Global Knowledge/local Bodies: Family Planning Service Providers' Interpretations of Contraceptive Knowledge(s)

By Richey, Lisa Ann | Demographic Research, January-June 2008 | Go to article overview

Global Knowledge/local Bodies: Family Planning Service Providers' Interpretations of Contraceptive Knowledge(s)


Richey, Lisa Ann, Demographic Research


Abstract

Contraceptive technologies and the knowledges that are constructed around them are simultaneously global and local. Family planning methods in the context of international development interventions are interpreted and understood as part of the relationship between meanings that are at once embodied and remote. While quality of care issues have been raised over nearly two decades, the interactive relationship between policy/program, supply, and interpersonal relations in forming identities has not been analyzed. This paper is based on two years of qualitative fieldwork conducted in Tanzania over a period between the mid-1990s and the mid-2000s. It examines Tanzanian service providers' perceptions of contraceptives to shed light on questions of local level dissemination of population knowledge(s) and shaping of identities. The findings suggest that the family planning program serves in a process of differentiation between two groups of "local" women: the service providers and their clients. This differentiation subsequently shapes the implementation of the family planning program.

1. Introduction

African population policies are implemented through donor-funded family planning programs that promote modern contraceptives. This type of development "intervention" (Ferguson 1994) arises out of the view that overpopulation is a fundamental development obstacle in African countries (Richey 2008). A discourse of global population knowledge is constituted by academic and policy debates over the conceptualization of population "problems" and the implementation of "solutions." While these debates have been ostensibly resolved by the post-Cairo agenda of reproductive health, fundamental assumptions linking controlled fertility and "development" as neoliberal modernity persist and there is no seamless flow of information from global to local. Furthermore, as demonstrated by recent scholarship (Ali 2002; Browner and Sargent 2008; Maternowska 2006; Richey 2008), the remoteness of global population knowledge from the realities of the local women who are its subjects requires skillful translation in the context of local and global political economies.

Issues of quality of care remain central in debates about family planning and provision of reproductive health services (Adeokun 1991; Blaney 1993; Brown et al. 1995; Bruce 1992; Hardon 1997; Katz et al. 1993; Lane 1994; Rogow 1987; Schuler et al. 1985; Simmons and Simmons 1992; UNFPA 1994; Veney et al. 1992). Some have argued that without sufficient attention to quality, "we will neither see a sustained increase in the contraceptive prevalence rate, nor succeed in lowering birth rates through voluntary means" (Jain 1992, xi). Others emphasize quality as a means of providing services that address the reproductive needs of women in a way that upholds their rights and enables them to gain control over their reproductive capacity. As suggested by the concept of quality of care, the critical juncture between the global discourse and policy, on one hand, and local level receptivity, on the other, takes place in clinic interactions, but these are never simply "local" affairs (see Maternowska 2006). Family planning service providers act as translators between global population knowledge and local bodies. Interpretation takes place within a process of an ongoing construction of subjectivities: what is the identity and role of the provider vis a vis the client and vice versa? As members of local communities, these providers embody and interpret scientific knowledge for themselves and for their clients. This article will explore some meanings and negotiations of contraceptive technologies in Tanzanian family planning clinics.

I would like to suggest that the family planning program serves in a process of differentiation between two groups of "local" women: the service providers and their clients. This differentiation subsequently shapes the implementation of the family planning program in ways that create identities and thus, go beyond simply "gate keeping" in which providers use access to enhance their own control. …

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