Papers by Kathleen (Kate) Rice
The Journal of Pain, Mar 1, 2023
Anthropological Quarterly, 2020
Women and Birth, 2021
Problem & background Since the onset of the COVID-19 pandemic in Canada, policies have been i... more Problem & background Since the onset of the COVID-19 pandemic in Canada, policies have been implemented to limit interpersonal contact in clinical and community settings. The impacts of pandemic-related policies on experiences of pregnancy and birth are crucial to investigate and learn from. Aim To examine the impact of pandemic policy changes on experiences of pregnancy and birth, thereby identifying barriers to good care; to inform understandings of medicalization, care, pregnancy, and subjectivity during times of crisis; and to critically examine the assumptions about pregnancy and birth that are sustained and produced through policy. Methods Qualitative descriptive study drawing on 67 in-depth interviews with people who were pregnant and/or gave birth in Canada during the pandemic. The study took a social constructionist standpoint and employed thematic analysis to derive meaning from study data. Findings The pandemic has resulted in an overall scaling back of perinatal care alongside the heavy use of interventions (e.g., induction of labour, cesarian section) in response to pandemic stresses and uncertainties. Intervention use here is an outcome of negotiation and collaboration between pregnant people and their care providers as they navigate pregnancy and birth in stressful, uncertain conditions Discussion Continuity of care throughout pregnancy and postpartum, labour support persons, and non-clinical services and interventions for pain management are all essential components of safe maternal healthcare. However, pandemic perinatal care demonstrates that they are not viewed as such. Conclusion The pandemic has provided an opportunity to restructure Canadian reproductive health care to better support and encourage out-of-hospital births – including midwife-assisted births – for low-risk pregnancies.
Gender & Development, 2019
Medical Anthropology Quarterly
Social determinants and vulnerable populations
Medicine often ignores the social aspects of health experience. Applying the lens of social deter... more Medicine often ignores the social aspects of health experience. Applying the lens of social determinants of health has not fully mitigated the tendency of Western medicine to focus on biological causes and pharmaceutical solutions. Objective: We present the stories of 26 people living with chronic pain who have been rendered socially, economically, and politically marginal by existing systems and structures of inequity in ways that exacerbate suffering. We argue that their diverse and multi-faceted experiences are better understood by the term "chronic struggle" rather than "chronic pain", thus de-centering the medical aspects of people's experiences. Study Design: Institutional ethnography (IE) is a sociological approach increasingly used in health studies. IE begins in the standpoint of people with lived experience and considers them as experts of that experience. IE analysis follows sequences of action, with one informant's interview leading the way to the next or to a text for analysis. Through this process, we linked participants' micro level experiences to macro level systems and structures. Setting or Dataset: Participants were recruited for in-depth telephone interviews in online spaces (e.g. Twitter and Kijiji) and through existing networks of our multidisciplinary research team across several provinces in Canada. Population Studied: Our study focuses on people who are over the age of 18, speak fluent English and who self-identify as living with chronic pain and marginalization. Results: Our findings call attention to the complexities and 'everyday emergencies' (Millar, 2014; Mitchell, 2020) that come to shape and define one's experiences with chronic pain. Our themes capture the cascading and interrelated experiences of illness, mental illness, addiction and poverty as they are described and understood by people with lived experience. Combined, we are made aware of how chronic pain is not the key defining difficulty of one's life-a biographical disruption-but rather one additional difficulty in a life that is always already defined by health and social complexities. Conclusions: As these stories illustrate, while the social and the medical are managed as separate sectors within Western society, for patients they are intertwined and inseparable. Focusing on only one aspect of this experience-be it medical or social-impairs our ability to understand the experience of either or to offer meaningful relief.
