Women's Health Issues 23-6 (2013) e329–e331
www.whijournal.com
Commentary
Everything Is Not Abortion Stigma Anuradha Kumar, PhD, MPH * Ipas, Chapel Hill, North Carolina Article history: Received 8 August 2013; Received in revised form 6 September 2013; Accepted 10 September 2013
a b s t r a c t The topic of abortion stigma has caught the attention of researchers and activists working on reproductive health and rights around the world. But as research on abortion stigma grows, I fear that the concept is in danger of becoming so large and all-encompassing that it may mask deeply rooted inequalities. In addition, abortion stigma may be seen as too complex and tangled an issue, thereby leading to paralysis. It is important that we become more precise in our understanding of abortion stigma so that we can carry out better research to understand and measure it, design interventions to mitigate it, and evaluate those interventions. Copyright Ó 2013 by the Jacobs Institute of Women’s Health. Published by Elsevier Inc.
The topic of abortion stigma has caught the attention of researchers and activists working on reproductive health and rights around the world. A search of blogs on RH Reality Check reveals that the term “abortion stigma” was used in 132 blogs from 2009 to the present compared with just 26 from 2006, when RH Reality Check was founded, to 2009. In fact, the phrase “abortion stigma” did not appear in any blog before 2010. I selected 2009 as the demarcation mark because that was the year that my colleagues and I published our piece on conceptualizing abortion stigma (Kumar, Hessini, & Mitchell, 2009). In writing that paper, we discovered that there was little research on the topic at that time and so we embarked on a project of conceptualizing and researching abortion stigma. As research on abortion stigma grows, I fear that it is starting to suffer from “conceptual inflation” (Deacon, 2006) and is in danger of becoming so large and all-encompassing a concept that it may mask deeply rooted inequalities. In the stigma literature, there are two schools of thought on this. One sees a range of stigmatizing processes while others see the need to be more sharp and clear cut about what constitutes stigma (Herek, 2004; Link & Phelan, 2001). Research on abortion stigma is too nascent to take a firm stand on this matter right now, although there does seem to be a drift toward the broader, more inclusive argument. My fear and the reason for this commentary is that we may be heaping too much into the stigma basket and, in the process, will mask existing and persistent inequalities. In addition, abortion * Correspondence to: Dr. Anuradha Kumar, PhD, MPH, P.O. Box 9990, Chapel Hill, NC 27515, United States. Phone: þ1 9199605710. E-mail address: [email protected]
stigma will be seen as too complex and tangled an issue, leading to paralysis. It is important that we become more precise in our understanding of abortion stigma so that we can carry out better research to understand and measure it, design interventions to mitigate it, and evaluate those interventions. Abortion stigma has been defined as “a negative attribute ascribed to women who seek to terminate a pregnancy that marks them, internally or externally, as inferior to ideals of womanhood” (Kumar et al., 2009). This definition is linked to ideals of womanhood such as female sexuality being solely for the purpose of procreation, that women are not “real women” until they are mothers, and the idea that all women at all times wish to be mothers. The distinguishing feature, however, of abortion stigma from other types of reproductive stigmas is that women who seek to end a pregnancy are making an active decision to end a potential life (Kumar et al., 2009). It is not only life that women can give, but also death and that is deeply disturbing to the moral order. Although there are no other competing definitions of abortion stigma in the literature, there are a number of scholars who suggest variations on this definition or an expansion of it. Coming mostly from the public health, sociology, or clinical literature, we find discussion of abortion stigma as a physical deformity and a character blemish (Lipp, 2011), as a mark of shame, disgrace, or disapproval that results in social exclusion (Tagoe-Darko, 2013), as having a lasting effect that can be measured after an abortion procedure (Cockrill, Upadhyay, Turan, & Foster, 2013), as “concealable” with secrecy and disclosure being important factors (Norris et al., 2011), as a form of discrimination (Anonymous, 2012), and, for providers, as
1049-3867/$ - see front matter Copyright Ó 2013 by the Jacobs Institute of Women’s Health. Published by Elsevier Inc. http://dx.doi.org/10.1016/j.whi.2013.09.001
e330
A. Kumar / Women's Health Issues 23-6 (2013) e329–e331
