MeSsy identities: an ethnographic exploration of a multiple sclerosis support group.

The following is an ethnographic study of a multiple sclerosis (MS) support group. This study underscores the importance of access to counternarratives for individuals with chronic illness and disabilities through organizational structures such as support groups. This work can help those with disabilities/chronic diseases, such as MS, because it provides a space for discussing the communicative forces that shape individual experiences of living with disability and chronic illness. Thus, this study seeks to understand how pharmaceutical representatives' and doctors' grand medical narratives influence the communication of MS support group attendees and their construction/performance of self. This study shows that participation in support groups provides a space to renegotiate identity in which new forms of self can develop external to the dominant discourse. The support group becomes a space where counternarratives of empowerment develop in the face of master narratives.

Health disparities in service delivery in the intensive care unit: A critical ethnographic study.

BACKGROUND: The intensive care unit has structural complexities, and critically ill patients are exposed to disparities. Thus, the intensive care unit can be a potential health disparity setting. AIM: This study explored cultural knowledge associated with health disparities in the intensive care unit. STUDY DESIGN: This critical ethnographic study was conducted using Carspecken's approach. It was carried out in intensive care units in Western Iran from 2022 to 2023. Data collection and analysis were conducted in three interconnected stages. The initial stage involved over 300 h of field observation. In the subsequent stage, a horizon analysis was performed. Conversations with 17 informants were recorded in the final stage to enrich the dataset further. Then, the analysis process was carried out as in the previous step to uncover an implicit culture of health disparity. RESULTS: This research revealed the following themes: (a) extension of the impact of political, social, and cultural powers, (b) being influenced by individual diversity, (c) balancing services based on the consideration of benefits and consequences, (d) departure from professional behaviour and (e) insufficient organizational discipline. CONCLUSIONS: The findings of this study showed that individual diversity, political, social and cultural powers within a context of insufficient organizational discipline, and departure from professional behaviour influence the service delivery culture in the intensive care unit. Moreover, the benefits and consequences of service delivery impact its execution. These stereotypes have the potential to contribute to the emergence of health disparities. Cultural transformation is challenging because of deep-rooted stereotypes, but the reduction of disparities is possible through awareness, critical self-reflection and cultural competence. RELEVANCE TO CLINICAL PRACTICE: The findings of this research can prompt staff self-reflection in situations prone to disparities. Health leaders can use these findings to shape health policies at both macro and micro levels.

Exploring Nursing Professionalism: A Focused Ethnography of Community Nurses in Slovakia.

Background: Professionalism is a multidimensional and dynamic concept that is a fundamental requirement to providing safe, quality nursing care. In the Slovak sociocultural context, professionalism is given only limited attention, and research in this area is completely lacking in community nursing. Purpose: To explore how community nurses (CNs) working in home care agencies understand professionalism in the context of their practice in Slovakia. Methods: This focused ethnography involved 10 CNs working in home care in two Slovak regions. The study was conducted between January and July 2022 and employed semistructured interviews, field notes, and reflexive thematic analysis. Findings: In this specific group and setting, understanding of professionalism was reflected through four themes: professional socialization, community service provision, job satisfaction, and professionalism in danger. Conclusions: The findings showed the need to improve the conditions of the working environment of nurses in the community setting. Implications for practice: The findings have implications for local policy, home care agency management, and nursing education in terms of strengthening professionalism in this specific nursing setting and cultural context.

Mourning and orienting to the future in a liminal occasion: (Re)defining British national identity after Queen Elizabeth II's death.

In this paper, we conceptualize the days of mourning that followed the passing of Queen Elizabeth II. as constituting a liminal occasion, a moment of in-betweenness through which we can explore sense-making in times of transition. How do people navigate through liminal occasions, and are they always transformative? Through a rapid response ethnography (Ninterviews = 64, Nparticipants = 122), we were able to capture the raw moments within which a collective comes together, as part of a national ritual, to transition from 'here' to 'there'. In our data, liminality prompted participants to strategically define British national identity and its future by positioning the Queen as representative of Britishness, her loss as a national identity loss. No longer taken for granted, participants reasserted the value of the monarchy as an apolitical and unifying feature in an otherwise divided society, characterizing the continuity of the institution as an essential part of British identity and society. The analysis illustrates how liminality offers a useful conceptual tool for addressing how temporality and change are negotiated in relation to a shared identity, and how navigating transitional moments brings with it political implications for the future.

When Multispecies Ethnography Encounters a Shelter-Based Clinic: Uncovering Ecological Factors for Cultural Psychiatry.

