以人为本的护理的解体:分析避孕服务中的权力关系的价值和必要性。

IF 1.9 4区 医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Health Pub Date : 2025-04-30 DOI:10.1177/13634593251336175
Tracy Morison, Catriona Ida Macleod, Yanela Ndabula
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引用次数: 0

摘要

全球研究表明,在提供以人为本的避孕护理方面仍存在挑战。许多避孕研究使用以系统为重点的方法来调查这一问题,以绘制制度限制(例如,获得避孕药具的制度或卫生系统障碍)。这种研究方法背后的假设是,简单地消除结构性障碍可以解决问题并增强避孕自主权,但事实并非如此。我们的研究表明,话语构建的权力关系如何破坏身体的完整性和避孕机构,即使避孕提供者赞同以病人为中心的护理原则。使用综合叙事/话语方法分析南非和新西兰的提供者访谈,我们利用福柯式的生物权力分析来展示理想的以人为中心的护理叙事如何在医学风险、保护主义和生物医学专业知识的话语重压下崩溃,通过忏悔、责任和监督来表明权力的实践。我们的研究结果强调了在以系统为重点的避孕护理研究中经常缺失的一个基本观点:权力和生殖政治的关键维度。因此,我们认为除了系统性挑战之外,还有必要对这一维度进行调查。我们的工作证明了阐明权力动力学的框架的价值,例如我们进行的福柯式生物权力分析。扩大避孕研究的研究视角范围可以加深对制度约束和权力关系如何共同破坏关系性以人为本的避孕护理的理解。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The unravelling of person-centred care: The value and necessity of analysing power relations in contraceptive services.

Global research indicates ongoing challenges in delivering person-centred contraceptive care. Much of the contraceptive research investigates this issue using systems-focussed approaches to map institutional constraints (e.g. institutional or health system barriers to accessing contraception). The assumption underlying this research approach is that simply removing structural barriers can address issues and enhance contraceptive autonomy, but this is not the case. Our research shows how discursively constructed power relations undermine bodily integrity and contraceptive agency even as contraceptive providers endorse the principles of patient-centred care. Using a synthetic narrative/discourse approach to analyse provider interviews in South Africa and New Zealand, we draw on Foucauldian analytics of biopower to show how an idealised person-centred care narrative collapses under the weight of discourses of medicalised risk, protectionism, and biomedical expertise, signalling practices of power through confession, responsibilisation and surveillance. Our findings highlight an essential perspective frequently missing in systems-focussed research on contraceptive care: the crucial dimension of power and reproductive politics. Thus, we argue for the necessity of investigating this dimension, in addition to systemic challenges. Our work demonstrates the value of frameworks that illuminate power dynamics, such as the Foucauldian analytics of biopower we undertook. Expanding the range of research perspectives in contraceptive research can deepen understandings of how systems constraints and power relations together undermine relational person-centred contraceptive care.

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来源期刊
Health
Health Multiple-
CiteScore
4.90
自引率
0.00%
发文量
0
期刊介绍: Health: is published four times per year and attempts in each number to offer a mix of articles that inform or that provoke debate. The readership of the journal is wide and drawn from different disciplines and from workers both inside and outside the health care professions. Widely abstracted, Health: ensures authors an extensive and informed readership for their work. It also seeks to offer authors as short a delay as possible between submission and publication. Most articles are reviewed within 4-6 weeks of submission and those accepted are published within a year of that decision.
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