Mechanisms for Community Health Worker Action on Patient-, Institutional-, and Community-Level Barriers to Primary Care in a Safety-Net Setting.

Medically and socially complex patients disproportionately face barriers to primary care, contributing to health inequities and higher health care costs. This study elicited perspectives on how community health workers (CHWs) act upon barriers to primary care in 5 patient (n = 25) and 3 CHW focus groups (n = 17). Participants described how CHWs acted on patient-level barriers through social support, empowerment, and linkages, and system-level barriers by enhancing care team awareness of patient circumstances, optimizing communication, and advocating for equitable treatment. Limitations existed for influencing entrenched community-level barriers. CHWs, focusing on patient preferences, motivators, and circumstances, intervened on multilevel barriers to primary care, including advocacy for equitable treatment. These mechanisms have implications for existing CHW conceptual models.

Obstetric Violence in Their Own Words: How Women in Mexico and South Africa Expect, Experience, and Respond to Violence.

This article, based on ethnographic research in Mexico and South Africa, presents two central arguments about obstetric violence: (a) structural inequalities across diverse global sites are primarily linked to gender and lead to similar patterns of obstetric violence, and (b) ethnography is a powerful method to give voice to women's stories. Connecting these two arguments is a temporal model to understand how women across the world come to expect, experience, and respond to obstetric violence-that is, before, during, and after the encounter. This temporal approach is a core feature of ethnography, which requires long-term immersion and attention to context.

Making Women into Protagonists: Midwives Reimagine the Mexican Childbirth Narrative.

I examine midwives' interpretation of - and efforts to reimagine - the contemporary Mexican birth narrative. Throughout my research, midwives argued that, for birth outcomes to improve, women need to become "the protagonists of their own births". I analyze midwives' creative representations of how birth is and could be, and argue that the counter narrative they promote reveals the conditions within which they believe women can become empowered. By centering women's choice as the measure of success, this counter narrative stands in contrast to development initiatives and contemporary biomedical approaches to care. It also emphasizes the continued need for midwifery in Mexico. Examino los esfuerzos de parteras mexicanas para reinventar la narrativa mexicana sobre el nacimiento. Las parteras dijeron que, para que los resultados del parto mejoren, las mujeres deben convertirse en "las protagonistas de sus propios partos". Analizo las representaciones creativas de las parteras acerca del nacimiento, y sostengo que la contra-narrativa que promueven revela las condiciones dentro de las cuales creen que las mujeres pueden empoderarse. Al centrar el poder de las mujeres como la medida del éxito, esta contra-narrativa contrasta con las iniciativas de desarrollo y los enfoques biomédicos contemporáneos. También enfatiza la necesidad continuada de partería en México.