Online Program

Negotiating shame versus dignity-based service provision and policymaking in the Women Infant & Children Public Health Nutrition and Breastfeeding Program

Tuesday, November 3, 2015 : 12:50 p.m. - 1:10 p.m.

Aline Gubrium, PhD, Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA
Sabina Dhakal, MPH, Department of Research and Wellness, Caring Health Center, Springfield, MA
Cristina Huebner-Torres, M.A, Caring Health Center, Springfield, MA
Background: Psychosocial meanings of wealth and poverty go beyond the material, with poverty defined as a shameful and corrosive social relation characterized by a lack of voice, disrespect, humiliation and reduced dignity and self-esteem. Little attention has been paid to the implications of the poverty/shame nexus for the design of effective anti-poverty measures – including policies directed at maternal and child health. 

Objectives: To investigate the perspectives and experiences of provider and recipients (“participants”) of WIC programs located in Massachusetts.

Methods: Data was collected through individual interviews with providers and recipients and through observation of participant-recipient interactions at intake sessions and activities at a WIC office operating out of a federally qualified health center in MA.

Findings: Our findings highlight the need for advanced training for WIC staff focused on respectful communication. We also note key themes around staff support, namely in the areas of clear and realistic work expectations (i.e. especially in the realm of paperwork and documentation), number of staff supported at the site, continuous training opportunities, and work/life balance. Shame-proofing modifications directed at recipients include more individualized/personalized follow-up by an assigned caseworker and attention to how discretion is used in food supplement decisions and the provision of nutritional education. 

Conclusion/Discussion: Shame is an important dimension to consider when developing and delivering measures around nutrition and food security. Attention to this dimension across the spectrum of professional practice will enhance the effectiveness of these measures by promoting human dignity and social cohesion.

Learning Areas:

Administration, management, leadership
Assessment of individual and community needs for health education
Provision of health care to the public
Public health or related organizational policy, standards, or other guidelines
Public health or related public policy
Social and behavioral sciences

Learning Objectives:
Describe the structural role played by the social emotions, notably shame, in the delivery of anti-poverty services. Explain the implications of the poverty-shame nexus for the design of effective anti-poverty measures. Analyze the changing world of anti-poverty measure implementation through a poverty-shame lens. Differentiate shame and dignity based WIC service provision. List key features of dignity-focused policymaking around WIC and food security.

Keyword(s): Poverty, Food Security

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the Principal Investigator on the Poverty and Shame project and have conducted research and education in public health and focused on the provision of dignity-based services for the past 8 years.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.