Professor Nathanson has published widely on the relation of gender to morbidity, mortality, and health services use and on reproductive health, focusing on adolescent fertility and the institutional provision of reproductive health services (hospital care, abortion services, and the like). Nathanson published the first paper (Social Science and Medicine, 1975) to call attention to the (apparent) paradox of women’s higher morbidity as compared to men’s higher mortality, with subsequent work building on, and substantially complicating, these findings. In a large NICHD/DBSB-funded study of contraceptive continuation among teenage women, she discovered that family planning clinic variables (clinic structure, attitudes and beliefs of clinic nurses) played a far larger role in continuation than did the young women’s attitudes and beliefs. These unanticipated results led, first, to Ford Foundation-supported qualitative research on young women’s experience with birth control pill use (published in Dangerous Passage: The Social Control of Sexuality in Women’s Adolescence); second, to a conceptual paper using bargaining theory to account for the timing of sexual debut (Nathanson and Schoen, 1993); third, to a paper with Young Kim disaggregating change over time in adolescent fertility (published in Demography in 1989); and, finally, to a (continuing) interest in the social, political, and historical circumstances surrounding the emergence and definition of public health problems, and in solutions proposed and implemented. Dangerous Passage heralded a shift in Nathanson’s scholarship toward more historically-informed, policy-oriented approaches to population health research.
Beginning in 1997 with the publication (in PDR) of “Disease prevention as social change: toward a theory of public health,” Nathanson began an extended cross-national exploration of the social and political processes that shape public health policies. This work, published in a series of articles, culminated with the March 2007 publication by the Russell Sage Foundation of Disease Prevention as Social Change: The State, Society, and Public Health in the United States, France, Great Britain, and Canada. This research illuminates the close connection between political structures and public health policy processes and makes clear the limitations of social movements as catalysts for policy change, particularly as affecting marginalized and vulnerable populations. Building on her earlier research, Nathanson’s current work on gender and mortality, which explores interactions with socioeconomic status, represents collaboration with Peter Messeri and Tom DiPrete. Other current collaborations include research on the individual and societal impacts of ART (antiretroviral therapy) scale-up (with Jennifer Hirsch and a multi-university team) and a large capacity-building project in the social sciences and health in Vietnam, led by Jennifer Hirsch, with Richard Parker and colleagues at Hanoi Medical University. The former project was the subject of an R01 resubmission to NICHD in September 2007, and the latter has been approved by Council and is awaiting an NGA from NICHD. Finally, Nathanson is working with Richard Parker on a Ford Foundation-funded analysis of policy contests and conflicts around sexual and reproductive health policies in eight countries, the UN and the World Bank.
First, the project on interaction of gender and socioeconomic status with health and mortality mentioned earlier will provide preliminary data for an R01 submission in fall 2007. Second, recent years have seen an explosion of developing country social movements and NGOs in the arenas of reproductive and sexual health, attributed to a variety of factors (e.g., democratization, neoliberal economic policies), yet almost no empirical evidence exists as to the relative importance of various explanations; Nathanson plans to develop a proposal for submission to NICHD or NSF that will examine alternative hypotheses. Third, in the context of the two projects with Hirsch, Nathanson will develop a proposal to examine the relative importance of individual/couple level and structural (primarily clinic-level) variables on the implementation of ART scale-up.