Through a longstanding collaboration, psychiatrists and anthropologists have assessed the impact of sociocultural context on mental health and elaborated the concept of culture in psychiatry. However, recent developments in ecological anthropology may have untapped potential for cultural psychiatry. This paper aims to uncover how "ecologies" inform patients' and clinicians' experiences, as well as their intersubjective relationships. Drawing on my ethnography with Jerome, a carriage driver who became my patient in a shelter-based psychiatric clinic, and on anthropological work about how psychic life is shaped ecologically, I describe how more-than-human relationality and the affordances of various places-a clinic and a stable-influenced both Jerome's well-being and my perceptions as a clinician. I also explore how these ecologies shaped our different roles, including my dual roles as psychiatrist and ethnographer. In the discussion, I define ecological factors, describe their implications for clinical practice, and suggest how they could be integrated into DSM's cultural formulation.

Utilizing intricate care networks: An ethnography of patients and families navigating palliative care in a resource-limited setting.

BACKGROUND: The increase in non-communicable disease burdens and aging populations has led to a rise in the need for palliative care across settings. In resource-limited settings such as Indonesia, however, notably in rural areas, there is a lack of professional palliative care. Little is known about specific palliative care navigation, as previous studies have mostly focused on cancer care navigation. A locally tailored approach is crucial. AIM: To explore how patients and families navigate palliative care and the problems they experience. DESIGN: An ethnographic study using in-depth interviews and observations, analyzed using reflexive thematic analysis. SETTING/PARTICIPANTS: Interviews with 49 participants (patients, family caregivers, and health professionals) and 12 patient-family unit observations in Banyumas, Indonesia. THE ANALYSIS: Patients and families navigated palliative care through different strategies: (1) helping themselves, (2) utilizing complementary and alternative medicine, (3) avoiding discussing psychological issues, (4) mobilizing a compassionate and advocating community, and (5) seeking spiritual care through religious practices. CONCLUSIONS: Our participants used intricate care networks despite limited resources in navigating palliative care. Several problems were rooted in barriers in the healthcare system and a lack of palliative care awareness among the general public. Local primary health centers could be potential palliative care leaders by building upon pre-existing programs and involving community health volunteers. Cultivating a shared philosophy within the community could strengthen care collaboration and support.

Understanding the interplay between organisational injustice and the health and wellbeing of female police officers: a meta-ethnography.

BACKGROUND: Female police officers are reported to encounter more bias, discriminatory practices, and inadequate support than their male counterparts and experience poorer health outcomes. This meta-ethnographic review looks beyond individual responsibilities to consider which aspects of policing impact the health and well-being of female police officers. METHODS: Primary qualitative and mixed method studies published between 2000 and 2024 were included. ProQuest (all databases) and Ovid (Medline and Embase) were searched using terms related to health, wellbeing, females, police, and qualitative research. This was a cross-jurisdictional review, with no limit on country of study. In total, twenty-one papers met the inclusion criteria. A seven-phase inductive and interpretative meta-ethnographic technique was employed to synthesise, analyse, and interpret the data. RESULTS: The data analysis revealed a distinct outcome that demonstrated a strong relationship and substantial impacts of organisational injustice on the health and well-being of female police officers. Our findings showed that organisational injustice, encompassing procedural, relational, distributive, and gendered injustice, significantly influences the health and well-being of female officers. Impacts on mental health were commonly discussed, followed by aspects influencing social health, workplace wellbeing, and physical health. Moreover, the effects of these four forms of organisational injustice and the associated cultural, systemic, and structural risk factors extend beyond the immediate health and wellbeing impacts on the individual female officer through impeding other aspects of their work life, such as career progression and work-life balance, that can further impact long-term health and well-being. CONCLUSION: This review highlights the importance of addressing organisational injustice and the cultural, systemic, and structural risk factors within policing to promote healthier and more inclusive workforces for female officers. Policymakers and practitioners should critically examine policies and practices that may appear gender neutral but disproportionately impact women, affecting the health and well-being of female police officers. By addressing these issues, transformative action can be taken to create safer, more supportive, and healthier working environments for female police officers.

Desirable work: Creative autonomy and the everyday turn in game production.

