ECAS 2013

Globalization of biomedicine involves the distribution, use and appropriation of various technologies, including assisted reproductive technologies. Medical anthropologists have shown and argued that biomedicine is not a 'monolithic enterprise' (Lock and Kaufert 1998): local factors reshape the way globalized technologies are offered and used in particular local sites. This is also what we observed during our fieldwork in private fertility clinics in Ghana, Mali, and Uganda: medical views, procedures and practices are not applied in a standardized way, but differ among countries and among clinics. In the anthropological literature there seems to be an inclination to contrast such findings to synthesized `international standards` (mostly European and North-American ones), referring mainly to the authors` countries of origin. In this paper we try to avoid this inclination; contrarily, we describe and make an attempt to understand the inter-African and inter-clinic diversity. We focus on the diversity in views and practices regarding the issue of (prolonged) bed rest after embryo transfer, which is the last stage of In-Vitro-Fertilization. We will see that providers not only have different arguments for their divergent practices, but that women also react differently to these practices. While the women's reactions reflect both their appreciation of the clinic's practices and their hesitations about these practices, they also point to their dependence on the clinic staff to be able to deliver the child (or children) they so much want.

Emergency contraceptive pills have been developed at an international level as a back-up method: to be used when other contraceptive methods have failed or after having unplanned, unprotected sexual intercourse. Like other contraceptive technologies, the emergency contraceptive pill is not a neutral object and how women actually use it in their daily lives may vary per country and differ from the way its developers intended people to use it. Fieldwork conducted in Addis Ababa - where the emergency contraceptive pill was introduced a few years ago and made available over-the-counter in pharmacies and drug stores - shows that a growing group of young women use emergency contraceptive pills repeatedly, as their preferred method of birth control.

This paper explores the reasons behind the growing popularity of this pill by focussing on the characteristics of the pill itself, reproductive intentions within relationships, perceptions about beauty, and the multiple roles fulfilled by men in emergency contraceptive pill use. It also explores pharmacists' and chemists' worries about and responses to customers who come to buy the pill repeatedly. Finally, the paper looks at how national level distributors and policy makers in Ethiopia feel they can't control the use of the emergency contraceptive pill and feel how, instead it "has taken on a life of its own".

Global development practitioners long believed the key to improving nutritional status in Africa lay in boosting food security through food aid or interventions centred on green revolution-type technologies. Since 1982, the author has directed a panel study covering beneficiaries of a land reform program in Zimbabwe intended broadly to enhance rural welfare. Anthropometric assessments of the nutritional well-being of over 12,000 children have revealed an unexpected finding: the nutritional status of children declined by an average of 1.4 percent annually, i.e. children whose families benefited from land reform had nutritional levels two decades later that were worse by 25 percent than when land reform began. These declines mirror secular worsening elsewhere in Zimbabwe and occurred despite generally rising incomes and farm productivity. This lack of association has led to alternative medical explanations for chronically poor nutritional outcomes and resulted in proposed therapeutic interventions that include infant feeding practices, improved water supplies and public health and sanitation/hygiene programs.

The paper explores the relationship between worsening child nutrition and a hygiene-related disorder—known as environmental enteropathy—among rural Zimbabwean households. It questions the extent to which individually proposed therapeutic interventions may result in sustained behavioural changes through creative adaptation and thus positively to shape nutritional outcomes. The paper explores the reasons for the decline by identifying correlates between children's nutritional status and the setting of rural households and concludes with a discussion of local child-rearing practices and the role of relatively simple technologies and changes in understanding to improve nutritional status.

The expansion of mobile phone use across Africa in the past decade has been remarkable in terms both of speed of adoption and spatial penetration; there are few areas of life that have not been affected. The potential of mobile phones to enhance healthcare provision, particularly in rural areas, has received much attention from international donors and policy-makers; one example among many is the use of text message-based systems in maternal healthcare which is now being widely adopted across the continent. The focus of this paper, however, is not on the 'formal' adoption of phone-based systems into healthcare, but rather on the myriad informal ways in which young Africans in particular are using mobile phones to access health information, advice and care. Examples include: browsing the internet on smart-phones for information on symptoms, calling into radio phone-in shows to consult healers (an issue particularly in Ghana where informal-sector healers broadcast regularly on local radio to promote their business), and receiving SMS health 'tips' and advertising (both solicited and unsolicited). Based on preliminary work in 24 field-sites in Ghana, Malawi and South Africa, we use narrative ethnographic material to explore young people's creative use of phone-based technologies to bridge gaps in formal health service access and to navigate increasingly complex, pluralistic and globalised therapeutic landscapes.