Arctic passages: maternal transport, Iñupiat mothers and Northwest Alaska communities in transition

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Author
Schwarzburg, Lisa Llewellyn
Chair
Duffy, Lawrence
Loring, Philip
Committee
Fast, Phyllis
Saylor, Brian
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URI
http://hdl.handle.net/11122/4482
Abstract
While the primary goal of the northwest Alaska Native village maternal transport program is safe deliveries for mothers from remote villages, little has been done to examine the impact of transport on the mothers and communities involved. I explore how present values (Western and Iñupiat cultural values) can influence the desire of indigenous women of differing eras and Northwest Alaska villages to participate in biomedical birth practices, largely as made available by a tribal health-sponsored patient transport system. The work that follows portrays the varying influences on these women and their communities as they determine the level of importance for mothers to get to the hospital to deliver. I have enlisted viewpoints of Alaska Native families and women of different generations from various lñupiat villages to help paint a picture of the situation. With this research, I ask, how do generations of mothers, transport situations, and villages compare in terms of experiences during the processes of these Iñupiat women becoming mothers? What gender, ethnicity, and power interplays exist in this dynamic helix of social and political elements (embodiment) during their periods of liminality? What are influences (biomedical and community) that contribute to a woman's transition to motherhood in this community? Moreover, how do women, families, and community members perceive the maternal transport policy today? I examine how the transport policy figures into stages of liminality, as these mothers and communities produce future generations. With theoretical frameworks provided by medical anthropology and maternal identity work, I track the differences concerning the maternal transport operation for lñupiat mothers of the area. I compare the influences of cultural value systems present in each of the communities by birth era and location. Using content analysis to determine common themes, I found connections among presence of Iñupiat values, community acceptance of maternal transport, and expressed desire for community autonomy in maternal health care.
Description
Dissertation (Ph.D.) University of Alaska Fairbanks, 2013
Table of Contents
Preface -- Chapter 1. Maternal health care for Iñupiat mothers of the Northwest -- 1.1. Introduction -- 1.2. The Alaska Native Village Maternal Health Transport (ANVMT) policy -- 1.3. Arctic passages research questions -- 1.4. Risk assessment and postneonatal mortality statistics -- 1.4.1. Data used for risk assessment -- 1.4.2. 'They must simply be asked' -- 1.5. Liminality, communitas, and maternal identity work -- 1.5.1. Liminality -- 1.5.2. Related studies use of liminality as analysis tool -- 1.5.3. Communitas -- 1.5.4. Communitas and Turner's contribution to liminality -- 1.5.5. Maternal identity work -- 1.6. Iñupiat communities of Northwest Alaska -- 1.6.1. Population -- 1.6.2. Geography, climate, and transportation -- 1.6.3. NW Alaska socio-political maternal health care governing bodies -- 1.7. Overview of the thesis -- Chapter 2. Design, methods and analytical techniques -- 2.1. Selection of topic and study area -- 2.1.1. ANVMT policy analysis in exploratory phase -- 2.1.2. ANVMT policy analysis and early stage hypothesis development -- 2.2. Version one of study scope and parameters -- 2.2.1. Development of new study scope -- 2.2.2. Development of new study design -- 2.3. Arctic Passages study scope and parameters -- 2.4. Sampling and data collection techniques -- 2.4.1. Arctic Passages framework approach -- 2.4.2. Arctic Passages grounded theory -- 2.5. Methodological and analytical techniques -- 2.5.1. Familiarization -- 2.5.2. Identifying thematic framework -- 2.5.3. Indexing -- 2.5.4. Charting -- 2.5.5. Mapping and interpretation -- 2.6. Summary -- Chapter 3. Biomedicine, maternal health policy, and birth models -- 3.1. Introduction: US maternal health care policy and biomedicine -- 3.2. Use of Alaska Native maternal and infant health data to inform policy -- 3.3. Anthropology of birth: medical anthropology and cultural competency -- 3.3.1. Physician-patient cultural divide and cultural competency -- 3.3.2. Cultural competency efforts in Alaska Native health care -- 3.3.3. History and cross-cultural treatment of birth -- 3.3.4. Jordan's midwife construct -- 3.4. Emergence of birth models -- 3.5. Midwifery and biomedical birth models -- 3.5.1. The midwifery birth model -- 3.5.2. The biomedical birth model -- 3.5.3. Authoritative knowledge in birth constructs -- 3.5. Summary -- Chapter 4. Maternal identity, embodiment and Iñupiat cultural values -- 4.1. Introduction -- 4.2. Nursing theories and maternal identity -- 4.2.1. Maternal identity and ethnic identity -- 4.2.2. Maternal identity and group membership -- 4.2.3. Public health policy, nationalism, and tribalism and maternal identity -- 4.3. Embodiment and birthing practice -- 4.3.1. Embodiment and the body politic -- 4.3.2. Embodiment among maternal Third and Fourth World identities -- 4.4. Iñupiat Ilitqusiat: backdrop to everyday changing realities -- 4.4.1. Maternal and medical cultural influences -- 4.4.2. Iñupiat Ilitqusiat definition for Arctic Passages -- 4.4.3. Iñupiat Ilitqusiat expressions in Arctic Passages -- 4.5. Summary -- Chapter 5. Iñupiat Birthways in Northwest Alaska and ANVMT policy -- 5.1. Sampling results and scope -- 5.2. Secondary birth and transport figures -- 5.2.1. Arctic Passages statistical data sources -- 5.2.2. Maternal and infant health statistical records on Maniilaq region births -- 5.2.3. Maniilaq region flight services impact on ANVMT policy -- 5.2.4. Maniilaq region facility usage trends, historical and current data -- 5.3. Delivery and infant mortality figures -- 5.3.1. Maniilaq service area 'type of delivery' statistics -- 5.3.2. Maniilaq Service Area infant mortality statistics -- Chapter 6. Iñupiat mothers navigating the ANVMT system: today and yesterday -- 6.1. Arctic Passage mothers and the ANVMT policy -- 6.1.1. Themes -- 6.1.2. Buckland mothers' views of the ANVMT policy -- 6.1.3. Kotzebue mothers' views of the ANVMT policy -- 6.1.4. Point Hope mothers' views of the ANVMT policy -- 6.2. Arctic Passages community and family members and the ANVMT policy -- 6.2.1. Buckland -- 6.2.2. Kotzebue -- 6.2.3. Point Hope -- 6.3. Maternal transport: a new tradition in the Arctic Passages communities? -- 6.4. Maternal identity work, liminality, communitas and the ANVMT system -- 6.4.1. Self-identification and embodiment as Iñupiat mothers -- 6.4.2. Iñupiat mothers, liminality, and communitas -- 6.5. Different generations of Arctic Passages Iñupiat mothers as participants -- 6.6. Influences and the ANVMT system -- 6.6.1. Biomedical influences -- 6.6.2. Family and community influences -- Chapter 7. Conclusion -- 7.1. Conclusions -- 7.2. Arctic Passages limitations and questions for further research -- 7.2.1. Limitations -- 7.2.2. Questions for further research -- 7.3. Maniilaq ANVMT policy: availability versus accessibility -- 7.3.1. Trust and communication between worldviews in Maniilaq maternal care -- 7.3.2. Alignment of like-minded communities and health care philosophies -- References.
Date
2013-12
Type
Dissertation
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