The Global Code of Conduct for Research in Resource-Poor Settings (GCC) aims to stop the export of unethical research practices from higher to lower income settings. Launched in 2018, the GCC was immediately adopted by European Commission funding streams for application in research that is situated in lower and lower-middle income countries. Other institutions soon followed suit. This article reports on the application of the GCC in two of the first UK-funded projects to implement this new code, one situated in (...) India and one in Pakistan. Through systematic ethics evaluation of both projects, the practical application of the GCC in real-world environments was tested. The findings of this ethics evaluation suggest that while there are challenges for implementation, application of the GCC can promote equity in international research collaborations. (shrink)

This paper examines whether low income is a barrier to contraceptive use in Pakistan, a country in which economic conditions are deteriorating at a time when the private sector is becoming a more important supplier of contraception. Multivariate regression analysis performed using the Pakistan Contraceptive Demand Survey suggests that low income is a deterrent to modern contraceptive use in Pakistan. This is particularly the case for contraceptive methods supplied through the private sector. It is concluded that, if the aim of (...) family planning programmes is to reach low[hyphen]income people, the prices of contraceptives supplied through the private sector should be kept as low as possible. (shrink)

We explore success drivers of reward-based crowdfunding for poverty alleviation in China. The results from our econometric modeling using data from 4375 reward-based crowdfunding campaigns suggest that poverty alleviation campaigns, as compared to ordinary ones, benefit from higher funded amounts, larger backer numbers, and greater success rates. The results also suggest that poverty alleviation campaigns perform better when the products sold originate from poorer (as compared to wealthier) regions and when price premiums are lower (as compared to higher). We corroborate (...) important findings from the field study with an experimental study, showing that the consumer’s feeling of warm glow accounts for the positive effects of poverty alleviation campaigns (as compared to ordinary) campaigns. We expand the applications of warm-glow theory into the context of reward-based crowdfunding campaigns for poverty alleviation and offer new insights into success drivers of such campaigns. (shrink)

The current qualitative study explores women’s conceptions of the normative family and their day-to-day family lives. To that aim, we conducted five focus group interviews in two low-income neighborhoods of Istanbul. The sample included 43 women who had at least one child between ages 3 and 8 in their care. Participants were 35.64 years old on average and were all married. Women had approximately two children whose mean age was 7.92 years old. Each focus group was semi-structured, lasted for 1–1.5 (...) h, and included 5–12 participants. Thematic analysis of the focus group interview data, moderator memos, and observer’s notes revealed five defining features of healthy family functioning: cohesion, healthy child, parenting, conflict, control, and family organization. Overall, women prioritized motherhood over their other social identities and idealized the happy family, which contradicted their actual lived experiences in the family system. We discuss how women’s depictions of all family processes revolved around cultural constructs of gender, socio-economic status, and independence/interdependence. The findings of this study shed light on future interventions for low-income women and their families in Turkey. (shrink)

A sample of 460 low-income women completed a mate preference questionnaire and surveys that assessed family background, life history, conscientiousness, sexual motives, self-ratings (e.g., looks), and current circumstances (e.g., income). A cluster analysis revealed two groups of women: women who reported a strong preference for looks and money in a short-term mate and commitment in a long-term mate, and women who reported smaller differences across mating context. Group differences were found in reported educational levels, family background, sexual development, number of (...) children, and motives for having sex. Implications for understanding individual differences in women’s mate-preference trade-offs are discussed. (shrink)

In this article, we use qualitative methodology to explore how 15 low‐income women of diverse sociocultural location construct and experience health and weight gain during pregnancy, as well as how they position themselves in relation to messages pertaining to weight gain, femininity and motherhood that they encounter in their lives. Discussing the findings through a feminist poststructuralist lens, we conclude that the participants are complex, fragmented subjects, interpellated by multiple and at times conflicting subject positions. While the discourse of (...) maternal responsibility (i.e. managing personal behaviours for the baby's health) is very much in evidence in their narratives, embodied experiences of pregnancy, lived experiences of financial constraints and religious beliefs provided some with an alternative discourse and resistant subject position. Participants also had mixed emotions about weight gain; they recognized the need to gain weight in order to have a healthy pregnancy, but weight gain was also not welcome as participants reproduced the dominant discourse of obesity and the discourse of ‘feminine’ bodily norms. Based on our results, we advocate for change to recent clinical guidelines and social discourses around pregnancy and weight gain, as well as for policies that provide pregnant women with a range of health‐promoting resources. (shrink)

