Lindsay M. Stevens. 2018. “‘We Have to be Mythbusters’: Clinician Attitudes about the Legitimacy of Patient Concerns and Dissatisfaction with Contraception.” Social Science & Medicine 212: 145-152.
Abstract: Although women in the United States use birth control at high rates, they also discontinue it at high rates, often citing dissatisfaction and side effects. At the same time, research shows that clinicians often neglect to discuss or discursively downplay the importance of side effects in contraceptive counseling. Scholars have yet to consider how clinicians’ beliefs about the legitimacy of patient concerns and dissatisfaction may undergird these patterns. This study uses in-depth interviews with reproductive healthcare providers (N=24) to examine their attitudes about common complaints regarding hormonal birth control. I identify how their reliance on formal medical knowledge, including evidence-based models, can lead them to frame patients’ experiences or concerns about side effects as “myths” or “misconceptions” to be corrected rather than legitimized. I also describe a pattern of providers portraying negative side effects as normal to contraception and therefore encouraging patients to “stick with” methods despite dissatisfaction. Finally, I explore how these themes manifest in racialized and classed discourses about patient populations. I discuss the potential cumulative impact of these attitudes – if providers do carry them into clinical practice, they can have the effect of minimizing patient concerns and dissatisfaction, while steering women towards more effective methods of contraception.
Lindsay M. Stevens. 2016. “Environmental Contaminants and Reproductive Bodies: Provider Perspectives on Risk, Gender, and Responsibility.” Journal of Health and Social Behavior 57(4): 471-485. [pdf]
Abstract: Increasingly, leading health organizations recommend that women who are pregnant or considering pregnancy avoid certain toxic chemicals found in our products, homes, and communities in order to protect fetuses from developmental and future harm. In the contemporary United States, women’s maternal bodies have been treated as sites of exceptional risk and individual responsibility. Many studies have examined this phenomenon through the lens of lifestyle behaviors like smoking, drinking, and exercise. However, we know little about how environmental hazards fit into the dominant framework of gendered, individual responsibility for risk regulation. I draw on in-depth interviews with 19 reproductive healthcare providers in the United States to explore how they think about their patients’ exposure to environmental contaminants and sometimes subvert this gendered, individualized responsibility and adopt more collective frames for understanding risk.
Lindsay M. Stevens 2015. “Planning Parenthood: Health Care Providers’ Perspectives on Pregnancy Intention, Readiness, and Family Planning.” Social Science & Medicine 139: 44-52. [pdf]
Abstract: A major health care goal in the United States is increasing the proportion of pregnancies that are planned. While many studies examine family planning from the perspective of individual women or couples, few investigate the perceptions and practices of health care providers, who are gatekeepers to medicalized fertility control. In this paper, I draw on 24 in-depth interviews with providers to investigate how they interpret and enact the objective to “plan parenthood” and analyze their perspectives in the context of broader discourses about reproduction, family planning, and motherhood. Interviews reveal two central discourses: one defines pregnancy planning as an individual choice, that is as patients setting their own pregnancy intentions; the second incorporates normative expectations about what it means to be ready to have a baby that exclude poor, single, and young women. In the latter discourse, planning is a broader process of achieving middle-class life markers like a long-term relationship, a good job, and financial stability, before having children. Especially illuminating are cases where a patient’s pregnancy intention and the normative expectations of “readiness” do not align. With these, I demonstrate that providers may prioritize normative notions of readiness over a patient’s own intentions. I argue that these negotiations of intention and readiness reflect broader tensions in family planning and demonstrate that at times the seemingly neutral notion of “planned parenthood” can mask a source of stratification in reproductive health care.
Roos, Patricia A. and Lindsay M Stevens. 2018. “Integrating Occupations: Changing Occupational Sex Segregation from 2000 to 2010.” Demographic Research 38(5): 127-154. [link]
Abstract: Declining occupational sex segregation in the late 20th century helped to usher in unprecedented occupational and economic advancement for women. As the 21st century dawned, that advancement stalled. We examine how occupational integration occurred in the early decades of the 21st century by focusing on (1) the extent of occupational feminization and masculinization and (2) occupational succession. More broadly we examine how the representation of women in detailed occupational categories changed between 2000 and 2014, regardless of whether they were historically ‘male’ or ‘female,’ and how sociodemographic characteristics contributed to uneven shifts in occupational integration. We use Integrated Public Use Microdata Series data to estimate the percentage point female at the detailed occupation level, specifically the 5% census microdata sample for 2000, and two 1% American Community Survey (ACS) samples for 2013 and 2014. Despite a stall in overall integration, there was much fluctuation within detailed occupations. Moreover, occupational inroads have been uneven in the post-2000 period. Women gained entry into the same types of professional and managerial occupations they entered between 1970 and 2000, especially in the health professions. Men increased their representation in lower-level, nonprofessional occupations. Rather than focus solely on predominantly male or female occupations, we focus more broadly on how occupations feminize and masculinize. More occupations masculinized than previously. Moreover, those in feminizing occupations are more likely to be advantaged (e.g., white, citizens, and educated), while those in masculinizing occupations are more likely to be disadvantaged (e.g., black, Hispanic, and poor English speakers).
MacKendrick, Norah and Lindsay M. Stevens. 2016. “‘Taking Back a Little Bit of Control’: Managing the Contaminated Body through Consumption.” Sociological Forum 31(2): 310-329.
In this article, we explore the lived experience of avoiding environmental chemicals through safer consumption, such as buying “eco-friendly” products. Using focus groups and in-depth interviews involving 50 subjects, we investigate how individuals become aware of environmental chemicals and how they adapt to this awareness. Our participants describe being surprised or alarmed to learn that chemicals are present in food and commodities that they believed were safe. They respond by developing a set of heuristics rendering the “dangerous” consumer landscape into a space that is amenable to personal control. They learn to read an ingredient label and look for organic certification seals on product packaging. We develop the idea of the “contingent boundary” to describe how participants perceive personal control as uneven: they believe they can activate a protective boundary in local and familiar contexts, but outside these contexts, they believe the boundary dissolves. They accept this contingency as normal and describe having to ignore some chemical exposures, for fear of becoming too “crazy.” We conclude that the individuals in our study accept that inverted quarantine (Szasz 2007) is out of reach, and instead try to impose order upon a ubiquitous risk.