In the Journals

In the Journals, July 2020 (Part 3)

This post includes articles published in both April 2020 and July 2020. 

In April, Technology and Culture featured a special section on Rethinking Reproductive Technologies and Modernities in Time and Space.

Social Science and Medicine 

“Cutting out the surrogate: Caesarean sections in the Mexican surrogacy industry”

April Hovav

Childbirth practices shed light on cultural values, ideologies of gender and motherhood, and social inequalities. Transnational, commercial surrogacy presents a useful lens through which to view the social dynamics that shape childbirth experiences. Surrogacy challenges dominant views on the naturalness and inevitability of maternal-fetal bonds because it involves the separation of gestation from motherhood. What ideologies inform childbirth practices in the consumer-driven context of surrogacy in which the woman giving birth is neither the consumer nor the “mother”? Based on multi-sited ethnographic research between 2014 and 2017 and in-depth interviews with 120 participants in the Mexican surrogacy industry, I argue that doctors draw on normative ideologies of kinship, gender, and maternal-child bonding to justify and normalize the use of Caesarean sections among surrogates. The ideology espoused by these doctors reinforces the notion that maternal-fetal bonding is natural and inevitable, constructs women as irrational and driven by hormones, and presumes that bonding between surrogate mothers and the children they gestate is detrimental to the surrogacy process. Furthermore, the proffered justifications for the Caesarean sections reproduces stereotypes about poor Mexican women as risky patients, contributes to the “disposability” of their labor, and reinforces a hierarchy in which the perceived interests of intended parents and children are elevated above those of surrogate mothers. This article contributes to social science studies of medicine by demonstrating how classist and racist stereotypes, and folk notions of kinship, gender, and maternal-child bonding are biologized in medical practice.

Sociology of Health and Illness

“Post‐place care: disrupting place‐care ontologies” (Open Access)

Dara Ivanova

With the advent of telecare and the logic of information technologies in health care, the idea of placeless care has taken root, capturing imaginations and promising placeless caring futures. This ‘de‐territorialisation of care’ has been challenged by studies of care practices ‘on the ground’, showing that care is always (materially) placed. Yet, while sociological scholarship has taken the role of place seriously, there is little conceptual attention for how we may think through immateriality and the changing nature of place in health care. Based on a case study of the introduction of a sensory reality technology into a care organisation, this paper argues that we need (1) to push the definition of placed care into new (digitally produced) landscapes and (2) a new vocabulary, with which to address and conceptualise this changing nature of care places. The paper introduces the term post‐place, as a first step in developing such a vocabulary. Post‐place care, unlike the idea of placeless care or emplaced care, is an inclusive, open and generative concept. Its strength lies in its disruptive potential for challenging existing place‐care ontologies and opening up productive space for thinking through the changing landscapes of health care.

“Patient data work: filtering and sensing patient‐reported outcomes”

Rikke Torenholt, Lena Saltbæk, and Henriette Langstrup

With digital patient‐reported outcome (PRO) tools in clinical practice, patients are given new tasks of providing data that aim at supporting and individualising care, simultaneously reducing unnecessary clinical visits. While the innovative potential of mobilising PRO data for care is increasingly explored, little attention is given to the efforts that the provision of PRO data rests on – that of the patients. Based on ethnographic fieldwork carried out among cancer patients receiving PRO‐based follow‐up care, we argue that with the increased reliance on patient‐generated health data, we need to consider patients’ data work. Drawing on emerging literature on healthcare professionals’ data work and the rich work in sociology and Science and Technology Studies (STS) on patients’ active engagement in shaping and managing care, we conceptualise PRO patient data work as two simultaneous processes: the process of data filtering – patients filter information to fit the envisaged recipient and purpose; and the process of data sensing – patients evaluate their embodied experiences. By doing so, we show that patients’ data work has implications beyond simply providing data that represent their experiences.

