developed over the past few years, I can see many
issues that greatly limit the potential benefits that could have been reaped
from such an extensive undertaking. The issues Barbara Gurr discusses in her
book are clearly visible in this project (Gurr, 2015). Highly evident is the
doctrine of scientific motherhood. Women in the Safe Passage study are
discussed only as mothers and producers (p. 57). This also ties to Gurr’s
discussion of the preconception model of care, which prioritizes the health of
mothers as secondary to their potential or real children (p. 58-59). The
European American valorization of empirical science can be seen throughout the
language of the PASS publications, despite the fact that this lens of
evidence-based medicine is generally acultural and inconsistently generalizable
(p. 5, 57). Also obvious upon examination of the PASS network and its studies
is that it is coming from a point of view external to the population in need.
That means that those conducting the study and publishing its results will not
have intimate knowledge of the true comprehensive needs of this community. This
means that the study will go on to produce and encourage intervention efforts
that will have to have an outside-in approach. These approaches, as well as the idea of telling Native American women what the can and cannot do with their bodies reveals the assumption of authority over women and their bodies held by professional medical organizations (p. 43).
Linguistically, the PASS and Safe Passage websites and
publications position their study population of Native women as passive
recipients of instruction who, if left unattended, will drink their children to
death. As Gurr discusses in her book, networks of health care providers and the
services they provide for Native American women constantly position them as
people who will not get the care they need, people who will be noncompliant,
and many other perceptions that allow us to see the identity collectively
shaped for Native women by the State. This includes the assumption that Native
people will abuse alcohol. This assumption was greatly reflected in the recommendations
I reviewed several summers ago. Finally, the entire basis of the study revolved
around the assumption of individual choice and agency as the primary
contributor to the alcohol consumption rates seen in Native communities. This
is a false and deeply problematic assumption that misdirects intervention
efforts, masks the true systems responsible for these outcomes, and places the
blame solely on Native women.
There are a multitude of concerns that I can see now that I could
not have seen as I was working on this project. Simply telling women not to
drink is simply an inadequate approach to take, yet it is the only message consistently
and aggressively given to Native American women. Since Gurr primarily focuses
on the problems with how Native American women are minimized, silenced, made
invisible, and governed by the ruling State, I want to use this knowledge to
try and envision what a justice approach to the Safe Passage study might look
like.
Several studies have shown that self-expression and identity
processes can dampen and counteract the negative effects, including alcohol consumption,
of health stressors (p. 147). Native practices and beliefs may decrease rates
of alcoholism seen in indigenous populations, thereby reducing the incidence of
FAS and SIDS observed. Conversely, inhibiting the integration of these elements
into the health care received by Native women may increase the chance that they
consume alcohol, even when pregnant. Another approach may be the implementation
of a Centering Pregnancy model of prenatal care, which is largely lead by
Native participants and integrates evidence-based medical care with
tradition-oriented knowledge (p. 96). This allows it to be much more culturally
appropriate than other models, as well as reduce costs, empower native women to
become more fully engaged with their prenatal care, and can encourage trust
between the Native community and their medical system. It is important to
remember that successful justice interventions must start from within the
community or at the very least be partnered with the community and they must address
the external governances that shape the lives of the population they are
working with. We must address those systems that, as Dr. Camara Jones would say, push certain groups of people towards a cliff, rather than trying to
improve the strength of the net meant to catch them. Only once these elements
are considered can projects such as the Safe Passage study have the truest
beneficial impact.
Dukes, K. A.,
Burd, L., Elliott, A. J., Fifer, W. P., Folkerth, R. D., Hankins, G. D. V., …
Kinney, H. C. (2014). The Safe Passage Study: Design, Methods, Recruitment, and
Follow-Up Approach. Paediatric and Perinatal Epidemiology,28(5), 455–465. http://doi.org/10.1111/ppe.12136
Gurr, B. (2015). Reproductive Justice: The Politics of Health Care for Native
American Women. New Brunswick,
New Jersey: Rutgers University Press.
Pictures retrieved from
http://usercontent2.hubimg.com/5735993_f260.jpg (FAS Facial Characteristics)
https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiL5rE2MI_h-GP2s3hnV58wP9TSbK5VDkd9GPEhoKSIsCIFDbz9aotu1adje0_-DvPV9SUyPFYXR7WWlHiUJLsxjNb3J9OPa8uR2C-0EwNofb5RJjwnFePVoyhBYGpjqfS1SJ9zSEOJjw/s400/AP_ALCOHOL_ABUSE.gif
(Alcohol Abuse graph)
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