Priority setting presents one of the biggest challenges policy makers in low-income countries have to deal with on a daily basis. Extreme lack of resources in these contexts introduces non-state stakeholders whose priorities may not necessarily reflect the national priorities. This raises concerns about the legitimacy of the non-state stakeholders' involvement in priority setting. To date, the meagre literature on priority setting in low-income countries has not focused on the question of the legitimacy of the non-state stakeholders, specifically, the development (...) partners. This article fills this gap in the literature. We provide an overview of some of the health sector priority setting approaches, of relevance to low-income countries, including the processes, the stakeholders and their roles, and the priority setting challenges. These factors are explored, in-depth, using the case of Uganda. The sources of legitimacy of development assistance partners' involvement in priority setting is assessed based on current literature on sources of legitimacy and legitimacy in priority setting. The article concludes that both the government and development assistance partners need to work together to foster and maintain their legitimacy through; having fair priority setting processes with wide representation of all relevant stakeholders, explicit priority setting processes and a balance of decision making powers with commitment to accountability and transparency. (shrink)

Background. Despite common recognition of joint responsibility for global health by all countries particularly to ensure justice in global health, current discussions of countries’ obligations for global health largely ignore obligations of developing countries. This is especially the case with regards to obligations relating to health financing. Bearing in mind that it is not possible to achieve justice in global health without achieving equity in health financing at both domestic and global levels, our aim is to show how fulfilling the (...) obligation we propose will make it easy to achieve equity in health financing at both domestic and international levels. Discussion. Achieving equity in global health financing is a crucial step towards achieving justice in global health. Our general view is that current discussions on global health equity largely ignore obligations of Low Income Country governments and we recommend that these obligations should be mainstreamed in current discussions. While we recognise that various obligations need to be fulfilled in order to ultimately achieve justice in global health, for lack of space we prioritise obligations for health financing. Basing on the evidence that in most LICs health is not given priority in annual budget allocations, we propose that LIC governments should bear an obligation to allocate a certain minimum percent of their annual domestic budget resources to health, while they await external resources to supplement domestic ones. We recommend and demonstrate a mechanism for coordinating this obligation so that if the resulting obligations are fulfilled by both LIC and HIC governments it will be easy to achieve equity in global health financing. Summary. Although achieving justice in global health will depend on fulfilment of different categories of obligations, ensuring inter- and intra-country equity in health financing is pivotal. This can be achieved by requiring all LIC governments to allocate a certain optimal per cent of their domestic budget resources to health while they await external resources to top up in order to cover the whole cost of the minimum health opportunities for LIC citizens. (shrink)

This article presents qualitative interview data to explore the health-related carework of low-income women caregivers with special-needs children and the implications of carework for women’s financial security. The author documents “direct” and “advocacy” carework as two types of caregiving that low-income women carry out in the context of declining government resources for poor disabled children. The author shows that the unique demands of carework responsibilities and the conditions of low-wage work combine to limit caregivers’ employment and education options as well (...) as their long-term prospects for financial stability. (shrink)

Access to fruits and vegetables by low-income residents living in selected urban and rural Minnesotan communities was investigated. Communities were selected based on higher than state average poverty rates, limited access to grocery stores, and urban influence codes (USDA ERS codes). Four communities, two urban and two rural, were selected. Data were gathered from focus group discussions (n = 41), responses to a consumer survey (n = 396 in urban neighborhoods and n = 400 in rural communities), and an inventory (...) of foodstuffs available at stores located in all the communities and at large grocery stores in neighborhoods adjacent to the urban communities. In the two urban neighborhoods, a significant number of foods (26% and 52%) were significantly more expensive than the Thrifty Food Plan’s (TFP) market basket price (MBP). Additionally, a significant number of foods in the two rural communities were more expensive (11% and 26%). In focus groups, participants identified major barriers to shopping in their community to be cost, quality of food, and food choice limitations. Results of the food inventory show that foods within the communities were costly, of fair or poor quality, and limited in number and type available, supporting complaints verbalized by focus group participants. Through focus groups and surveys, participants expressed concern that healthy food choices were not affordable within their communities and believed that people in their community suffered from food insecurity. The absence of quality, affordable food for low-income residents in these four Minnesota communities prevents or diminishes their ability to choose foods that help maintain a healthy lifestyle. (shrink)