Based on an ethnography of gamemaking in the Toronto game development scene, I introduce the concept of the everyday gamemaker to reveal how the everyday turn of game production work has transformed the identities of gameworkers. Whereas, previous research has documented the extensive self-exploitation and willingness of creative workers to accept difficult and precarious working conditions, I uncover how everyday gamemakers "make-do" with these modes of cultural production by their desires to going it alone as independent gamemakers, establish second careers through employment and craft work, and find professional development opportunities to make games. I argue these desires shape the nuanced work and leisure identities of everyday gamemakers and evoke their widespread struggle to achieve creative autonomy in the circuits of game production.

Time-Use Sequences: A Mixed-Methods Study Exploring How, When, and Where Spatiotemporal Patterns of Everyday Routines Can Strengthen Public Health Interventions.

BACKGROUND: Behavior change interventions are critical for the secondary prevention of cardiovascular disease and for reducing the risk of a repeat event or mortality. However, the effectiveness of behavior change interventions is challenged by a lack of spatiotemporal contexts, limiting our understanding of factors that influence the timing and location in which day-to-day activities occur and the maintenance of behavior change. This study explored how behavior change interventions could incorporate spatiotemporal contexts of patient activities for modifying behaviors. METHODS: A mixed-methods approach with adapted geo-ethnography techniques was used to solicit detailed descriptions of patients' day-to-day routines, including where, when, and how patients spend time. Data were gathered from patients in one cardiac intervention program in Nova Scotia, Canada, from June to September 2021. RESULTS: A total of 29 individuals (19 men and 10 women) between the ages of 45 and 81 and referred to the program after a cardiac event participated. The results show three key findings: (1) most patients exceeded the minimum guidelines of 30 min of daily physical activity but were sedentary for long periods of time, (2) patient time-use patterns are heterogenous and unique to contexts of individual space-time activity paths, and (3) time-use patterns reveal when, where, and how patients spend significant portions of time and opportunities for adapting patients' day-to-day health activities. CONCLUSIONS: This study demonstrates the potential for interventions to integrate tools for collecting and communicating spatial and temporal contexts of patient routines, such as the types of activities that characterize how patients spend significant portions of time and identification of when, where, and how to encourage health-promoting changes in routine activities. Time-use patterns provide insight for tailoring behavior change interventions so that clinic-based settings are generalizable to the contexts of where, when, and how patient routines could be adapted to mitigate cardiovascular risk factors.

Putting patients first: when home-based care staff prioritise loyalty to patients above the system and themselves. An ethnographic study.

BACKGROUND: The growing number of older people worldwide poses challenges for health policy, particularly in the Global North, where policymakers increasingly expect seniors to live and receive care at home. However, healthcare professionals, particularly in home-based care, face dilemmas between adhering to care ideals and meeting external demands. Although they strive to uphold ethical care standards, they must deal with patients' needs, cooperation with colleagues and management guidelines. Home-based care is an essential part of healthcare services in Norway, but staff struggle with high patient numbers and time management. This article focuses on how staff deal with ethical challenges related to contextual and organisational constraints. METHODS: An ethnographic fieldwork in three municipalities in South-East Norway. The first author conducted three to four months of participant observation in each municipality. In addition, she conducted in-depth interviews with key informants in two municipalities and a focus group interview with seven home-based care workers in one municipality. The data was analysed by using a reflexive thematic analysis. RESULTS: Staff in home-based care are frequently more loyal to the patient than to the system and to their own needs. To provide good care, all informants disregarded the patient's formal decision, i.e. they provided more care than the formalised decision stipulated. To prioritise beneficence to patients, informants also disregarded some of the rules applicable in home-based care. In addition, staff accepted risks to their own safety and health to provide care in the patient's home. CONCLUSION: The loyalty of home-based care staff to their patients can go beyond their loyalty to the rules of the system and even their own safety. This commitment might be attributed to a sense of doing meaningful work, to providing relationship-based and individualised care, and to strong moral courage. However, the staff's emphasis on flexibility and individualised care also brings challenges related to unclear boundaries related to patient care.

Polymedia Literacy and Other Ethical Considerations for Online Ethnographic Research on Social Networking Sites.

Drawing on the authors' own ethnographic research, this article discusses the importance of developing polymedia literacy as a key step toward ethical online research on social networking sites (SNS). Polymedia literacy entails the ability to critically analyze the vast landscape of SNS, their affordances, and users' social motivations for choosing specific SNS for their interactions. Internet researchers face several ethical challenges, including issues of informed consent, "public" and "private" online spaces, and data protection. Even when research ethics committees waive the need for a formal ethics approval process, researchers of online spaces need to ensure that their studies are conducted and presented in an ethical and responsible manner. This is particularly important in research contexts that pertain to vulnerable populations in online communities.