something that can coexist with the moral conviction that the service they are providing is valuable (Martin, Debbink, Hassinger, & Harris, 2011). Stigma is a complex concept because it is both a cause and a consequence of inequality, thus, challenging our generally linear approach to logic. The fact that access to abortion is so limited, that few providers are trained and prepared to provide safe abortion care, and that abortion laws are part of criminal codes in many countries could all be causes of abortion stigma. Or, they could be consequences of abortion stigma. Or, more likely, it is not a binary concept and the intensity of abortion stigma may fluctuate depending on how legally restricted abortion is (Shellenberg et al., 2011). As we pointed out in our 2009 paper and as others working on stigma and leprosy, HIV, and mental health have said, stigma is a dynamic social process (Harris & Grossman, 2011; Kumar et al., 2009; Scambler, 2009). Nonetheless, it is important to analytically separate abortion stigma from other simultaneous social processes including prejudice and discrimination, both to understand the linkages between abortion stigma and these processes and to determine the specific contribution that abortion stigma makes (Phelan, Link, & Dovidio, 2006; Stuber, Meyer, & Link, 2006). Research on health stigma has shown that discrimination, that is, the treatment of one group in a preferential manner over another group, is a consequence of stigma (Bell, Salmon, Bowers, Bell, & McCullough, 2010). At the root of discrimination is a power differential; in other words, only disempowered groups or individuals are discriminated against. The women who are denied care, who go to untrained providers, or who are imprisoned for procuring an abortion, those are the women who are discriminated against. In addition, there are larger groups of women who experience stigma but not all of them face discrimination, although they may experience internalized stigma (Shellenberg et al., 2011). The extent to which this internalized stigma is harmful to women is not yet known. Power is a key variable and an imbalance of power will continue to exist even if we somehow eradicate abortion stigma. For example, we have known for years that it is poor, young, and socially excluded groups of women who are most at risk for an unsafe abortion. These groups are often stigmatized even before they enter into the abortion landscape because, for example, premarital sex may be a social taboo. Thus, the question is, how does abortion stigma as experienced by poor, young, and/ or socially excluded women affect abortion care seeking behavior. It does not mean, however, that we can ignore these power differentials. As Parker and Aggleton write: “Ultimately, therefore, stigma is linked to the workings of social inequality and to properly understand issues of stigmatization and discrimination, whether in relation to HIV and AIDS or any other issue, requires us to think more broadly about how some individuals and groups come to be socially excluded, and about the forces that create and reinforce exclusion in different settings’ (cited in Bayer, 2008, p. 465). A focus on abortion stigma must not distract us from tackling the fundamental inequalities that exist and persist in our world. Another cause for concern in having an overly broad conceptualization of abortion stigma is that activists, providers, and those of us working to improve women’s health and rights will become paralyzed in our actions, complacent in our thinking, and simplistic in our design and evaluation of stigma reduction activities. If everything is stigma, then how are we ever going to be able to hone in on a particular set of issues? How will we intervene to reduce abortion stigma? How will we know that
we have reduced stigma? In addition, we may assign too much importance to the role of abortion stigma or fail to see sites of resistance and resilience. In our 2009 paper, citing Castro and Farmer, we cautioned against this (Kumar et al., 2009). Subsequent research has shown that it is possible for women to perceive and feel abortion stigma in the form of guilt or shame while at the same time seeking out abortion services (Shellenberg et al., 2011). Providers as well can feel stigmatized and simultaneously proud of their ability to provide life-altering care to women (Harris et al., 2011; Joffe, 2010; Martin et al., 2011). It may also be possible, as it is in the HIV/AIDS field, for women to subvert abortion stigma, but we may never know if that strategy is successful if we are unable to define the edges of abortion stigma. At a recent meeting of experts in Bellagio on abortion stigma, participants agreed that not every negative reaction or attitude toward abortion is abortion stigma. The report from this meeting contains a refinement of the conceptual framework for abortion stigma as well as a learning agenda for the topic (forthcoming). In the meantime, I offer the following general suggestions. 1. Look for the edges of abortion stigma versus stigma associated with unwanted or mistimed pregnancies. Where does one end and the other begin? What are the defining features of each? 2. In environments, such as the United States, where abortion is highly politicized, greater conceptual clarity is needed on the power differentials that create and maintain abortion stigma such as those related to race, age, and class. Further research as suggested by Norris and colleagues (2011), among diverse groups and within those groups would be helpful. 3. In the United States, a strategy of storytelling or disclosure by women of their abortion experience has been used with the intention of reducing stigma and “normalizing” it. We need evidence to show if this is effective and, if so, at which leveldindividual, community, or other? 4. Time is emerging as a potentially important variable in abortion stigma; thus, longitudinal studies would be helpful, as would a retrospective look of abortion policies and laws from the point of view of stigmatizing language or behaviors.