Medical Anthropology Quarterly, 2021
Social Anthropology, 2020
Anthropology and Humanism, 2019
This creative nonfiction essay is both a reflection about a complex intimate relationship that de... more This creative nonfiction essay is both a reflection about a complex intimate relationship that developed during doctoral fieldwork and a commentary on what anthropologists are socialized to compartmentalize, silence, and refuse for the sake of academic credibility. Grounded in the author's personal experience of having an affair in the field, it explains that pursing a course of action that the author was trained and socialized to eschew had the unexpected outcome of advancing the author's anthropological research. [fieldwork ethics, ethnographic method, creative nonfiction, intimacy, relationships in the field] I was not initially attracted to him. We first met outside my mud hut, which was on a hilltop and in those days was one of the few places in the village with cellphone reception. He was brusque and dismissive, seemingly annoyed to be interrupted. I remember feeling that this reaction was unfair, but I knew from experience that even on that high hill cellphone coverage was usually spotty. Perhaps his frustration had little to do with me. Before I could introduce myself he informed me that he was a guest at the nearby backpacker lodge and that he'd climbed the hill to call his wife. He'd been told, apparently, that no one was home at my house and that everyone made phone calls from my front porch. Upon explaining this, he quickly turned back down the hill. Our second conversation was in the kitchen at the backpacker lodge. I was chatting with the kitchen staff, and he was intrigued that I was conversant in the local language but spoke English with a foreign accent. "Where are you from?" he asked. "And what are you doing out here? Do you live in that hut on the hill?" He became friendlier when he learned that I was from Canada: his wife was American, and they had applied to immigrate to my home country. Canada appealed to them because they could live near her mother but in a more palatable political climate. He was vacationing on his own, he said, because his wife had gone back to the States to visit her family. He had dropped her at the airport only a few days before, on his way out of town. His plan, he told me, was to meander along South Africa's glorious Eastern seaboard. The
African Studies, 2018
While marriage rates in South Africa are exceptionally low, ukuthwala ('abduction marriage,' or '... more While marriage rates in South Africa are exceptionally low, ukuthwala ('abduction marriage,' or 'bride abduction') appears to be increasing in some rural communities despite declining rates of marriage overall. Moreover, contemporary abductions seem to be increasingly characterised by gendered violence. Drawing on 18 months of ethnographic fieldwork in a rural Xhosa village, in this article I link the growing incidence and escalating violence of contemporary ukuthwala to the decline of the migrant labour system, and secondarily, to ideological transformations in desired forms of conjugal intimacy. Grounded in ethnographic fieldwork, I discuss contemporary forms of ukuthwala as an outcome of loss of security and status for older women, masculine economic marginalisation, and a growing conviction among young women that marriage should be premised on autonomous spousal choice. In so doing, I show connections between contemporary ukuthwala and broader issues of political economy, domesticity, and gendered and generational sociality. Situating ukuthwala within broader social, economic, and political contexts, as I do in this article, can offer a richer appreciation of the motivations and moral values that scaffold it, and can contribute to broader conversations about violence, social change, gendered and generational struggles in South Africa today.
Journal of the Royal Anthropological Institute, 2016
In the rural Eastern Cape, South Africa, contests over the meaning and merit of human rights feat... more In the rural Eastern Cape, South Africa, contests over the meaning and merit of human rights feature prominently in intergenerational and intergendered conflicts. In this article I identify and analyse a tension between amalungelo (a socially embedded and relational form of rights) and irhayti (a Xhosaization of the English '[human] right') as a means of exploring the interpersonal tensions that arise through the production and contestation of the subject positions that human rights set in motion. Using the examples of elders' complaints of neglect, and of young men's accusations of human rights violations on the part of women, I ground this investigation in men's and elders' explanations of how human rights enable morally reprehensible actions, and are implicated in what they perceive to be a climate of interpersonal neglect. In analysing these claims, I show that gendered and generational conflict in this region is grounded in uncertainty about the content of gendered and generational subject positions themselves, and speaks to the relative moral value of autonomous versus relational forms of personhood. Moreover, I show that where inequality and interdependence are intrinsic to the ways in which gendered and generational subject positions are constituted and understood, human rights serve both to destabilize the content of these subject positions in ways that render appropriate gendered and generational sociality unclear, and also to bring into question the relative moral value of autonomous versus more relational forms of personhood. 'The problem that we are having with rights' , said Mbeko, 1 'is that people are exercising their rights but ignoring their responsibilities'. Mbeko, a man in his mid-twenties, was one of my most insightful acquaintances in the rural Xhosa village where I have carried out fieldwork since early 2011. We had discussed human rights many times before, and I was well aware of his ambivalent feelings about them. 'What do you mean "ignoring their responsibilities"?' I asked. Mbeko explained by way of example: children have a right to education, and parents have a responsibility to care for their children and to ensure that their child is attending school. Moreover, as a condition of their right to education, children likewise have a responsibility to their parents and teachers to do their homework and to attend school regularly. This, according to Mbeko, is as it should be. However, problems arise because children have the right not to be beaten by parents and teachers even if they skip school. This is reprehensible, according to Mbeko, because the teacher is fulfilling his responsibility to the child by teaching her and her parents are fulfilling their
Journal of Women's Health, 2010
Background: Recent research identifies gender inequality as a driver of the HIV=AIDS epidemic. Th... more Background: Recent research identifies gender inequality as a driver of the HIV=AIDS epidemic. The feminization of poverty is also increasingly apparent, as is the disproportionate vulnerability of members of femaleheaded households. We sought to examine the relationships among sex, gender, age, HIV status, and socioeconomic characteristics, focusing on heads and nonheads of households. Methods: We interviewed 6,338 men and 10,057 women. Results: Significantly more males (51.4%) than females (34.8%) indicated that they were heads of households (p < 0.001). Female heads of households were significantly more likely to be infected with HIV than their male counterparts (17.9% vs. 13.1%). Among 15-24-year-old males, those who are often without cash are more likely to be infected with HIV than those who are never without cash (OR ¼ 3.33, 95% CI 1.17-9.49). Similar results were observed among females, who sometimes had no cash (OR ¼ 1.86, 95% CI 1.22-2.82), and among adults aged 25 years. Results confirmed that age and gender are related to HIV infection in South Africa and that poverty is a social determinant for HIV infection across all age groups. However, sex is a determinant only among the younger age groups. Young female heads of household are more likely to be poor and are more likely to be HIV positive. Conclusions: The results indicate that the HIV=AIDS epidemic in South Africa is characterized by gender inequalities. Young women are more likely to be HIV infected, especially heads of households. Young women are also more likely to live in poverty, although this study cannot establish the directionality of a causative relationship between poverty and risk of HIV. Greater attention must be paid to young women, especially those who head households, in terms of treatment, prevention, and poverty alleviation.
