頁籤選單縮合
題名 | 醫療專業、性別與國家:臺灣助產士興衰的社會學分析=Medical Professions, Gender and the State: A Sociological Analysis of the Rise and Decline of Midwives in Taiwan |
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作者 | 吳嘉苓; Wu, Chia-ling; |
期刊 | 臺灣社會學研究 |
出版日期 | 20000700 |
卷期 | 4 2000.07[民89.07] |
頁次 | 頁191-268 |
分類號 | 419.95 |
語文 | chi |
關鍵詞 | 專業化; 專業自主權; 性別; 國家權力; 助產士; Professionalization; Professional autonomy; Gender; State power; Midwives; |
中文摘要 | 本研究試圖從專業社會學文獻中「權力論」的角度,來分析台灣助產士近百年的興衰。本文藉由專業變遷的四個行動者(國家、醫師、助產士、消費者)的互動關係,從專業化的五個機制(重新定義問題,工具與技術的使用,教育制度、證照制度、保險制度)切入探究。本研究發現,台灣助產士的興衰不是主流論述中「經濟及教育的成長」等結構性變遷的必然趨勢,而是各種作用力在特定歷史時空的作用結果。日治時期殖民政府由上而下的規定,固然使得助產士在教育與證照的正式規範受控於醫師,但是鑑於其女性身份在助產關係中的去性化、人力的充分以及接生自然產技術的優良,助產士成為主要的接生人。國民政府帶來了新的醫師法,使得西醫醫師突然必須面對其專業自主權所受的威脅,進而意識到與助產士的競爭關係。要到1960年代中後期起,家庭計畫等重要衛生政策才逐漸形成助產士與醫師的從屬位置。此時期在證照、教育、保險制度上國家的忽略與限制,也影響助產士的地位,造成其接生率急速下滑。90年代,助產士展開其專業計畫,也從證照、保險、教育等制度著手。台灣主流生產模式對於侵入性醫療的濫用,特別成為助產士爭取再生的利器。從台灣的例子可看出專業化的幾個機制在不同時期,有其迴異效果。同時,國家、醫療專業與性別的關係,亦存在著多種變異,必須放在特定的社會文化脈絡來探究。 |
英文摘要 | This paper investigates the rise and decline of licensed midwives in Taiwan from the power approach. I analyze the five mechanisms of (de-)professionalization ─ the redefinition of problems, the use of tools and skills, the educational system, the credential system, and the health insurance system ─ through the interaction of four social actors implicated in the process, i.e. the state, the physicians, the midwives, and the consumers. This analysis shows that the rise and decline of midwives in Taiwan is neither the inevitable outcome of a massive cause such as fast economic development or modernization, nor a “natural selection” of skills, but the consequence of diverse power struggles under specific historical conditions. Japan's colonization of Taiwan between 1895 and 1945 imported the ideas and practices of scientific midwifery. It was a top-down state policy. Although obstetricians controlled training and licensing, midwives with their superiority in numbers, gender and superlative skills, gained professional autonomy and monopolized birth attendance. Another historical rupture ─ the arrival of the Nationalist government after 1945─brought a sudden threat to the Western-style physicians' professional dominance. However, through the revision of the Physician Act in the 1960s, and the timely “help” of the family planning programs, Western-style physicians successfully augmented their hegemonic status in the medical hierarchy. In addition, without state support, such as upgrading midwifery education, midwifery quickly declined. The inauguration of National Health Insurance in 1995 and its exclusion of midwives triggered a midwifery survival/revival movement ─ a female professional project ─ for the first time in Taiwan's history. The transformation of birth attendants in Taiwan has been entangled in multi-dimensioned power struggles under specific social and historical contexts. The case of Taiwan also demonstrates the importance of historicizing the changing relationship between the state and the profession, as well as the changing nature of gender in the discussion of professionalization. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。