References Anonymous. (2012). Independence of private versus public abortion providers: Implications for abortion. Journal of Family Planning and Reproductive Health Care, 38, 262–263. Bayer, R. (2008). Stigma and the ethics of public health: Not can we but should we. Social Science & Medicine, 67, 463–472. Bell, K., Salmon, A., Bowers, M., Bell, J., & McCullough, L. (2010). Smoking, stigma and tobacco ‘denormalization’: Further reflections on the use of stigma as a public health tool. A commentary on Social Science & Medicine’s Stigma, Prejudice, Discrimination and Health Special Issue (67:3). Social Science & Medicine, 70(6), 795–799. Cockrill, K., Upadhyay, U. D., Turan, J., & Foster, D. G. (2013). Stigma of having an abortion: Development of a scale and characteristics of women experiencing abortion stigma. Perspectives on Sexual and Reproductive Health, 45, 79–88. Deacon, H. (2006). Towards a sustainable theory of health-related stigma: Lessons from the HIV/AIDS literature. Journal of Comparative and Applied Social Psychology, 16, 418–425. Harris, L. H., Debbink, M., Martin, L., & Hassinger, J. (2011). Dynamics of stigma in abortion work: Findings from a pilot study of the Providers Share Workshop. Social Science and Medicine, 73, 1062–1070. Harris, L. H., & Grossman, D. (2011). Confronting the challenge of unsafe secondtrimester abortion. International Journal of Gynecology and Obstetrics, 115, 77–79. Herek, Gregory M. (2004). Beyond “homophobia”: Thinking about sexual prejudice and stigma in the twenty-first century. Sexuality Research & Social Policy, 1, 6–24.
A. Kumar / Women's Health Issues 23-6 (2013) e329–e331 Joffe, C. (2010). Dispatches from the abortion wars: The costs of fanaticism to doctors, patients, and the rest of us. Boston: Beacon Press. Kumar, A., Hessini, L., & Mitchell, E. M. H. (2009). Conceptualizing abortion stigma. Culture, Health, and Sexuality, 11, 1–15. Link, B. G., & Phelan, J. C. (2001). Conceptualizing stigma. Annual Review of Sociology, 27, 363–385. Lipp, A. (2011). Stigma in abortion care: Application to a grounded theory study. Contemporary Nurse: A Journal for the Australian Nursing Profession, 37, 115– 123. Martin, L. Debbink, M. Hassinger, J. & Harris, L. (2011). Conceptual model of the dynamics of stigma in abortion work. Poster presented at 35th Annual Meeting of the National Abortion Federation (NAF), Chicago, IL, 9-12 April 2011. Norris, A., Bessett, D., Steinberg, J. R., Kavanaugh, M. L., Zordo, S. D., & Becker, D. (2011). Abortion stigma: A reconceptualization of constituents, causes and consequences. Womens Health Issues, 21(Suppl. 3), S49–S54. Phelan, J. C., Link, B. G., & Dovidio, J. F. (2006). Stigma and prejudice: One animal or two? Social Science and Medicine, 67, 358–367.
e331
Scambler, G. (2009). Health-related stigma. Sociology of Health and Illness, 31, 441–455. Shellenberg, K. M., Moore, A. M., Bankole, A., Juarez, F., Omideyi, A. K., & Palomino, N. et al (2011). Social stigma and disclosure about induced abortion: Results from an exploratory study. Global Public Health, 6(Suppl. 1), S111–S125. Stuber, J., Meyer, I., & Link, B. (2006). Stigma, prejudice, discrimination and health. Social Science and Medicine, 67, 351–357. Tagoe-Darko, E. (2013). “Fear, shame and embarrassment”: The stigma factor in post abortion care at Komfo Anokye Teaching Hospital, Kumasi. Ghana Asian Social Science, 9, 10.
