Adaptation and Resignation to Perceived Risks in Rural Tanzania
Total Page：16
File Type：pdf, Size：1020Kb
‘Ni kubahatisha tu!’ ‘It’s just a game of chance!’ Adaptation and resignation to perceived risks in rural Tanzania Nicola Desmond © A Thesis submitted to the University of Glasgow in fulfilment of the degree of Doctor of Philosophy Medical Research Council Social and Public Health Sciences Unit University of Glasgow February 2009 Abstract Many HIV/AIDS prevention interventions have been shown to increase awareness and knowledge but few have been shown to impact on behaviour. This ethnographic study was designed to provide a holistic account of risk perception in order to inform our understandings of how HIV risk is perceived. Through qualitative methods it is both a deductive testing of the risk theories of Douglas and Giddens and an inductive, grounded investigation to identify which risks are prioritised and the discourses which influence risk perceptions in one rural and one neighbouring peri-urban site in north-western Tanzania. Risk perception is framed by multiple, sometimes contradictory, discourses which shape individual perceptions of risk at particular moments. These are defined as a series of ‘risk moments’, each of which is context specific and contingent on dynamic social conditions. Living in a society in flux, where multiple forms of tradition co-exist with modern ideals, rural dwellers’ experiences of past misfortune are often interpreted to inform a future- oriented risk perception. The role of chance and fatalism are dominant public and private discourses, but ones which co-exist with collective and individual capabilities to control risk through reliance on social capital and social networks to create maendeleo (development), despite restricted lifestyle alternatives and vulnerable socio-economic conditions. Responses to some risks are invariable and predictable, such as routinised actions like hand washing. Responses to other risks, such as crop failure, vary according to predictable patterns. These patterns include social position and biography, defined through gender, socio-economic status, partner type and exposure to alternative lifestyle choices through migration. This is one of several ways in which risk perceptions are dominated by social factors. Others are the presumed social causes of many risks, and the social benefits or costs of risk aversion. Conflicting social risks, such as exposure to jealousy and being too trusting, are subject to cautious strategies to manage ambiguous social relations. Within this dynamic social world, characterised by contradictions between adaptation and resignation, risk priorities are constantly re-assessed and management strategies re- negotiated as individuals encounter novel circumstances. The results from this research have confirmed this contingent nature of risk perception and contributed to our knowledge of people’s approaches towards health risks and understandings of prevention which may be useful in the design of appropriate behaviour change campaigns. 2 Table of Contents Abstract_________________________________________________________________2 Table of Contents _________________________________________________________3 Acknowledgements________________________________________________________6 A note on the text ________________________________________________________10 Glossary of Swahili and Sukuma Terms______________________________________11 Chapter 1: Introduction ___________________________________________________14 Chapter 2 Literature Review _______________________________________________23 2.1 Introduction _____________________________________________________________23 2.2 The meaning of risk_______________________________________________________25 2.3 Theories of risk __________________________________________________________27 2.3.1 Risk perception at the individual level_____________________________________________ 27 2.3.2 Risk perception at the social level ________________________________________________ 28 2.3.3 Risk perception as societal change _______________________________________________ 30 2.4 An overview of empirical studies ____________________________________________32 2.4.1 Methodological Approaches ____________________________________________________ 32 2.4.2 Development of mid-level theory ________________________________________________ 37 2.4.3 The deductive use of grand theory________________________________________________ 39 2.5 Risk perception as a route to understanding HIV/AIDS _________________________41 2.6 The Sukuma of north-western Tanzania______________________________________42 2.6.1 Broad social divisions _________________________________________________________ 43 2.6.2 The family and marriage _______________________________________________________ 46 2.6.3 Parochialism and involvement in the cash economy __________________________________ 48 2.6.4 Village organizations__________________________________________________________ 50 2.7 Witchcraft as discourse____________________________________________________51 Chapter 3: ‘Risky practice’: qualitative methods for risk research in Tanzania_______56 3.1 Introduction _____________________________________________________________56 3.2 Background _____________________________________________________________57 3.3 Communication strategies _________________________________________________60 3.4 Learning to live a different life______________________________________________62 3.5 Researching risk: the tools and process of data collection________________________65 3.5.1 Participant Observation ________________________________________________________ 66 3.5.2 Focus Group Discussions_______________________________________________________ 68 3.5.3 In-depth Interviews ___________________________________________________________ 69 3.5.4 Sampling ___________________________________________________________________ 71 3.5.5 Other data collection tools ______________________________________________________ 73 3.5.6 Limitations of the data_________________________________________________________ 75 3.6 Managing perceptions through participation: Personal experiences and challenges in social relations ______________________________________________________________75 3.7 Seeking explanation: post-fieldwork data analysis______________________________81 Chapter 4: A comparative ethnography of two field sites ________________________85 4.1 Geography of the field sites_________________________________________________85 4.2 Economic landscape ______________________________________________________86 4.2.1 Agricultural livelihoods________________________________________________________ 86 4.2.2. Livestock husbandry__________________________________________________________ 92 3 4.2.3 Non-agricultural livelihoods ____________________________________________________ 95 4.2.4 The role of fishing in a mixed livelihood, lakeside economy __________________________ 100 4.2.5 The role of migration_________________________________________________________ 101 4.3 The social landscape _____________________________________________________103 4.3.1 Socio-demographic characteristics ______________________________________________ 103 4.3.2 Home environments__________________________________________________________ 104 4.3.3 Aspects of family life_________________________________________________________ 108 4.3.4 Wider social networks and obligations ___________________________________________ 113 4.4 Local administration, health and religion ____________________________________118 4.4.1 Political organisation and law enforcement________________________________________ 118 4.4.2 Education__________________________________________________________________ 119 4.4.3 Health ____________________________________________________________________ 121 4.4.4 Cosmologies _______________________________________________________________ 122 4.5 Conclusion _____________________________________________________________124 Chapter 5: Mapping Risk ________________________________________________125 5.1 The construction of risk perception_________________________________________125 5.2 Etic descriptions of risk___________________________________________________126 5.2.1 Externally funded interventions as socially constructed ‘objectivity’ ____________________ 126 5.2.2 Local biomedical services and risk assessments as value-laden and partial _______________ 128 5.3 Emic descriptions of risk__________________________________________________132 5.3.1 The meaning of ‘risk’ through methodological differences____________________________ 132 5.3.2 The meaning of ‘risk’ in translation______________________________________________ 144 5.4 Quantified descriptions of risk priorities ____________________________________148 5.5 Conclusions_____________________________________________________________156 Chapter 6: The centrality of the social in risk perception _______________________157 6.1 Risk perception explored through a social framework _________________________157 6.2 Risk perceptions embedded in social relations ________________________________159 6.2.1 Mariam’s risk priorities: a case study of ambiguity in social relations ___________________ 159 6.2.2 The significance of social relations to economic risk ________________________________ 164 6.3 The influence of social position on risk perception_____________________________169 6.4 Risk aversion informed by social relations ___________________________________181 6.5 The ‘impact of anti-social capital’ and the salience of social risks ________________189 6.6 Conclusions_____________________________________________________________194