Category Archives: Applied Anthropology

Applying medical anthropology: a history of stress in Puerto Rico and its impacts on birth outcomes

Over the course of the last six years, Holly Horan, a doctoral candidate in the Applied Anthropology program at Oregon State University, has developed and carried out a course of research culminating in the largest-ever study measuring perceived and biological maternal stress during and after pregnancy in Puerto Rico. By combining in-depth interviews with Puerto Rican mothers with quantitative analysis of perceived stress and the stress hormone cortisol during each stage of pregnancy, Holly has gained insights into both the perceived and the physiological components of maternal stress that have potential to impact birth outcomes (in particular, timing of birth).

Holly describes herself as an applied medical anthropologist. She strives to take a holistic approach to health, considering not only the physiology of an individual, but external factors as well: the political situation, economics, the culture, and the historical context of the research site. She is passionate about “community-led research.” In community-led research, the community where the research is being conducted takes a role in the development, execution, analysis, and evaluation of the research.

Holly has found a way to combine her personal and professional interests in maternal and infant health with her desire to engage in research with Puerto Rican communities. Holly’s mother is Puerto Rican, and she had long wanted to engage in research that could benefit the island. While completing a master’s degree in anthropology at the University of Montana, Holly did preliminary research on the early onset of puberty among Puerto Rican girls. Here at OSU, Holly has been able to use both qualitative and quantitative methods to research maternal and infant health within a community-led framework.

At the beginning of her dissertation research, Holly learned that the cesarean birth rate in Puerto Rico was close to 50% — far higher than the rate in the continental U.S., which hovers around 30%. Both rates are much higher than the rate recommended by the World Health Organization, which indicates that the cesarean birth rate should be no higher than 15%. She also learned that the island struggled with high incidence of preterm birth and low birth weight, both of which are important population-level health indicators. Holly’s advisor, Dr. Melissa Cheyney, is a home-birth midwife and an associate professor within the Applied Anthropology program in the School of Language, Culture, and Society. Dr. Cheyney helped connect Holly to Puerto Rican midwives, who, in turn, connected them to other medical providers in Puerto Rico.

In the summer of 2014, Holly conducted a pilot study, spending six weeks in Puerto Rico interviewing maternal and infant health-care professionals. These interviews allowed her to develop goals for her dissertation research that aligned with the needs of the community. Participant narratives frequently displayed concerns associated with unexplainable high rates of preterm birth.

Holly’s National Science Foundation (NSF)-funded dissertation research examined the relationship between perceived maternal stress, biological maternal stress, and prematurity. After the 2014 pilot study, she moved to Puerto Rico for 16 months, where she used semi-structured interviews and perceived stress questionnaires to develop an understanding of this relationship. In addition to this qualitative component, she also measured the stress hormone cortisol from maternal hair samples. Cortisol is one of the most well-understood biological stress indicators. Up until recently, the primary available way to measure cortisol levels was through blood or saliva samples, which provided only an indication of short-term stress. As it turns out, however, cortisol is also incorporated into hair. Hair cortisol provides a measure of long-term stress — the type of stress that is speculated to impact maternal and infant health outcomes, including preterm birth.

In the summer of 2016, Holly initiated her dissertation research with an extensive series of in-depth interviews with pregnant and recently-postpartum women. At this time, the ZIKA virus was declared a public health emergency, and there was a variety of public health messaging concerning delayed reproduction and the risk of microcephaly. Through these interviews, Holly learned that the U.S. Government’s public health messaging led to an internal conflict for many pregnant Puerto Rican women. Families felt stress and fear about the prospect of infants developing microcephaly. However, the warnings and official recommendations to delay reproduction provided uncomfortable reminders of the island’s colonial past, which includes targeted experimental clinical trials of oral contraceptives and sterilization offered primarily to low-income women. This led many interviewees to be skeptical about the threat of the Zika virus, but did not deter them from being concerned for their fetus’ well-being.

These participants identified sources of stress that varied widely, ranging from socioeconomic concerns, political changes, and gender-based inequalities. For example, in May 2016, Puerto Rico’s government defaulted on over 70 billion dollars of debt. Under the regulations passed by La Junta, the appointed fiscal board, many employees were fired and then rehired for lower pay. Also affected was the secondary public-school system: nearly 150 schools were closed. While these events are structural, the interviews revealed that within the Puerto Rican people, the impact of the events was personal, and the magnitude of impacts depended on individuals social support networks and life circumstances.

After comparing maternal cortisol levels with the perceived maternal stress from the structured surveys, which were collected in each trimester across pregnancy, Holly found a counter-intuitive result: some of the mothers who had most problems with their pregnancies (such as premature birth) had unusually low levels of cortisol. One current theory is the concepts of allostasis or allostatic load and “weathering,” a term which has been in the media in recently describing the cumulative effects of chronic stress on health (discussed in an NPR interview here in the context of race-based discrimination). Normally, the body responds to stress by heightening the amount of hormones such as cortisol. After the stressor is removed, hormone levels shift back to a low-stress state. However, if stress is prolonged over months or years–such as when living under a system of oppression–the body starts to experience “wear-and-tear,” causing the body’s stress response system to become ineffective. This ultimately impacts health outcomes, such as premature birth.

There have been road bumps along the way. In late summer 2017, Holly was nearly three quarters completed with data collection and the project was moving along smoothly. However, Mother Nature had different plans: In September 2017, Puerto Rico was hit first by Hurricane Irma and then by Category 4 Hurricane Maria two weeks later. The hurricanes destroyed the power grid and most of the island’s infrastructure. Holly was evacuated by OSU a week after the storm. Although she was worried about the well-being of her participants, and the impact this storm would have on the research project, NSF and her other funders graciously supported her to return and complete the study, which she did in February and March of 2018. As a separate side-project, Holly plans to return to Puerto Rico this summer to share study results with the community and with community partners.