Ethical dilemmas are part of medicine, but the type of challenges, the frequency of their occurrence and the nuances in the difficulties have not been systematically studied in low-income settings. The objective of this paper was to map out the ethical dilemmas from the perspective of Ethiopian physicians working in public hospitals. A national survey of physicians from 49 public hospitals using stratified, multi-stage sampling was conducted in six of the 11 regions in Ethiopia. Descriptive statistics were used and the (...) responses to the open-ended question “If you have experienced any ethical dilemma, can you please describe a dilemma you have encountered in your own words?” were analyzed using a template analysis process. A total of 587 physicians responded, and 565 met the inclusion criteria. Twelve of 24 specified ethically challenging situations were reported to be experienced often or sometimes by more than 50% of the physicians. The most frequently reported challenge concerned resource distribution: 93% agreed that they often or sometimes had to make difficult choices due to resource limitation, and 83% often or sometimes encountered difficulties because patients were unable to pay for the preferred course of treatment. Other frequently reported difficulties were doubts about doing good or harming the patient, relating to conflicting views, concern for family welfare, disclosure issues and caring for patients not able to consent. Few reported dilemmas related to end-of-life issues. The 200 responses to the open-ended question mirrored the quantitative results. Ethiopian physicians report ethical challenges related more to bedside rationing and fairness concerns than futility discussions and conflicts about autonomy as described in studies from high-income countries. In addition to the high report of experienced challenges, gravity of the dilemmas that are present in their narratives are striking. Recognition of the everyday experiences of physicians in low-income settings should prompt the development of ethics teaching and support mechanisms, discussion of ethical guidelines as well as increase our focus on how to improve the grave resource scarcity they describe. (shrink)

Farmers markets in low-income, urban areas struggle to establish and sustain themselves. Accordingly, farmer recruitment and retention remain a challenge. This paper examines the perspectives of farmers who have been recruited to participate in farmers markets located in LIUA. Taking an ethnographic approach, we seek to understand why farmers join, stay, and/or leave newly-developed farmers market in LIUA. In-depth interviews revealed different motivations for joining new LIUA markets and that these motivations were closely tied to farmers’ reasons for farming. We (...) identified four categories of motivations: farming as a primary livelihood strategy; a new business opportunity; recreation; a social mission. Retention differed across these motivational categories. Farmers who joined LIUA farmers markets to support their livelihoods were the most likely to drop out of these markets. Farmers who used the farmers market to explore a new business opportunity were less likely to drop out and those who farmed for recreation or for a social mission were most loyal and did not drop out. The results indicate that understanding the motivations of farmers may be crucial to retaining farmers at LIUA farmers markets. They also indicate that farmers who are most suited to LIUA farmers markets may be currently overlooked by market managers who regularly target full-time livelihood vendors. These findings have implications for creating more stable farmers markets in LIUA. (shrink)

Paediatric research in low-income countries is essential to tackle high childhood mortality. As with all research, consent is an essential part of ethical practice for paediatric studies. Ethics guidelines recommend that parents or another proxy provide legal consent for children to participate, but that children should be involved in the decision through providing assent. However, there remain uncertainties about how to judge when children are ready to give assent and about appropriate assent processes. Malawi does not yet have detailed guidelines (...) on assent. Understanding perspectives among children and their parents can assist in developing contextually-appropriate assent guidance. Qualitative research was conducted with children and parents in three settings in Southern Malawi, to take account of any variations between socioeconomic and cultural contexts. In each setting, interviews were conducted with parents and their children who had participated in paediatric research to understand their experiences of assent and views on appropriate assent practice. Focus groups were also conducted with children and parents, to understand broader social perspectives. We found widespread support for involving children in decisions on research participation. Participants identified a range of factors that affect children’s capacity to give assent, including intellectual capacity, emotional development, life experience and cultural norms. Age was often mentioned as a consideration, but deemed an unreliable sole indicator of capacity to assent. In relation to appropriate assent processes, participants emphasised considerations such as supporting effective understanding and minimizing harms. Views on how to achieve these aims varied; for example, there were different ideas about the appropriate order in which to approach children and parents, and about whose decision to respect in the event of disagreement. Parents and children agreed about the value of involving children in decisions on research, and about the need to promote children’s decision-making capacity while respecting parents’ interests in children’s welfare. Developing practical guidance that meets these principles is challenging, particularly given the need for flexible approaches that suit different study types, children’s capacities and family environments. Further discussion within the Malawi research and ethics community will help develop contextually-appropriate guidelines. (shrink)

