Clinical Practice in Prenatal Care: Perspectives of Latina Mothers, Healthcare Providers, and Scientists on Male Circumcision

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This study examines how the interplay between biomedical and ethnomedical perspectives impacts on reproductive health services and consumer decision to circumcise among Latinos in Prince Georges County, Maryland. International research influenced circumcision decision-making during prenatal care: little is known about how neonatal male circumcision (MC) is understood at local clinics; about what patients and providers know regarding circumcision benefits; and the reasoning behind the choices made regarding MC among Latinos. What are the beliefs, practices, and policies regarding MC at community clinics and the international research that influences these policies? Ethnographic research was conducted in three clinics in the state of Maryland including participant observation in the clinics, and interviews with healthcare providers, Latina women who sought services, and scientists and policy makers currently active in MC research. The study explored the interplay between biomedical and ethnomedical knowledge of prenatal care services. Interviews were also conducted with six scientists and policy makers currently active in MC research. The study found that as a reproductive health procedure MC illustrated a complex interplay between biomedical and consumer knowledge. Specifically, healthcare providers did not talk about MC to patients mainly because: 1) They thought that the majority of the Latina women seeking services did not want the procedure; 2) The clinics are constrained for resources and circumcision is not a priority when compared to other prenatal care topics deemed more important in the short prenatal visits. In addition, the policy makers and scientists made assumptions referring to the discussion of circumcision by reproductive and sexual health services clinics when providing prenatal care to clients. Their knowledge relied exclusively on the results of clinical trial data, and how this data could inform policy and clinical guidelines. This dissertation contributes to understanding how services impact MC decision-making and increase the pool of data in regards to the feasibility of overarching MC policies aimed at infants. In addition, this research recommends to critically examine MC as a biomedical practice that is now being rationalized as an HIV prevention strategy.