To hear more about Holly’s research, tune in Sunday, December 9th at 7 PM on KBVR 88.7 FM, live stream the show at http://www.orangemedianetwork.com/kbvr_fm/, or download our
podcast on iTunes!

Diving for Discovery

Jon and others looking at the way that light passes through an obsidian artifact

Jon Krier was six-years-old when he found his first skull. He was on a walk with his mother in Wales, Alaska where his father worked as a surveyor. “She immediately told me to put it down,” he said. But he couldn’t shake his fascination: Where did the skull come from? Why did it have so many holes? Years later, after interviewing an elder, he learned that the area was the site of an ancient battle between the Siberian Yupik and Iñupiat tribes. Jon’s curiosity into humanity’s past grew throughout his childhood as he wandered the plains of Alaska, conducted experiments with the science kit that he toted around, and dissected animals he found.

 
After a detour in the security field in his twenties, Jon returned to college to study his passion, archaeology. He’s currently a Master of Arts candidate in Applied Anthropology; his primary research focus lies in helping locate former settlements along the Oregon coast and the Bering Sea. Under the direction of his advisor, ecological anthropologist Drew Gerkey and archaeologist Loren Davis, Jon uses geographic information systems to recreate ice age landscapes as far back as 20,000 years. The goal of this project is to predict the location of underwater archaeological sites off of the Oregon coast, as well as his childhood home along the Bering Sea.

Jon volunteering at the 2014 Connley Caves Field School, where he’s been volunteering for the last three years.

These predictive models are a potentially important key in locating possible underwater sites. Coastlines have shifted over the last 20,000 years, making it difficult to find and excavate former coastal settlements. If located, these sites can preserve important artifacts of the lives of our coastal predecessors.

Jon is also invested in employing native historical and cultural knowledge in his research. For a recent project, “20,000 Year of Isostatically Adjusted Paleoshorelines for Northern Oregon: the Tillamook Peninsula,” Jon worked with Confederated Tribes of Grand Ronde to incorporate traditional knowledge into his research. The Tribes’ input included identifying place names and culturally important locations into the models. This helped researchers understand the cultural, geographic and natural resources of the area.

Jon inspects an artifact he found on a survey.

To learn more about Jon’s research and his journey to graduate school, tune in to hear our conversation on Sunday, January 29th at 7:00 pm on 88.7 FM KBVR Corvallis or listen live online.

Blood Quantum: A Pass-fail Exam With No Questions

“What are you?” is a common question asked in the United States. Few people when asked say, “American,” simply because they might be of European descent. No matter how recently their ancestors migrated to the United States, 200 years ago, 100 years ago, some European Americans would still say, “Italian,” “English”, or “German.” This question of ancestry now becomes a fun conversation about history and ties to peoples an ocean away.

For American Indians this question carries much more meaning, and “What are you?” becomes a loaded question. American Indians have much more, “American,” blood purity than those of us whose families have lived here for a century or two, but instead of simply stating, “American Indian,” they carry identification cards that list their blood quantum for a particular tribe.

The picture belongs to Marty Two Bulls Sr. Our source.

The picture belongs to Marty Two Bulls Sr.
Our source.

Blood Quantum is the practice of quantifying purity of blood as a measure of tribal membership for American Indians. This form of assessment was first used for the Dawes Allotment Act of 1887 which required tribal members to prove that they had one half or more tribal blood purity to be legally recognized as an Indian; the federal standard has since been lowered to one quarter blood quantum. Indigenous people receive benefits of health and education among other things, and blood quantum is a tool for the federal government and for the tribes to decide who can claim these benefits. You may not realize that blood quantum is an ever-diminishing characteristic due to colonization and assimilation. Over time tribes become more and more intra-related and marriage more and more challenging. Thus, the responsibility of the government to native tribal peoples continues to decrease. Ask yourself: Is this by design? In some ways blood quantum protects tribes and the government from supporting people who fraudulently claim American Indian rights, but blood quantum also fractionates communities and can be used as a tool for lateral oppression.

How do you assess your membership to a particular culture? Lineage? Language? Participation in cultural practices? Unfortunately, at present lineage is all that matters for tribal membership. Our guest this week, Max Sage, Masters student in the department of Applied Anthropology, is interested in how American Indians respond to these and other questions about blood quantum. He is investigating their specific knowledge about blood quantum and how blood quantum has shaped their identity and their tribal experience.

For Max, himself a member of the Oneida tribe, these questions have personal significance, and he has been aware of blood quantum since his childhood. “How much native are you?” is a common question. He can precisely answer this, but Max wants to move away from blood quantum. For Max, tribal membership is more than blood, it is support for culture and preservation of culture throughout life. Max, like many American Indians, now face hard choices when it comes to growing their culture. For example, who to love comes with heavy consequences of blood quantum and the membership of his future family in his tribe. Many American Indians across the USA face similar choices: assimilate or isolate. Disenrollment is also occurring across tribes, and blood is called into question before tribal participation.

Max’s research is his life, and his work to illuminate how people identify as American Indian is deeply rooted in his personal experience. He is driven to help grow Indigenous cultures in a meaningful way, and his own ties to his culture motivate his current exploration. For Max, this task doesn’t stop at OSU. Max hopes to continue his work by pursuing a PhD and JD in Native American Policy at the University of Arizona where he will continue to be an ally to all Indigenous peoples.

Tune in to hear our conversation with Max Sage Sunday November, 6 at 7 pm on 88.7 FM KBVR Corvallis or stream the show live.