For several years, MBA students enrolled in a Business & Society/Business Ethics class at the University of Wisconsin-Madison have been volunteering their services at homeless shelters and in low-income communities. Students also work with low-income residents and relevant stakeholders on evolutionary team projects aimed at improving living conditions in low-income communities. These projects include starting a grocery co-op, credit union, day-care center, job training center and a transportation business. In addition, student groups develop service networks that link low-income communities with (...) student organizations, other university professors and United Way volunteers. This article provides an evolutionary summary of these projects with the hope that other professors will adopt them for their classes. (shrink)

In order to involve children in the decision-making process about participation in medical research it is widely recommended that the child’s assent be sought in addition to parental consent. However, the concept of assent is fraught with difficulties, resulting in confusion among researchers and ethics committees alike.

Human infection challenge studies (HCS) involve intentionally infecting research participants with pathogens (or other micro-organisms). There have been recent calls for more HCS to be conducted in low-income and middle-income countries (LMICs), where many relevant diseases are endemic. HCS in general, and HCS in LMICs in particular, raise numerous ethical issues. This paper summarises the findings of a project that explored ethical and regulatory issues related to LMIC HCS via (i) a review of relevant literature and (ii) 45 qualitative interviews (...) with scientists and ethicists. Among other areas of consensus, we found that there was widespread agreement that LMIC HCS can be ethically acceptable, provided that they have a sound scientific rationale, are accepted by local communities and meet usual research ethics requirements. Unresolved issues include those related to (i) acceptable approaches to trade-offs between the scientific aim to produce generalisable results and the protection of participants, (iii) the sharing of benefits with LMIC populations, (iii) the acceptable limits to risks and burdens for participants, (iv) the potential for third-party risk and whether the degree of acceptable third-party risk is different in endemic settings, (v) the conditions under which (if any) it would be appropriate to recruit children for disease-causing HCS, (v) appropriate levels of payment to participants and (vi) appropriate governance of (LMIC) HCS. This paper provides preliminary analyses of these ethical considerations in order to (i) inform scientists and policymakers involved in the planning, conduct and/or governance of LMIC HCS and (ii) highlight areas warranting future research. Insofar as this article focuses on HCS in (endemic) settings where diseases are present and/or widespread, much of the analysis provided is relevant to HCS (in HICs or LMICs) involving pandemic diseases including COVID19. (shrink)

Abstract.“Dumpster diving” is a term generally used for obtaining items, in this case food for consumption, from dumpsters. This study evaluates the prevalence of dumpster diving in two low-income urban communities in Minneapolis, Minnesota. Additionally, attitudes and beliefs of adults who engage in this behavior are reported. Surveys (n=396) were used to collect data including individual dumpster diving behavior, food security, health, and demographic data. Nearly one-fifth of those surveyed had used dumpster diving as a means to obtain food. Focus (...) groups (n=17) were conducted to further evaluate dumpster divers’ attitudes and beliefs about dumpster diving, use of food assistance programs including benefits and barriers, and other strategies used to obtain food such as stealing. Focus group participants were primarily homeless and most were high school educated. Ways to improve delivery of food assistance are suggested. In conclusion, more research on the use of dumpsters as a source of food is needed. Utilizing more of the 96 billion pounds of food wasted each year in the US through food recovery and donation programs could help to provide socially acceptable means for low-income urban dwellers to obtain food. (shrink)

The objective of this article is to gain an in-depth understanding of the eating lives of low-income single mothers in Japan. Semi-structured interviews were conducted with nine low-income single mothers living in the three largest urban areas (Tokyo, Hanshin [Osaka and Kobe] and Nagoya) in Japan. Framed by the capability approach and sociology of food, their dietary norms and practices, as well as underlying factors that impact the norm-practice gap were analysed across nine dimensions: meal frequency, place of eating, meal (...) timing, duration, persons to eat with, procurement method, food quality, meal content and pleasure of eating. These mothers were deprived of various types of capabilities, extending not only from the quantity and nutritional aspects of food, but also to spatial, temporal, qualitative and affective aspects. Aside from financial constraints, eight other factors (time, maternal health, parenting difficulties, children’s tastes, gendered norms, cooking abilities, food aid and local food environment) were identified as influencing their capabilities to eat well. The findings challenge the view that food poverty is the deprivation of economic resources required to ensure a sufficient amount of food. Social interventions that go beyond monetary aid and food provision need to be proposed. (shrink)