Sedated beauty: The invisible knife in online narratives about cosmetic breast augmentation.

Breast augmentation is a prevalent cosmetic surgery procedure among women in Western societies, and the cosmetic surgery market has witnessed substantial growth. Today, websites and online forums are platforms that feature discussions about cosmetic procedures. A genre on surgery clinic websites is 'patient stories', but also lay-initiated internet forums facilitate discussions and shared experiences related to cosmetic surgery. This study aims to analyse lay-initiated online narratives about cosmetic breast augmentation. The shared narratives contain descriptions of how women who are about to undergo breast augmentation prepare for surgery, the medical procedures that take place on the day of surgery itself, and the experiences and feelings after waking up after anaesthesia. Employing a structural analysis of 30 of these stories, this research illuminates how the surgery stories adhere to a conventional storytelling format, and how key characters within the stories are 'helpers and makers', including relatives, nurses and surgeons. The focus in these narratives revolves around the woman herself, although her active involvement is primarily observed during the preparation phase, with a more passive role assumed during subsequent clinic routines. Despite instances of pain and discomfort in the narratives, the stories are enveloped in an aura of glamour and a spa-like atmosphere. It is discussed how this 'fairy tale' story, narrating a surgical metamorphosis, seems to align with the popularisation of the cosmetic surgery sector.

One the development of a professional mandate by social workers in medical rehabilitation- key results from the SWIMMER Project.

Social work in the German rehabilitation sector is practiced with great variation and its interventions lack research evidence. The SWIMMER project aims to develop a program theory of social work in rehabilitation to explain this variation and to discuss possible conditions. The dealing with ethical dilemmas by social workers is one possible influence and the focus of this paper. The social workers' practice was analyzed using the triple mandate, a German-Swiss concept that describes three possible, sometimes simultaneous directives without a concrete call to action from society, the client or the profession. This qualitative, case-comparative research project collected data from interviews with social workers and managers, participant observation and counseling sessions in ten German rehabilitation facilities. Social workers were confronted with all three mandates. They prioritized either the societal mandate or the client mandate. A consequence for social work practice was the limitation of options under social law (mandate by society). Social workers relied on their professional experience to reflect on the mandates. They used a variety of strategies when faced with conflicting mandates. The research project has succeeded in systematizing the orientations of social workers in goal conflicts. Further investigation on this topic on a broader basis would be beneficial.

Integrating Social Determinants of Health in Critical Care.

BACKGROUND: Social determinants of health (SDOHs) mediate outcomes of critical illness. Increasingly, professional organizations recommend screening for social risks. Yet, how clinicians should identify and then incorporate SDOHs into acute care practice is poorly defined. RESEARCH QUESTION: How do medical ICU clinicians currently operationalize SDOHs within patient care, given that SDOHs are known to mediate outcomes of critical illness? STUDY DESIGN AND METHODS: Using ethnographic methods, we observed clinical work rounds in three urban ICUs within a single academic health system to capture use of SDOHs during clinical care. Adults admitted to the medical ICU with respiratory failure were enrolled prospectively sequentially. Observers wrote field notes and narrative excerpts from rounding observations. We also reviewed electronic medical record documentation for up to 90 days after ICU admission. We then qualitatively coded and triangulated data using a constructivist grounded theory approach and the Centers for Disease Control and Prevention Healthy People SDOHs framework. RESULTS: Sixty-six patients were enrolled and > 200 h of observation of clinical work rounds were included in the analysis. ICU clinicians infrequently integrated social structures of patients' lives into their discussions. Social structures were invoked most frequently when related to: (1) causes of acute respiratory failure, (2) decisions regarding life-sustaining therapies, and (3) transitions of care. Data about common SDOHs were not collected in any systematic way (eg, food and housing insecurity), and some SDOHs were discussed rarely or never (eg, access to education, discrimination, and incarceration). INTERPRETATION: We found that clinicians do not incorporate many areas of known SDOHs into ICU rounds. Improvements in integration of SDOHs should leverage the multidisciplinary team, identifying who is best suited to collect information on SDOHs during different time points in critical illness. Next steps include clinician-focused, patient-focused, and caregiver-focused assessments of feasibility and acceptability of an ICU-based SDOHs assessment.

Professionalisation experiences of a 'business-minded' HIV targeted intervention NGO in India: An organisational ethnography.