“Wild data: how front‐line hospital staff make sense of patients’ experiences” (Open access)

Catherine M. Montgomery, Alison Chisholm, Stephen Parkin, and Louise Locock

Patient‐centred care has become the touchstone of healthcare policy in developed healthcare systems. The ensuing commodification of patients’ experiences has resulted in a mass of data but little sense of whether and how such data are used. We sought to understand how front‐line staff use patient experience data for quality improvement in the National Health Service (NHS). We conducted a 12‐month ethnographic case study evaluation of improvement projects in six NHS hospitals in England in 2016–2017. Drawing on the sociology of everyday life, we show how front‐line staff worked with a notion of data as interpersonal and embodied. In addition to consulting organisationally sanctioned forms of data, staff used their own embodied interactions with patients, carers, other staff and the ward environment to shape improvements. The data staff found useful involved face‐to‐face interaction and dialogue; were visual, emotive, and allowed for immediate action. We draw on de Certeau to re‐conceptualise this as ‘wild data’. We conclude that patient experience data are relational, and have material, social and affective dimensions, which have been elided in the literature to date. Practice‐based theories of the everyday help to envision ‘patient experience’ not as a disembodied tool of managerialism but as an embedded part of healthcare staff professionalism.

In a vigilant state of chronic disruption: how parents with a young child with type 1 diabetes negotiate events and moments of uncertainty

Natasja Kingod and Dan Grabowski

Living as a parent and self‐care surrogate of a young child with type 1 diabetes (T1D) is demanding and a disruption to ‘normal’ routinised daily living. Research has mainly focused on the time of diagnosis as a one‐time biographical disruption. In this article, we will show how, in the case of families with young children with T1D, the biographical disruption can be viewed as a continuous state of vigilance that affects family functioning and ‘normal’ living. We will show this by focusing on the temporal events and moments that keep the families in a state of what we will term ‘chronic disruption’. The events are the transitions from hospitalisation to home, home to nursery, nursery to daycare, and daycare to school and preparations for social activities concerning the child. The moments are more fluid, ranging from daily interruptions when daycare workers and teachers call parents with doubts about self‐care to negotiations with institutions and municipalities and a constant state of worry.

Technology and Culture

“The Half-Life of Radiotherapy and Other Transferred Technologies”

Marissa Mika

This article considers the long-term ramifications of biomedical technology transfer in Uganda. It tells the story of the procurement of a radiotherapy machine through a partnership with the International Atomic Energy Agency (IAEA) in the early 1990s. This radiotherapy machine was seen as “rugged,” “simple,” “affordable,” and capable of quickly and cost-effectively treating cancer patients. By the late 2000s, this machine had a reputation for frequent disruptions of service due to breakdowns large and small. In addition, the Cobalt-60 source was severely depleted and in need of replacement. The article highlights the constellation of efforts and decisions made by Ugandan physician-scientists, mechanics, and technocrats to keep radiotherapy services going. The article suggests that the history of the radiotherapy machine offers a much-needed perspective on the half-life of technology transfer, the darker side of repair, and the politics of responsibility.

Special Section: Rethinking Reproductive Technologies and Modernities in Time and Space

“Rethinking Reproductive Technologies and Modernities in Time and Space”

Gonçalo Santos and Suzanne Z. Gottschang

This overview proposes new ways of interrogating assumptions about globally circulating reproductive technologies and modernities. Comparing and contrasting East Asian experiences of childbirth medicalization provides an alternative to Western-centric discourses and models that tend to focus on notions of individual choice. This special section draws on Chinese and Japanese materials from the twentieth century forward to document how the medicalization of childbirth and use of technology alongside shifting moral ideals and public health policies work to co-produce globalized frameworks of distinctly East Asian modernities. We situate women’s birthing experiences in the context of larger reproductive assemblages and hierarchies to highlight the flexible, variable, and contingent spatial and temporal moral tensions and social inequalities shaping ongoing processes of childbirth medicalization and modernization.