Journal of Southern African Studies, 2014
ABSTRACT
COVID-19
Context: Since the onset of the COVID-19 pandemic policies have been implemented to limit disease... more Context: Since the onset of the COVID-19 pandemic policies have been implemented to limit disease transmission and manage patient flow in clinical settings, including perinatal healthcare settings. Emergent literature indicates increased medicalization of childbirth during the pandemic, however experiences of pregnancy and birth remain unexplored. Understanding the impact of pandemic policies on healthcare practices is important for planning better care in future. Objective: To examine how people in Canada who gave birth during the COVID-19 pandemic were affected by pandemic-related policies, especially policies aimed at limiting interpersonal contact to reduce SARS-CoV-2 transmission. Study Design: exploratory qualitative descriptive study. Dataset: Semi-structured telephone interviews. Population studied: 67 participants were recruited. Study inclusion was extended to anyone aged 18 years or more who was located in Canada and was pregnant or had given birth during the COVID-19 pandemic. Intervention/Instrument (for interventional studies): N/A. Outcome Measures: N/A. Results: Findings suggest that the pandemic has resulted in an overall scaling back of perinatal care alongside the heavy use of interventions (e.g., induction of labour, cesarean section) in response to pandemic stresses and uncertainties on the part of both healthcare providers and pregnant people themselves. Some participants pushed for non-medically necessary interventions as a means of averting the possibility that their partner would be banned from attending the birth (e.g. if the partner contracted COVID-19). Some participants reported being offered interventions as a means of controlling patient flow and in response to clinicians' fears of healthcare system collapse in the event of escalating infection rates. Conclusions: For some people in Canada, giving birth during the COVID-19 pandemic entails medicalization and implementation of non-medically necessary interventions. If healthcare systems are increasing intervention use at the same time that the "safety net" intended to catch the complications from those interventions is reduced, then birthing people are being exposed to extra risk precisely when it is most important to minimize it. Continuity of care throughout pregnancy and postpartum, labour support persons, and non-medical forms of care are all essential components of safe maternal healthcare, however pandemic perinatal care demonstrates that they are not viewed as such.
Social determinants and vulnerable populations
Context: The current pandemic has drawn attention to the importance, failings and weaknesses of t... more Context: The current pandemic has drawn attention to the importance, failings and weaknesses of the public health system in promoting and maintaining health for all and especially vulnerable groups and those living with serious chronic conditions; this includes those living with chronic pain. COVID-19 response measures are creating barriers to accessing services for those living with pain, such as pain management services and supervised injection sites, which is contributing to a spike in overdoses. Objective: Our project examines how people living with chronic pain and marginalization persevere during COVID-19. Our overarching research question is "how do participants with chronic pain, who also live with poverty, addictions and mental illness, manage their lives in the time of this pandemic?". Study Design: Our research is conducted using applied qualitative methods, drawing on an approach known as institutional ethnography, which uses people's everyday experiences as the starting point for an exploration of the often invisible social relations that orient those experiences. Setting or Dataset: Given the pandemic restrictions, participants were recruited in online spaces (e.g. Twitter and Kijiji) and through the existing networks of our multidisciplinary study team and interviewed by telephone. Interviews were approximately 60-90 minutes in length depending on how much information the participants wanted to share. Population Studied: Our study focused on people living in Canada over the age of 18, who speak fluent English and who self-identify as living with chronic pain, and marginalization. Results: Our findings highlight the complex ways in which people have been impacted by policies, both negatively and positively. For some people, the pandemic was an equalizer, insofar as they already lived lives marked by isolation and believed that others now knew "how that felt". Others described their mistrust of or inability to adhere to public health recommendations as causing additional stress. Conclusions: By identifying the strategies people use to persevere we are able to provide information for targeted interventions to address structural vulnerabilities and social determinants of health. This knowledge is critical to help better (re)design our systems and inform decision-making across jurisdictions in Canada to ultimately strengthen our public health, health and social care systems now and into the future.
University of Toronto Journal of Public Health, 2022
Background: Qualitative health research seeks to elucidate the realities of context, reveal the c... more Background: Qualitative health research seeks to elucidate the realities of context, reveal the complexities of behaviour, probe the intersecting and multiple determinants of health at individual, community and institutional levels, and capture the dynamics of health care provision from the perspectives of patients, providers, and systems. Traditionally, in our Family Medicine Department at McGill University, graduate students are trained in qualitative health research in the context of a synchronous in-person classroom. Amidst the pandemic, synchronous learning shifted to online modalities, obliging rapid innovation in pedagogic practice. Careful consideration and creation of new online modalities for engaged student learning took place, and when implemented, instructor and student feedback was solicited on whether or how they were effective. Together, co-instructors and the teaching assistant for the course reflected on the challenges and opportunities of teaching qualitative rese...
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Papers by Kathleen (Kate) Rice