Author Descriptions Dr. Kumar has served at Ipas since 2002. Her MPH and MA in Anthropology, and her PhD in Anthropology are all from the University of North Carolina at Chapel Hill. Her A.B. in anthropology is from the University of California, Berkeley.
www.whijournal.com
Commentary
Everything Is Not Abortion Stigma Anuradha Kumar, PhD, MPH * Ipas, Chapel Hill, North Carolina Article history: Received 8 August 2013; Received in revised form 6 September 2013; Accepted 10 September 2013
a b s t r a c t The topic of abortion stigma has caught the attention of researchers and activists working on reproductive health and rights around the world. But as research on abortion stigma grows, I fear that the concept is in danger of becoming so large and all-encompassing that it may mask deeply rooted inequalities. In addition, abortion stigma may be seen as too complex and tangled an issue, thereby leading to paralysis. It is important that we become more precise in our understanding of abortion stigma so that we can carry out better research to understand and measure it, design interventions to mitigate it, and evaluate those interventions. Copyright Ó 2013 by the Jacobs Institute of Women’s Health. Published by Elsevier Inc.
The topic of abortion stigma has caught the attention of researchers and activists working on reproductive health and rights around the world. A search of blogs on RH Reality Check reveals that the term “abortion stigma” was used in 132 blogs from 2009 to the present compared with just 26 from 2006, when RH Reality Check was founded, to 2009. In fact, the phrase “abortion stigma” did not appear in any blog before 2010. I selected 2009 as the demarcation mark because that was the year that my colleagues and I published our piece on conceptualizing abortion stigma (Kumar, Hessini, & Mitchell, 2009). In writing that paper, we discovered that there was little research on the topic at that time and so we embarked on a project of conceptualizing and researching abortion stigma. As research on abortion stigma grows, I fear that it is starting to suffer from “conceptual inflation” (Deacon, 2006) and is in danger of becoming so large and all-encompassing a concept that it may mask deeply rooted inequalities. In the stigma literature, there are two schools of thought on this. One sees a range of stigmatizing processes while others see the need to be more sharp and clear cut about what constitutes stigma (Herek, 2004; Link & Phelan, 2001). Research on abortion stigma is too nascent to take a firm stand on this matter right now, although there does seem to be a drift toward the broader, more inclusive argument. My fear and the reason for this commentary is that we may be heaping too much into the stigma basket and, in the process, will mask existing and persistent inequalities. In addition, abortion * Correspondence to: Dr. Anuradha Kumar, PhD, MPH, P.O. Box 9990, Chapel Hill, NC 27515, United States. Phone: þ1 9199605710. E-mail address: [email protected]
stigma will be seen as too complex and tangled an issue, leading to paralysis. It is important that we become more precise in our understanding of abortion stigma so that we can carry out better research to understand and measure it, design interventions to mitigate it, and evaluate those interventions. Abortion stigma has been defined as “a negative attribute ascribed to women who seek to terminate a pregnancy that marks them, internally or externally, as inferior to ideals of womanhood” (Kumar et al., 2009). This definition is linked to ideals of womanhood such as female sexuality being solely for the purpose of procreation, that women are not “real women” until they are mothers, and the idea that all women at all times wish to be mothers. The distinguishing feature, however, of abortion stigma from other types of reproductive stigmas is that women who seek to end a pregnancy are making an active decision to end a potential life (Kumar et al., 2009). It is not only life that women can give, but also death and that is deeply disturbing to the moral order. Although there are no other competing definitions of abortion stigma in the literature, there are a number of scholars who suggest variations on this definition or an expansion of it. Coming mostly from the public health, sociology, or clinical literature, we find discussion of abortion stigma as a physical deformity and a character blemish (Lipp, 2011), as a mark of shame, disgrace, or disapproval that results in social exclusion (Tagoe-Darko, 2013), as having a lasting effect that can be measured after an abortion procedure (Cockrill, Upadhyay, Turan, & Foster, 2013), as “concealable” with secrecy and disclosure being important factors (Norris et al., 2011), as a form of discrimination (Anonymous, 2012), and, for providers, as
1049-3867/$ - see front matter Copyright Ó 2013 by the Jacobs Institute of Women’s Health. Published by Elsevier Inc. http://dx.doi.org/10.1016/j.whi.2013.09.001
e330
A. Kumar / Women's Health Issues 23-6 (2013) e329–e331