“Historical Dynamism of Childbirth in Japan: Medicalization and its Normative Politics, 1868–2017”

Chiaki Shirai

This article explores the changing institutional and technological frameworks of childbirth practices in Japan, highlighting the historical dynamism and the normative dimensions of women’s experiences. This article shows how childbirth in Japan was subject to a very powerful and far-reaching process of medicalization going back to the mid-nineteenth century. In present-day Japan, the drive towards high-tech medicalization remains strong, but there is also an emphasis on the need to be “natural” and “healthy” and to avoid unnecessary medical interventions in the body. These two seemingly contradictory sets of demands are an important feature of contemporary Japanese society. Their coexistence is only possible due to the continuing hold of a system of moral responsibility that emphasizes the duty of mothers to do whatever is necessary in terms of medical care to protect the safety and the well-being of their babies.

“Birthing Stories and Techno-moral Change across Generations: Coping with Hospital Births and High-tech Medicalization in Rural South China, 1960s–2010s”

Gonçalo Santos

In the last 100 years, new biomedical technologies altered childbirth practices in China on virtually every level. This transformation was significantly accelerated after the launch of the Birth Planning Policy in 1979. At the turn of the millennium, the government enforced a policy of mandatory hospital births to bring the country closer to United Nations’ Millennium Development Goals in terms of maternal and infant health, but these reforms were accompanied by a dramatic increase in cesarean rates. Drawing on oral history materials collected in a rural community in Guangdong province, this article shows how China’s cesarean surge gave rise to complex generational frictions in women’s techno-moral understandings of what should be the right way to give birth. These generational frictions show that the history of childbirth medicalization is not just a history of changing institutions, policies and technologies; it is also a history of changing technological selves and moral ideals.

“Reproductive Modernities in Policy: Maternal Mortality, Midwives, and Cesarean Sections in China, 1900s–2000s”

Suzanne Z. Gottschang

China is one of a few countries to reach the 2015 United Nations Millennium Development Goal of reducing maternal mortality by 75 percent in fifteen years. The longstanding and intractable problem of maternal mortality in the Global North and South makes China’s success all the more remarkable. This article examines relationships between China’s reproductive health policies aimed at reducing maternal mortality and technological changes in managing childbirth associated with them from the early twentieth century to the present day. Tracing technological choices to prevent maternal deaths at junctures in the history of health-based reforms makes visible China’s broader economic and political priorities in its internal modernization projects and in its interest in raising the nation’s global standing. Finally, the consequences of state reproductive priorities emerging in recent years suggest that women’s decisions to delay childbearing or to bear multiple children, may bring about circumstances increasing the risk of maternal death.

Time and Society

“Seizure aesthetics: Temporal regimes and medical technology in epilepsy diagnosis”

Megh Marathe

Epilepsy is a neurological condition defined by time; it is characterized by a lifelong tendency for recurrent, unpredictable, and unprovoked seizures, during which people lose control over parts of body-mind function. Diagnosing seizures involves using electroencephalograms to represent and classify brain waves in relation to clock time. Drawing upon ethnographic fieldwork in a North American teaching hospital, this paper shows that as neurologists learn to diagnose seizures, they internalize clock time norms for normal and abnormal brain waves. The paper demonstrates how these temporal norms work to assign a set of aesthetics to brain waves: patterns that conform to clock-time norms are beautiful, whereas hard-to-classify patterns are ugly. These aesthetic judgments follow diagnostically complex patients in future hospital visits, who become known, for instance, as “the patient with the ugly EEG.” The paper critiques this ascription of labels to patients and situates the role of the electroencephalogram’s clock time in this predicament. It concludes with a speculative design project that reorients the relationship between temporality and embodiment by using the heartbeat as a situated and co-produced alternative to the standardized and invariant clock. Ultimately, the paper argues that the aesthetics of medical technology are fundamental to clinical care, thereby opening up new directions for research at the intersection of critical time studies and disability studies.

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