This paper contributes to the literature on the professionalisation of NGOs in the context of the rise of 'business-minded' approaches whereby donors establish a market environment in which NGOs compete for funding by demonstrating their achievement of targets and implementing globally recognised management models. Theoretically, we use the distinction between 'economies of performance' and 'ecologies of practice' to explore how NGOs simultaneously 'perform' themselves publicly as meeting expected professional standards while simultaneously producing themselves practically through 'unprofessional' means. Limited global health and development literature addresses professionalisation as an empirical practice and experience. We report on an ethnography of a Bill and Melinda Gates Foundation-funded, HIV-targeted intervention NGO in western India, drawing on six months of participant observation and 17 interviews with NGO workers. The organisation meets 'business-minded' success criteria but does so through informal, personal, hierarchical arrangements at odds with the professionalisation model. Frontline workers are demotivated by their professionalisation experience, are suspicious of the performance of success, and find ways of achieving their vocation despite a system which they feel does not recognise the value of human relationships. Showing that 'business-minded' approaches do not necessarily rule out informal, potentially 'corrupt' ways of working, we argue against the 'professional-unprofessional' binary.

Toward the Definition of a Repertoire of Technical Professional Specialist Competencies for Operating Room Nurses: An Ethnographic Study.

Registered nurses in the operating room require specialized competencies that surpass basic educational training. Existing national and international documents attempt to outline these competencies but often lack comprehensive details. To address this, a repertoire of technical and professional competencies for operating room nurses, aligned with European and National Qualifications Frameworks, is proposed. Aim: Develop a repertoire of technical and professional competencies for perioperative and perianesthesiological specialist nursing roles. Methods: An at-home ethnography design was employed, utilizing participant observation, interviews to the double, and focus groups. Convenience sampling included 46 participants from a university and a public hospital in northern Italy. Data were collected from September 2021 to June 2023 and analyzed using inductive content analysis and data triangulation. Results: Identified 17 specialized technical professional competencies for perioperative and perianesthesiological nursing, divided into 6 areas of activity. These competencies encompass 19 learning outcomes, 152 tasks, 222 knowledge elements, and 218 skills. Conclusions: This competency repertoire aids in the public recognition of qualifications and serves as a valuable tool for identifying, validating, and certifying competencies. Future research should focus on exploring the competencies of central sterilization nurses and transversal competencies.

Anthropologies of health policy.

In this introduction to our special issue, we take a wide view of the history and epistemic stakes of anthropological and ethnographic approaches to health policy. Drawing on the history of critical medical anthropology, the anthropology of policy, and critical policy studies, we show how anthropologies of health policy are particularly essential in this current moment, as policy production becomes increasingly abstracted and even more entwined with specific forms of evidence making. Taken together, the contributors of this special issue argue that anthropology's interventions into health policy are essential in three ways. First, they shed light on the practices of policy 'communities', the pragmatic parameters under which they work, and the central logics under which health policy actors are operating. Second, they examine the effects of policy implementation upon those intended to be the subjects of health policy, highlighting the effects of policy for those marginalised by gender, race, and caste. Here, anthropology provides a view into the 'lived experience' of those targeted by health policy, but it also demands that anthropologists provide 'counter-stories' and 'counter-evidences' that dismantle narrow systems of policy knowledge production. Finally, anthropological attention provides an essential lens into the things that carry over in the act of policy reform-the past reverberations and imperial inheritances. Together with our contributors, we call for anthropologies of health policy that work to highlight and dismantle such inheritances.

A Clinically Immersive Medical Innovation Program for US MD Students: Curricular Description and Program Outcomes.

Background: There is growing need for physician-innovators to address the mounting challenges within the US healthcare system. Despite this, there remains a significant gap in understanding of the efficacy of innovation programs for US MD candidates. We present initial program outcomes of a novel, clinically immersive medical innovation program offered to MD candidates at the David Geffen School of Medicine (DGSOM) at UCLA. Methods: A novel clinically immersive medical innovation curriculum was developed based on existing and reputable medical innovation frameworks and tailored for medical students. Curricular topics broadly included clinical ethnography, interviewing techniques, mind mapping, needs formulation and prioritization, quality improvement, intellectual property, reimbursement pathways, solution landscaping and prioritization, regulatory processes. The program was trialed during an unscheduled summer with voluntary enrollees from DGSOM Class of 2024. The traditional four-level Kirkpatrick model was employed to assess program outcomes. Results: Program outcomes were positive on all four Kirkpatrick levels. Students rated enjoyment at 9.5/10 for lectures and 9.1/10 for clinical immersion. Student-perceived confidence in key skills increased by 43%, and 75% of faculty directly perceived improvement in ethnographic skills. Students were highly engaged in both didactics and clinical immersion, discovering on average 2.6 faculty-verified needs per week. Faculty largely felt their students discovered important unmet clinical needs and added value to their clinical practice. Conclusion: We developed and trialed a novel clinically immersive medical innovation curriculum tailored for medical students. This program achieved positive outcomes on all four levels of the Kirkpatrick model. Our findings have driven the local adoption of this program into our institution's medical school curriculum. We hope that the program efficacy demonstrated herein catalyzes more institutions to trial similar medical innovation programs.