Alternative food networks are emerging in opposition to industrial food systems, but are criticized as being exclusive, since customers’ ability to patronize these market spaces is premised upon their ability to pay higher prices for what are considered the healthiest, freshest foods. In response, there is growing interest in widening the demographic profile given access to these alternative foods. This research asks: what barriers do alternative food businesses face in providing access and inclusion for low income consumers? Surveys and interviews (...) with 45 alternative food businesses in British Columbia, Canada uncovered five key barriers. The findings indicate that the barriers are symptomatic of structural issues in the Canadian food and social welfare systems. Although opportunities exist for business operators to widen access for low income shoppers, these alone cannot meaningfully ameliorate food-access inequality. Rather, these barriers underscore issues of income-disparity, poverty, and food-access inequality more broadly, and require structural and societal change to rectify. (shrink)

This article examines the cross-generational continuity of community work performed by women living and working in low-income communities and demonstrates the complex ways in which gender, race-ethnicity, and class contribute to the social construction of mothering. The analysis of low-income women's community work challenges definitions of mothering that are limited to biological and legal expressions, thus neglecting the significance of community-based nurturing work for geographic communities and racial-ethnic and class-based groups. The analysis utilizes a broadened understanding of labor and contests (...) the divisions between paid and unpaid work traditionally used to discuss women's work. The article compares and contrasts the experiences of African-American and Latina community workers from low-income communities in New York City and Philadelphia. The findings of the research further demonstrate the ways that knowledge generated from the standpoint of women from different classes and racial-ethnic backgrounds transforms our understanding of politics, labor, and mothering. (shrink)

BackgroundInternational partnerships in research are receiving ever greater attention, given that technology has diminished the restriction of geographical barriers with the effects of globalisation becoming more evident, and populations increasingly more mobile.DiscussionIn this article, we examine the merits and risks of such collaboration even when strict universal ethical guidelines are maintained. There has been widespread examples of outcomes beneficial and detrimental for both high and low –income countries which are often initially unintended.SummaryThe authors feel that extreme care and forethought should (...) be exercised by all involved parties, despite the fact that many implications from such international work can be extremely hard to predict. However ultimately the benefits gained by enhancing medical research and philanthropy are too extensive to be ignored. (shrink)

Ethical research with children requires a special concern for their well-being as individuals. Researchers are therefore expected to report problems children experience and to refer children for assistance. This article addresses difficulties that can arise as researchers attempt to meet this obligation in research with low-income ethnic minority children. Potential difficulties include both failure to report and overreporting suspected problems. The role of institutional review boards in researchers' reporting and referring behavior is also discussed.

There is wide agreement that community engagement is important for many research types and settings, often including interaction with ‘representatives’ of communities. There is relatively little published experience of community engagement in international research settings, with available information focusing on Community Advisory Boards or Groups (CAB/CAGs), or variants of these, where CAB/G members often advise researchers on behalf of the communities they represent. In this paper we describe a network of community members (‘KEMRI Community Representatives’, or ‘KCRs’) linked to a (...) large multi-disciplinary research programme on the Kenyan Coast. Unlike many CAB/Gs, the intention with the KCR network has evolved to be for members to represent the geographical areas in which a diverse range of health studies are conducted through being typical of those communities. We draw on routine reports, self-administered questionnaires and interviews to: 1) document how typical KCR members are of the local communities in terms of basic characteristics, and 2) explore KCR's perceptions of their roles, and of the benefits and challenges of undertaking these roles. We conclude that this evolving network is a potentially valuable way of strengthening interactions between a research institution and a local geographic community, through contributing to meeting intrinsic ethical values such as showing respect, and instrumental values such as improving consent processes. However, there are numerous challenges involved. Other ways of interacting with members of local communities, including community leaders, and the most vulnerable groups least likely to be vocal in representative groups, have always been, and remain, essential. (shrink)

