Of the millions of Community Health Workers (CHWs) serving their communities across the world, there are approximately twice as many female CHWs as there are male. Hiring women has in many cases become an ethical expectation, in part because working as a CHW is often seen as empowering the CHW herself to enact positive change in her community. This article draws on interviews, participant observation, document review and a survey carried out in rural Amhara, Ethiopia from 2013 to 2016 to explore discourses and experiences of empowerment among unpaid female CHWs in Ethiopia’s Women’s Development Army (WDA). This programme was designed to encourage women to leave the house and gain decision-making power vis-à-vis their husbands—and to use this power to achieve specific, state-mandated, domestically centred goals. Some women discovered new opportunities for mobility and self-actualization through this work, and some made positive contributions to the health system. At the same time, by design, women in the WDA had limited ability to exercise political power or gain authority within the structures that employed them, and they were taken away from tending to their individual work demands without compensation. The official rhetoric of the WDA—that women’s empowerment can happen by rearranging village-level social relations, without offering poor women opportunities like paid employment, job advancement or the ability to shape government policy—allowed the Ethiopian government and its donors to pursue ‘empowerment’ without investments in pay for lower-level health workers, or fundamental freedoms introduced into state-society relations.
Liminality as wage penalty for India's women community health workers
In this paper, I analyze the experiences of the world's largest all‐women community health workforce through the lens of liminality. Originally used to describe transition from one state to the other, the concept of liminality in the study of work and organizations can frame workers' experiences of being in‐between established structures and roles in varying degrees, times, and/or places. India's ASHAs, or Accredited Social Health Activists, are community women at the frontlines of the state's health care provisioning. But the state does not categorize them as workers or employees. ASHAs are considered volunteers. Instead of salaries, they are paid task‐based incentives. Based on 14 months of ethnographic fieldwork, including 80 interviews, I find that ASHAs' liminal occupational status as ‘paid volunteers’ produces conditions of chronic underpayment and control for them, further lowering their already low wages. This has implications for how we understand the gender wage gap. I argue that we need to consider not just how much women are paid, but how the payment is structured, and how that places marginalized women workers in relation to others in the workplace. Moving beyond whether liminality is a negative or positive experience, future research should delineate the conditions under which liminality is negative or positive.
more » « less- NSF-PAR ID:
- 10396038
- Publisher / Repository:
- Wiley-Blackwell
- Date Published:
- Journal Name:
- Gender, Work & Organization
- Volume:
- 30
- Issue:
- 2
- ISSN:
- 0968-6673
- Page Range / eLocation ID:
- p. 412-430
- Format(s):
- Medium: X
- Sponsoring Org:
- National Science Foundation
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Background The physical and emotional well-being of women is critical for healthy pregnancy and birth outcomes. The Two Happy Hearts intervention is a personalized mind-body program coached by community health workers that includes monitoring and reflecting on personal health, as well as practicing stress management strategies such as mindful breathing and movement. Objective The aims of this study are to (1) test the daily use of a wearable device to objectively measure physical and emotional well-being along with subjective assessments during pregnancy, and (2) explore the user’s engagement with the Two Happy Hearts intervention prototype, as well as understand their experiences with various intervention components. Methods A case study with a mixed design was used. We recruited a 29-year-old woman at 33 weeks of gestation with a singleton pregnancy. She had no medical complications or physical restrictions, and she was enrolled in the Medi-Cal public health insurance plan. The participant engaged in the Two Happy Hearts intervention prototype from her third trimester until delivery. The Oura smart ring was used to continuously monitor objective physical and emotional states, such as resting heart rate, resting heart rate variability, sleep, and physical activity. In addition, the participant self-reported her physical and emotional health using the Two Happy Hearts mobile app–based 24-hour recall surveys (sleep quality and level of physical activity) and ecological momentary assessment (positive and negative emotions), as well as the Perceived Stress Scale, Center for Epidemiologic Studies Depression Scale, and State-Trait Anxiety Inventory. Engagement with the Two Happy Hearts intervention was recorded via both the smart ring and phone app, and user experiences were collected via Research Electronic Data Capture satisfaction surveys. Objective data from the Oura ring and subjective data on physical and emotional health were described. Regression plots and Pearson correlations between the objective and subjective data were presented, and content analysis was performed for the qualitative data. Results Decreased resting heart rate was significantly correlated with