We conducted this investigation after recent literature identified a significant gap in our understanding of the role of innovation and entrepreneurship (I&E) programs in the United States (US) medical education. I&E programs are meant to teach the skills necessary to identify and assess ongoing challenges in health care and subsequently formulate a solution for such challenges. The rate of adoption of I&E programs into US medical education has been unexplainably slow, despite a strong reported interest among medical students in learning the associated topics. We sought to answer the question: how effectively can an I&E curriculum be integrated into the traditional US medical doctorate (M.D). curriculum? We designed a novel medical innovation program tailored for medical students and offered this six-week program to 16 M.D. candidates at UCLA during an unscheduled summer. By describing the curriculum in detail and presenting our holistic assessment of program outcomes including learners' feeling, learnings, transference of knowledge, and the program's real-world impact, we demonstrate methods by which medical innovation can effectively be taught to medical students and the impact this may have on our future physician workforce. Our implementation of a quality improvement conceptual framework examining multiple process measures enabled iterative and real-time improvement of the program throughout its offering. Our surveys were administered at regular intervals through the course, thereby allowing iterative feedback from enrolled students to drive course improvement, similar to how quality improvement frameworks incrementally improve outcomes through closed-loop feedback in health care settings. We posit that analogous medical innovation curricula should be increasingly integrated into MD curricula more broadly.

Care, co-survival, and decency: expanding the understanding of outdoor life and smaller alcohol and drug scenes in Denmark and Norway.

Introduction: Public spaces where alcohol and other drugs are openly used and marginal citizens gather, exist in many Nordic cities. The biggest open drug scenes in the Nordic countries are in cities like Oslo and Copenhagen; however, there are smaller scenes in other cities and suburbs, centered around shed-like structures, offering some form of shelter and a designated space for marginalized people involved in heavy drug and alcohol use who hang out in public space. In this paper, we investigate, in a comparative perspective, the characteristics and functions of smaller open alcohol and drug scenes, and how their existence is negotiated in the local community and among the citizens using them. Methods and material: This article is a comparative case-study based on data from fieldwork (participating observation and interviews) carried out in two specific, yet somewhat similar, locations in Denmark and Norway between 2017 - 2022. A cross-case analysis was performed to identify commonalities and differences. Results: Smaller open alcohol and drug scenes are non-regulated spaces of ambivalence and ongoing negotiation in local communities. Based on the data across locations, they represent possibilities for informal care and community for citizens in marginalized situations. The scenes are further, across location, characterized by a mutual agreement of performing decency, e.g., not allowing minor drug sale/use. Discussion: To enable public spaces as smaller alcohol and drug scenes can play a role in reducing harm for marginalized citizens. Communication and dialogue between citizens using an open drug scene and the wider community may help reduce stigma.

Does bride price harm women? Using ethnography to think about causality.

Many institutions claim that bride price - where the groom's family transfers wealth to the bride's family at marriage - harms women. Owing to its long-term engagement with communities that practise bride price, ethnography is well placed to identify causal mechanisms at play in this issue, and there is a substantial literature on its effects in a variety of world regions, including Melanesia. Here, we condense this literature, drawing out key causal arguments made about bride price in various Melanesian societies. This reveals a complex, multi-causal picture: rather than being singularly harmful, bride price may involve a mixture of drawbacks and benefits, making it a double-edged sword with contested implications. Bride price may constrain women's options before and during the marriage but also serves as a safety net that enhances their status. Its effects are probably influenced by many other variables, including age, kinship networks and residence structures. These dynamics have been transformed by conversion to Christianity, the (post-)colonial state, market integration, urbanisation and formal education, often yielding ambiguous outcomes. Rather than reducing ethnography to a collection of datapoints, we show that it can serve as a source of verbal arguments that can be used to challenge reductive narratives about sensitive issues and to formulate hypotheses for testing with quantitative data.