Access to fruits and vegetables by low-income residents living in selected urban and rural Minnesotan communities was investigated. Communities were selected based on higher than state average poverty rates, limited access to grocery stores, and urban influence codes (USDA ERS codes). Four communities, two urban and two rural, were selected. Data were gathered from focus group discussions (n = 41), responses to a consumer survey (n = 396 in urban neighborhoods and n = 400 in rural communities), and an inventory (...) of foodstuffs available at stores located in all the communities and at large grocery stores in neighborhoods adjacent to the urban communities. In the two urban neighborhoods, a significant number of foods (26% and 52%) were significantly more expensive than the Thrifty Food Plan’s (TFP) market basket price (MBP). Additionally, a significant number of foods in the two rural communities were more expensive (11% and 26%). In focus groups, participants identified major barriers to shopping in their community to be cost, quality of food, and food choice limitations. Results of the food inventory show that foods within the communities were costly, of fair or poor quality, and limited in number and type available, supporting complaints verbalized by focus group participants. Through focus groups and surveys, participants expressed concern that healthy food choices were not affordable within their communities and believed that people in their community suffered from food insecurity. The absence of quality, affordable food for low-income residents in these four Minnesota communities prevents or diminishes their ability to choose foods that help maintain a healthy lifestyle. (shrink)

This article offers a reconceptualization of “the political” from the standpoint of women working in and for low-income neighborhoods, with special emphasis on the contradictions between their actions as community workers and their understandings of the political aspects of their work. The author also examines how their gender and race identity influenced their political consciousness and practice. The date are drawn from in-depth interviews with forty-two perdominantly African American and Puerto Rican women from New York City and Philadelphia who were (...) hired in community action programs established by the Economic Opportunity Act of 1964. (shrink)

Improvements of the happiness of the rural population are an essential sign of the effectiveness of relative poverty governance. In the context of today’s digital economy, assessing the relationship between digital literacy and the subjective happiness of rural low-income groups is of great practicality. Based on data from China Family Panel Studies, the effect of digital literacy on the subjective well-being of rural low-income groups was empirically tested. A significant happiness effect of digital literacy on rural low-income groups was found. (...) Digital literacy promotes the subjective happiness of rural low-income groups through income increase and consumption growth effects. The observed happiness effect is heterogeneous among different characteristic groups, and digital literacy significantly positively impacts the subjective happiness of rural low-income groups. Decomposition of subjective happiness into life satisfaction and job satisfaction shows that digital literacy significantly positively affects the job and life satisfaction of rural low-income groups. This paper demonstrates that digital literacy induces a practical happiness effect. To further strengthen the subjective welfare effect of digital literacy in the construction of digital villages, the government should focus on cultivating digital literacy among low-income groups from the demand side. The construction of digital infrastructure should be actively promoted from the supply side. (shrink)

The Wisdom Way Solar Village in Greenfield, Massachusetts is a zero net energy mixed‐income, mixed‐ability subdivision/condominium of 20 solar homes. It stands as an ethical response to climate change in that it demonstrates that homes in the northern United States can be built to use almost no fossil fuel for heat or electricity and to use very little water. It also demonstrates that small groups of people can learn to work together and to enjoy the benefits of living in a (...) small community. (shrink)

A bottom-up approach grounded in micro-level understanding of the thinking, feeling, behavioral, and social aspects of living with low income and associated low literacy can lead to greater understanding and improvement of interactions in the health arena. This paper draws on what we have learned about marketplace interactions in subsistence economies to inform innovations in medical education, design and delivery of healthcare for lowincome patients, outreach education, and future micro-level research at the human-healthcare interface.

In the 1996 overhaul of federal welfare legislation, Congress included provisions to promote employment, marriage, and responsible fatherhood to prevent poverty among low-income families. Little previous research has focused on how marriage promotion policies construct paternal identity. Drawing on data from an 18-month study of a federally funded relationship skills program for low-income, unmarried parents, I analyze how responsible fatherhood policies attempt to shape ideas of successful fatherhood and masculinity in the service of the government’s pro-marriage, antipoverty agenda. The program (...) promoted a class-specific version of what I call marital masculinity, one that seeks to redefine marriageability for low-income men by claiming that marriage comes before financial success and encourages fathers to earn more. It did this by targeting fathers’ masculine identities in two ways: first, by emasculating fathers who only provide financially for their children, and second, by promoting a highly gendered conception of paternal caregiving. By analyzing how this strategy can be understood as both empowering and controlling for low-income men, this research adds to the sociological literature on how welfare policies shape paternal identity and gendered family practices. (shrink)