increased heart rate variability (r=–0.92, P<.001). We found significant associations between self-reported responses and Oura ring measures: (1) positive emotions and heart rate variability (r=0.54, P<.001), (2) sleep quality and sleep score (r=0.52, P<.001), and (3) physical activity and step count (r=0.77, P<.001). In addition, deep sleep appeared to increase as light and rapid eye movement sleep decreased. The psychological measures of stress, depression, and anxiety appeared to decrease from baseline to post intervention. Furthermore, the participant had a high completion rate of the components of the Two Happy Hearts intervention prototype and shared several positive experiences, such as an increased self-efficacy and a normal delivery. Conclusions The Two Happy Hearts intervention prototype shows promise for potential use by underserved pregnant women.more » « less
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null (Ed.)Crowdsourced content creation like articles or slogans can be powered by crowds of volunteers or workers from paid task markets. Volunteers often have expertise and are intrinsically motivated, but are a limited resource, and are not always reliably available. On the other hand, paid crowd workers are reliably available, can be guided to produce high-quality content, but cost money. How can these different populations of crowd workers be leveraged together to power cost-effective yet high-quality crowd-powered content-creation systems? To answer this question, we need to understand the strengths and weaknesses of each. We conducted an online study where we hired paid crowd workers and recruited volunteers from social media to complete three content creation tasks for three real-world non-profit organizations that focus on empowering women. These tasks ranged in complexity from simply generating keywords or slogans to creating a draft biographical article. Our results show that paid crowds completed work and structured content following editorial guidelines more effectively. However, volunteer crowds provide content that is more original. Based on the findings, we suggest that crowd-powered content-creation systems could gain the best of both worlds by leveraging volunteers to scaffold the direction that original content should take; while having paid crowd workers structure content and prepare it for real world use.more » « less
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Introduction and Theoretical Frameworks Our study draws upon several theoretical foundations to investigate and explain the educational experiences of Black students majoring in ME, CpE, and EE: intersectionality, critical race theory, and community cultural wealth theory. Intersectionality explains how gender operates together with race, not independently, to produce multiple, overlapping forms of discrimination and social inequality (Crenshaw, 1989; Collins, 2013). Critical race theory recognizes the unique experiences of marginalized groups and strives to identify the micro- and macro-institutional sources of discrimination and prejudice (Delgado & Stefancic, 2001). Community cultural wealth integrates an asset-based perspective to our analysis of engineering education to assist in the identification of factors that contribute to the success of engineering students (Yosso, 2005). These three theoretical frameworks are buttressed by our use of Racial Identity Theory, which expands understanding about the significance and meaning associated with students’ sense of group membership. Sellers and colleagues (1997) introduced the Multidimensional Model of Racial Identity (MMRI), in which they indicated that racial identity refers to the “significance and meaning that African Americans place on race in defining themselves” (p. 19). The development of this model was based on the reality that individuals vary greatly in the extent to which they attach meaning to being a member of the Black racial group. Sellers et al. (1997) posited that there are four components of racial identity: 1. Racial salience: “the extent to which one’s race is a relevant part of one’s self-concept at a particular moment or in a particular situation” (p. 24). 2. Racial centrality: “the extent to which a person normatively defines himself or herself with regard to race” (p. 25). 3. Racial regard: “a person’s affective or evaluative judgment of his or her race in terms of positive-negative valence” (p. 26). This element consists of public regard and private regard. 4. Racial ideology: “composed of the individual’s beliefs, opinions and attitudes with respect to the way he or she feels that the members of the race should act” (p. 27). The resulting 56-item inventory, the Multidimensional Inventory of Black Identity (MIBI), provides a robust measure of Black identity that can be used across multiple contexts. Research Questions Our 3-year, mixed-method study of Black students in computer (CpE), electrical (EE) and mechanical engineering (ME) aims to identify institutional policies and practices that contribute to the retention and attrition of Black students in electrical, computer, and mechanical engineering. Our four study institutions include historically Black institutions as well as predominantly white institutions, all of which are in the top 15 nationally in the number of Black engineering graduates. We are using a transformative mixed-methods design to answer the following overarching research questions: 1. Why do Black men and women choose and persist in, or leave, EE, CpE, and ME? 2. What are the academic trajectories of Black men and women in EE, CpE, and ME? 3. In what way do these pathways vary by gender or institution? 