something that can coexist with the moral conviction that the service they are providing is valuable (Martin, Debbink, Hassinger, & Harris, 2011). Stigma is a complex concept because it is both a cause and a consequence of inequality, thus, challenging our generally linear approach to logic. The fact that access to abortion is so limited, that few providers are trained and prepared to provide safe abortion care, and that abortion laws are part of criminal codes in many countries could all be causes of abortion stigma. Or, they could be consequences of abortion stigma. Or, more likely, it is not a binary concept and the intensity of abortion stigma may fluctuate depending on how legally restricted abortion is (Shellenberg et al., 2011). As we pointed out in our 2009 paper and as others working on stigma and leprosy, HIV, and mental health have said, stigma is a dynamic social process (Harris & Grossman, 2011; Kumar et al., 2009; Scambler, 2009). Nonetheless, it is important to analytically separate abortion stigma from other simultaneous social processes including prejudice and discrimination, both to understand the linkages between abortion stigma and these processes and to determine the specific contribution that abortion stigma makes (Phelan, Link, & Dovidio, 2006; Stuber, Meyer, & Link, 2006). Research on health stigma has shown that discrimination, that is, the treatment of one group in a preferential manner over another group, is a consequence of stigma (Bell, Salmon, Bowers, Bell, & McCullough, 2010). At the root of discrimination is a power differential; in other words, only disempowered groups or individuals are discriminated against. The women who are denied care, who go to untrained providers, or who are imprisoned for procuring an abortion, those are the women who are discriminated against. In addition, there are larger groups of women who experience stigma but not all of them face discrimination, although they may experience internalized stigma (Shellenberg et al., 2011). The extent to which this internalized stigma is harmful to women is not yet known. Power is a key variable and an imbalance of power will continue to exist even if we somehow eradicate abortion stigma. For example, we have known for years that it is poor, young, and socially excluded groups of women who are most at risk for an unsafe abortion. These groups are often stigmatized even before they enter into the abortion landscape because, for example, premarital sex may be a social taboo. Thus, the question is, how does abortion stigma as experienced by poor, young, and/ or socially excluded women affect abortion care seeking behavior. It does not mean, however, that we can ignore these power differentials. As Parker and Aggleton write: “Ultimately, therefore, stigma is linked to the workings of social inequality and to properly understand issues of stigmatization and discrimination, whether in relation to HIV and AIDS or any other issue, requires us to think more broadly about how some individuals and groups come to be socially excluded, and about the forces that create and reinforce exclusion in different settings’ (cited in Bayer, 2008, p. 465). A focus on abortion stigma must not distract us from tackling the fundamental inequalities that exist and persist in our world. Another cause for concern in having an overly broad conceptualization of abortion stigma is that activists, providers, and those of us working to improve women’s health and rights will become paralyzed in our actions, complacent in our thinking, and simplistic in our design and evaluation of stigma reduction activities. If everything is stigma, then how are we ever going to be able to hone in on a particular set of issues? How will we intervene to reduce abortion stigma? How will we know that
we have reduced stigma? In addition, we may assign too much importance to the role of abortion stigma or fail to see sites of resistance and resilience. In our 2009 paper, citing Castro and Farmer, we cautioned against this (Kumar et al., 2009). Subsequent research has shown that it is possible for women to perceive and feel abortion stigma in the form of guilt or shame while at the same time seeking out abortion services (Shellenberg et al., 2011). Providers as well can feel stigmatized and simultaneously proud of their ability to provide life-altering care to women (Harris et al., 2011; Joffe, 2010; Martin et al., 2011). It may also be possible, as it is in the HIV/AIDS field, for women to subvert abortion stigma, but we may never know if that strategy is successful if we are unable to define the edges of abortion stigma. At a recent meeting of experts in Bellagio on abortion stigma, participants agreed that not every negative reaction or attitude toward abortion is abortion stigma. The report from this meeting contains a refinement of the conceptual framework for abortion stigma as well as a learning agenda for the topic (forthcoming). In the meantime, I offer the following general suggestions. 1. Look for the edges of abortion stigma versus stigma associated with unwanted or mistimed pregnancies. Where does one end and the other begin? What are the defining features of each? 2. In environments, such as the United States, where abortion is highly politicized, greater conceptual clarity is needed on the power differentials that create and maintain abortion stigma such as those related to race, age, and class. Further research as suggested by Norris and colleagues (2011), among diverse groups and within those groups would be helpful. 3. In the United States, a strategy of storytelling or disclosure by women of their abortion experience has been used with the intention of reducing stigma and “normalizing” it. We need evidence to show if this is effective and, if so, at which leveldindividual, community, or other? 4. Time is emerging as a potentially important variable in abortion stigma; thus, longitudinal studies would be helpful, as would a retrospective look of abortion policies and laws from the point of view of stigmatizing language or behaviors.
