Written by Brianna Cusanno, graduate student at University of South Florida & alumna of the Institute for Public Health Summer Research Program
When I entered the Institute for Public Health Summer Research Program – Public and Global Health Track in June 2015, I was a college junior with little interest research as a career. Four years later, I’ve become a National Science Foundation Graduate Research Fellow, have nearly completed my master’s, and am preparing to begin my PhD this fall.
The work I did with my PI at WashU, Dr. Mary Politi, Associate Professor in the Department of Surgery, transformed my goals and led me to where I am today. I worked with Dr. Politi for two summers and, during this time, she encouraged my development as a scholar and demonstrated to me the power of research for creating social change.
One project I worked on with Dr. Politi focused on patient and provider narratives around contraception and, particularly, the important role social narratives play in women’s decisions about birth control. After publishing a paper on this work with Dr. Politi and several other collaborators*, I wanted to further explore the power of narratives in reproductive health. I recently completed my MA thesis, which focuses on these issues. Specifically, my study examined how healthcare providers communicate the intersections of race, reproductive health, and policy in their narratives.
I’d like to share a brief narrative from one of my thesis participants, Dr. Martin (pseudonym), a new attending in Obstetrics and Gynecology who is trained in providing abortions. He told me that he had not originally planned to get this training when he entered medical school. I asked him if there was any experience that changed his mind, and he told me the following story (Trigger Warning: Incest, rape, abortion).
- M: I do remember one patient that um, I saw at the- the small, under-funded, um, it was really a women’s healthcare clinic, but provided abortions on one day of the week. And, I saw a patient who was still in her high school years. Still a teenager. Who—again, I don’t wanna mess up details—but, this is her first or second abortion, as a result from an incestuous, like a molestation sort of relationship. And so, y’know, I say it’s not up to me whether it’s morally or ethically right to provide those services? But I would challenge anybody to find anyone who thought that relationship was a morally or ethically right relationship to be having. And, I challenge anybody to find that poor girl at fault for that. So.
- Bria: What do you think was so powerful about that, to you? That that patient sticks out to you.
- M: I think that patient was the first one that, I- first case like that that I had ever experienced. And, maybe ever have since. I- I’m not saying that that is a, y’know, common occurrence. But, y’know, when you follow the national debate about such topics, sure. You read the pros and cons about both sides? And, all the hypothetical situations. ‘What about this? What about that? What about’- And that was the first time— and the one, the only time that’s really emblazoned on my mind—that, um, it wasn’t a hypothetical or theoretical situation. It was a very real situation.
- Bria: What would you want people to take away from that? (…)
- M: I think what I would want people to take away from it is that, (pauses) is that (pauses), as the people who make these decisions, on a regional and national level, that have far reaching implications. And, um, ((pauses)) I wish that they ((pauses)) I just want them to be aware, that these are not trivial matters, and they’re not theoretical and hypothetical situations. That, again, they are not necessarily—well, in my experience, I haven’t commonly encountered, um, some of these things that they talk about—But, when, when you, look at things collectively across the region, or nation, numbers add up. And it becomes a much bigger deal. I don’t know. That’s a good question. I haven’t thought a lot about what I want people to know about it. ((Pauses)) Maybe that’s the problem. Maybe that’s my problem with being like, a bystander. You’re just waiting for things to ((laughing)) trickle down, excuse me. Um, that maybe not being proactive enough. Or active enough.
I wanted to share this story with my Institute of Public Health colleagues for two reasons. First, as debates about abortion rights and policies are currently raging, Dr. Martin’s narrative feels urgent and relevant to me. It reminds me to stay grounded in the knowledge that the consequences of our policy choices are “not theoretical or hypothetical.”
At the same time, it also illustrates the potential of narratives. Earlier in our interview, when I asked Dr. Martin what policy had meant to him, he had described policy as something made by more powerful people that eventually trickled down to him. He felt he had little role in policy decisions. This was not a point I pushed him on; I just listened. However, as he explored this story with me, he began to reconsider his view. He wondered aloud if being a “bystander” to politics might be a problematic approach. I’m not sure if Dr. Martin decided to take a more active role in politics after our conversation. Still, I value our interaction and the opportunity for reflection—on both sides—it created.
I’m grateful to the Summer Research Program and Dr. Politi for introducing me to qualitative methods and to research on health narratives. I’m eager to continue my research exploring the potential of health narratives for encouraging personal growth and social change.
*Cusanno, B. R., Estlund, A., Madden, T., Buckel, C. M., & Politi, M. C. (2018). The role of narratives in patient-provider discussions about contraceptive decisions. European Journal for Person Centered Healthcare, 6(2), 307-313.
Cusanno, Brianna R. 2019. “‘It’s a Broken System That’s Designed to Destroy’: A Critical Narrative Analysis of Healthcare Providers’ Stories about Race, Reproductive Health, and Policy.” Thesis. University of South Florida.