Rigorous attention has been paid to moral distress among healthcare professionals, largely in high-income settings. More obscure is the presence and impact of moral distress in contexts of chronic poverty and structural violence. Intercultural ethics research and dialogue can help reveal how the long-term presence of morally distressing conditions might influence the moral experience and agency of healthcare providers. This article discusses mixed-methods research at one nongovernmental social support agency and clinic in Rio de Janeiro, Brazil. Chronic levels of moral (...) distress and perceptions of moral harm among clinicians in this setting were both violent, following Nancy Scheper-Hughes’ use of that term, and a source of exceptional and innovative care. Rather than glossing over the moral variables of work in such desperate extremes, ethnography in these settings reveals novel skills and strategies for managing moral distress. (shrink)

Background Currently there is increasing recognition of the need for research in developing countries where disease burden is high. Understanding the role of local factors is important for undertaking ethical research in developing countries. We explored factors relating to information and communication during the process of informed consent, and the approach that should be followed for gaining consent. The study was conducted prior to a family-based genetic study among people with podoconiosis (non-filarial elephantiasis) in southern Ethiopia. Methodology/Principal Findings We adapted (...) a method of rapid assessment validated in The Gambia. The methodology was entirely qualitative, involving focus-group discussions and in-depth interviews. Discussions were conducted with podoconiosis patients and non-patients in the community, fieldworkers, researchers, staff of the local non-governmental organisation (NGO) working on prevention and treatment of podoconiosis, and community leaders. We found that the extent of use of everyday language, the degree to which expectations of potential participants were addressed, and the techniques of presentation of information had considerable impact on comprehension of information provided about research. Approaching podoconiosis patients via locally trusted individuals and preceding individual consent with community sensitization were considered the optimal means of communication. Prevailing poverty among podoconiosis patients, the absence of alternative treatment facilities, and participants' trust in the local NGO were identified as potential barriers for obtaining genuine informed consent. Conclusions Researchers should evaluate the effectiveness of consent processes in providing appropriate information in a comprehensible manner and in supporting voluntary decision-making on a study-by-study basis. (shrink)

The rapid growth of pharmaceutical markets in the 20th century has increased the demand for human research participants in clinical trials. However, with the globalization of clinical research, most clinical trials are conducted in low-income countries (LICs) with political and economic instability, and lack of basic healthcare, but easy access to human subjects. This paper explores the unique ethical challenges faced during the pre-enrollment phase of cross-cultural research in a country like Pakistan, and how these challenges make the Pakistani population (...) vulnerable to exploitation. It also outlines recommendations regarding conducting research in Pakistan within ethical parameters adopted according to local culture. This discussion is important because researchers must focus on the pre-enrollment phase of the research process for it’s cultural suitability and acceptability so that the research conducted is credible and valid and has social value for the research population. (shrink)

Rapid Ethical Assessment (REA) is a form of rapid ethnographic assessment conducted at the beginning of research project to guide the consent process with the objective of reconciling universal ethical guidance with specific research contexts. The current study is conducted to assess the perceived relevance of introducing REA as a mainstream tool in Ethiopia.

In most contexts, emotional support is crucial for the well-being of low-income single women and their children. Support from women may be especially important for single mothers because of precarious ties to their children’s fathers, the prevalence of extended matrifocal living arrangements, and gendered norms that place men as providers of financial rather than emotional support. However, in contexts marked by economic insecurity, spatial dispersion of families, and changing gender norms and kinship obligations, such an expectation may be problematic. Applying (...) theories of emotional capital and family bargaining processes, we address three questions: What is the gender composition of emotional support that single mothers receive? How does gender composition change over time? Does the gender composition of emotional support affect the self-reported stress of single mothers? Drawing on data from a unique data set on 462 low-income single mothers and their kin from Nairobi, Kenya, we uncover three key findings. One, whereas the bulk of strong emotional support comes from female kin, about 20 percent of respondents report having male-dominant support networks. Two, nearly 30 percent of respondents report change favoring men in the composition of their emotional support over six months. Three, having a male-dominant emotional support network is associated with lower stress. These results challenge what is commonly taken for granted about gender norms and kinship obligations in non-Western contexts. (shrink)