References Anonymous. (2012). Independence of private versus public abortion providers: Implications for abortion. Journal of Family Planning and Reproductive Health Care, 38, 262–263. Bayer, R. (2008). Stigma and the ethics of public health: Not can we but should we. Social Science & Medicine, 67, 463–472. Bell, K., Salmon, A., Bowers, M., Bell, J., & McCullough, L. (2010). Smoking, stigma and tobacco ‘denormalization’: Further reflections on the use of stigma as a public health tool. A commentary on Social Science & Medicine’s Stigma, Prejudice, Discrimination and Health Special Issue (67:3). Social Science & Medicine, 70(6), 795–799. Cockrill, K., Upadhyay, U. D., Turan, J., & Foster, D. G. (2013). Stigma of having an abortion: Development of a scale and characteristics of women experiencing abortion stigma. Perspectives on Sexual and Reproductive Health, 45, 79–88. Deacon, H. (2006). Towards a sustainable theory of health-related stigma: Lessons from the HIV/AIDS literature. Journal of Comparative and Applied Social Psychology, 16, 418–425. Harris, L. H., Debbink, M., Martin, L., & Hassinger, J. (2011). Dynamics of stigma in abortion work: Findings from a pilot study of the Providers Share Workshop. Social Science and Medicine, 73, 1062–1070. Harris, L. H., & Grossman, D. (2011). Confronting the challenge of unsafe secondtrimester abortion. International Journal of Gynecology and Obstetrics, 115, 77–79. Herek, Gregory M. (2004). Beyond “homophobia”: Thinking about sexual prejudice and stigma in the twenty-first century. Sexuality Research & Social Policy, 1, 6–24.
A. Kumar / Women's Health Issues 23-6 (2013) e329–e331 Joffe, C. (2010). Dispatches from the abortion wars: The costs of fanaticism to doctors, patients, and the rest of us. Boston: Beacon Press. Kumar, A., Hessini, L., & Mitchell, E. M. H. (2009). Conceptualizing abortion stigma. Culture, Health, and Sexuality, 11, 1–15. Link, B. G., & Phelan, J. C. (2001). Conceptualizing stigma. Annual Review of Sociology, 27, 363–385. Lipp, A. (2011). Stigma in abortion care: Application to a grounded theory study. Contemporary Nurse: A Journal for the Australian Nursing Profession, 37, 115– 123. Martin, L. Debbink, M. Hassinger, J. & Harris, L. (2011). Conceptual model of the dynamics of stigma in abortion work. Poster presented at 35th Annual Meeting of the National Abortion Federation (NAF), Chicago, IL, 9-12 April 2011. Norris, A., Bessett, D., Steinberg, J. R., Kavanaugh, M. L., Zordo, S. D., & Becker, D. (2011). Abortion stigma: A reconceptualization of constituents, causes and consequences. Womens Health Issues, 21(Suppl. 3), S49–S54. Phelan, J. C., Link, B. G., & Dovidio, J. F. (2006). Stigma and prejudice: One animal or two? Social Science and Medicine, 67, 358–367.
e331
Scambler, G. (2009). Health-related stigma. Sociology of Health and Illness, 31, 441–455. Shellenberg, K. M., Moore, A. M., Bankole, A., Juarez, F., Omideyi, A. K., & Palomino, N. et al (2011). Social stigma and disclosure about induced abortion: Results from an exploratory study. Global Public Health, 6(Suppl. 1), S111–S125. Stuber, J., Meyer, I., & Link, B. (2006). Stigma, prejudice, discrimination and health. Social Science and Medicine, 67, 351–357. Tagoe-Darko, E. (2013). “Fear, shame and embarrassment”: The stigma factor in post abortion care at Komfo Anokye Teaching Hospital, Kumasi. Ghana Asian Social Science, 9, 10.
Author Descriptions Dr. Kumar has served at Ipas since 2002. Her MPH and MA in Anthropology, and her PhD in Anthropology are all from the University of North Carolina at Chapel Hill. Her A.B. in anthropology is from the University of California, Berkeley.