4. What institutional policies and practices promote greater retention of Black engineering students? Methods This study of Black students in CpE, EE, and ME reports initial results from in-depth interviews at one HBCU and one PWI. We asked students about a variety of topics, including their sense of belonging on campus and in the major, experiences with discrimination, the impact of race on their experiences, and experiences with microaggressions. For this paper, we draw on two methodological approaches that allowed us to move beyond a traditional, linear approach to in-depth interviews, allowing for more diverse experiences and narratives to emerge. First, we used an identity circle to gain a better understanding of the relative importance to the participants of racial identity, as compared to other identities. The identity circle is a series of three concentric circles, surrounding an “inner core” representing one’s “core self.” Participants were asked to place various identities from a provided list that included demographic, family-related, and school-related identities on the identity circle to reflect the relative importance of the different identities to participants’ current engineering education experiences. Second, participants were asked to complete an 8-item survey which measured the “centrality” of racial identity as defined by Sellers et al. (1997). Following Enders’ (2018) reflection on the MMRI and Nigrescence Theory, we chose to use the measure of racial centrality as it is generally more stable across situations and best “describes the place race holds in the hierarchy of identities an individual possesses and answers the question ‘How important is race to me in my life?’” (p. 518). Participants completed the MIBI items at the end of the interview to allow us to learn more about the participants’ identification with their racial group, to avoid biasing their responses to the Identity Circle, and to avoid potentially creating a stereotype threat at the beginning of the interview. This paper focuses on the results of the MIBI survey and the identity circles to investigate whether these measures were correlated. Recognizing that Blackness (race) is not monolithic, we were interested in knowing the extent to which the participants considered their Black identity as central to their engineering education experiences. Combined with discussion about the identity circles, this approach allowed us to learn more about how other elements of identity may shape the participants’ educational experiences and outcomes and revealed possible differences in how participants may enact various points of their identity. Findings For this paper, we focus on the results for five HBCU students and 27 PWI students who completed the MIBI and identity circle. The overall MIBI average for HBCU students was 43 (out of a possible 56) and the overall MIBI scores ranged from 36-51; the overall MIBI average for the PWI students was 40; the overall MIBI scores for the PWI students ranged from 24-51. Twenty-one students placed race in the inner circle, indicating that race was central to their identity. Five placed race on the second, middle circle; three placed race on the third, outer circle. Three students did not place race on their identity circle. For our cross-case qualitative analysis, we will choose cases across the two institutions that represent low, medium and high MIBI scores and different ranges of centrality of race to identity, as expressed in the identity circles. Our final analysis will include descriptive quotes from these in-depth interviews to further elucidate the significance of race to the participants’ identities and engineering education experiences. The results will provide context for our larger study of a total of 60 Black students in engineering at our four study institutions. Theoretically, our study represents a new application of Racial Identity Theory and will provide a unique opportunity to apply the theories of intersectionality, critical race theory, and community cultural wealth theory. Methodologically, our findings provide insights into the utility of combining our two qualitative research tools, the MIBI centrality scale and the identity circle, to better understand the influence of race on the education experiences of Black students in engineering.more » « less
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Abstract This article examines how
HIV policies and the funding priorities of global institutions affect practices in prenatal clinics and the quality of healthcare women receive. Data consist of observations at health centres in Lilongwe, Malawi and interviews with providers (N = 37). I argue that neoliberal ideology, which structures the global health field, produces a fragmented healthcare system on the ground. Findings show two kinds of healthcare practices within the same clinic: donor‐fundedNGO s took onHIV services while government providers focused on prenatal care.NGO practices were defined bysurveillance , where providers targeted pregnantHIV ‐positive women and intensively monitored their adherence to drug treatment. In contrast, state‐led practices were defined byrationing . Government providers worked with all pregnant women, but with staff and resource shortages, they limited time and services for each patient in order to serve everyone. This paper builds on concepts of therapeutic citizenship and clientship by exploring how global health priorities produce different conditions, practices and outcomes ofNGO and state‐led care.