BackgroundA requisite for ethical human subjects research is that participation should be informed and voluntary. Participation during the informed consent process by way of asking questions is an indicator of the extent to which consent is informed.AimsThe aims of this study were to assess the extent to which parents providing consent for children's participation in an observational tuberculosis (TB) research study in India actively participated during the informed consent discussion, and to identify correlates of that participation.MethodsIn an observational cohort study (...) of tuberculosis in infants in South India, field supervisors who were responsible for obtaining informed consent noted down questions asked during the informed consent discussions for 4,382 infants who were enrolled in the study. These questions were post-coded by topic. Bivariate and multivariate analysis was conducted to examine factors associated with asking at least one question during the informed consent process.ResultsIn total, 590 out of 4,382 (13.4%) parents/guardians asked any question during the informed consent process. We found that the likelihood of parents asking questions during the informed consent process was significantly associated with education level of either parent both parents being present, and location.ConclusionsThe findings have implications for planning the informed consent process in a largely rural setting with low levels of literacy. Greater effort needs to be directed towards developing simple participatory communication materials for the informed consent process. Furthermore, including both parents in a discussion about a child's participation in a research study may increase the extent to which consent is truly informed. Finally, continuing efforts need to be made to improve the communication skills of research workers with regard to explaining research processes and putting potential research participants at ease. (shrink)

Bitton and Eyal's lengthy critique of our article on unassisted cessation was premised on several straw-man arguments. These are corrected in our reply. It also confused the key concepts of efficacy and effectiveness in assessing the impact of cessation interventions and policies in real-world settings; ignored any consideration of reach (cost, consumer acceptability and accessibility) and failed to consider that clinical cessation interventions which fail more than they succeed also may ‘harm’ smokers by reducing agency. Our article addresses each of (...) these problems, concluding that any consideration of the ethics of promoting smoking cessation in low-income nations should begin and end with the question of whether the strategies to be adopted have any prospect of influencing significant numbers of smokers to quit. (shrink)

Scholars are beginning to use the concept medicalization of poverty to theorize how the United States spends large amounts of money on illnesses related to poverty but invests much less in preventing these illnesses and the conditions that create them. This study examines the connection between poverty, disease burden and health-related costs through the in-depth interviews of 86 Black mothers living in neighborhoods with high levels of violence on the South Side of Chicago. The rippling costs of poverty and violence (...) include 56 percent of the mothers reporting post-traumatic stress disorder symptoms and 48 percent reporting mild to severe depressive symptoms. Mothers also report poor housing quality such as “toxic mold.” The physical costs include reports of back pains, stomach aches, hair falling out, panic attacks, hands shaking, insomnia, fainting from exhaustion and lack of sexual desire, and children with asthma and osteomyelitis reportedly from the exposure to mold. Transformative solutions are explored that build upon the cultural resources of Black mothers and engage policy levers. (shrink)

Ethical challenges surrounding the implementation of male circumcision as an HIV prevention strategyResearchers have been exploring the possibility of a correlation between male circumcision and lowered risk of HIV infection almost since the beginning of the HIV/AIDS epidemic.1 Results from a randomised controlled trial in South Africa in 2005 indicate that male circumcision protects men against the acquisition of HIV through heterosexual intercourse,2 confirming the findings from 20 years of observational studies.3 Circumcised men in the South African trial were 60% (...) less likely to acquire HIV than their uncircumcised counterparts. A mathematical modelling study, based on the South African trial, estimates that the practice of male circumcision could avert two million new HIV infections and 300 000 HIV-related deaths over the next 10 years in sub-Saharan Africa.4 More recently, two randomised controlled trials in Kisumu, Kenya and Rakai, Uganda showed, respectively, 53% and 48% reductions in HIV acquisition among circumcised men than uncircumcised men in the trial.5 These results strongly suggest that male circumcision could play an important role in the struggle against the continued rise in new HIV infections. However, as observers noted at the 2006 XVI International AIDS Conference in Toronto, Canada, excitement about the potential epidemiological impact has overshadowed the debate over the difficult translation of research on male circumcision, into policy and practice.6 Similar calls for caution have been raised before and elsewhere.7,8The topic of male circumcision carries an enormous amount of ethical baggage. Male infants, worldwide, are circumcised for various medical, social and/or religious reasons. Circumcision is a cultural act and a surgical procedure; medical reasons are not the only reasons to circumcise that people have found and continue to find as compelling. Benatar and Benatar9 have argued that—when …. (shrink)