front cover of Babylost
Racism, Survival, and the Quiet Politics of Infant Mortality, from A to Z
Monica J. Casper
Rutgers University Press, 2021
The U.S. infant mortality rate is among the highest in the industrialized world, and Black babies are far more likely than white babies to die in their first year of life. Maternal mortality rates are also very high. Though the infant mortality rate overall has improved over the past century with public health interventions, racial disparities have not. Racism, poverty, lack of access to health care, and other causes of death have been identified, but not yet adequately addressed. The tragedy is twofold: it is undoubtedly tragic that babies die in their first year of life, and it is both tragic and unacceptable that most of these deaths are preventable. Despite the urgency of the problem, there has been little public discussion of infant loss. The question this book takes up is not why babies die; we already have many answers to this question. It is, rather, who cares that babies, mostly but not only Black and Native American babies, are dying before their first birthdays? More importantly, what are we willing to do about it? This book tracks social and cultural dimensions of infant death through 58 alphabetical entries, from Absence to ZIP Code. It centers women’s loss and grief, while also drawing attention to dimensions of infant death not often examined. It is simultaneously a sociological study of infant death, an archive of loss and grief, and a clarion call for social change.

front cover of Bishops and Bodies
Bishops and Bodies
Reproductive Care in American Catholic Hospitals
Lori Freedman
Rutgers University Press, 2023
One out of every six patients in the United States is treated in a Catholic hospital that follows the policies of the U.S. Conference of Catholic Bishops. These policies prohibit abortion, sterilization, contraception, some treatments for miscarriage and gender confirmation, and other reproductive care, undermining hard-won patients’ rights to bodily autonomy and informed decision-making. Drawing on rich interviews with patients and providers, this book reveals both how the bishops’ directives operate and how people inside Catholic hospitals navigate the resulting restrictions on medical practice. In doing so, Bishops and Bodies fleshes out a vivid picture of how The Church’s stance on sex, reproduction, and “life” itself manifests in institutions that affect us all.

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Challenging Pregnancy
A Journey through the Politics and Science of Healthcare in America
Genevieve Grabman
University of Iowa Press, 2022
In Challenging Pregnancy, Genevieve Grabman recounts being pregnant with identical twins whose circulatory systems were connected in a rare condition called twin-to-twin transfusion syndrome. Doctors couldn’t “unfuse” the fetuses because one twin also had several other confounding problems: selective intrauterine growth restriction, a two-vessel umbilical cord, a marginal cord insertion, and, possibly, a parasitic triplet.

Ultimately, national anti-abortion politics—not medicine or her own choices—determined the outcome of Grabman’s pregnancy. At every juncture, anti-abortion politics limited the care available to her, the doctors and hospitals willing to treat her, the tools doctors could use, and the words her doctors could say. Although she asked for aggressive treatment to save at least one baby, hospital ethics boards blocked all able doctors from helping her.

Challenging Pregnancy is about Grabman’s harrowing pregnancy and the science and politics of maternal healthcare in the United States, where every person must self-advocate for the desired outcome of their own pregnancy.

front cover of Dying to Count
Dying to Count
Post-Abortion Care and Global Reproductive Health Politics in Senegal
Siri Suh
Rutgers University Press, 2021
During the early 1990s, global health experts developed a new model of emergency obstetric care: post-abortion care or PAC. In developing countries with restrictive abortion laws and where NGOs relied on US family planning aid, PAC offered an apolitical approach to addressing the consequences of unsafe abortion. In Dying to Count, Siri Suh traces how national and global population politics collide in Senegal as health workers, health officials, and NGO workers strive to demonstrate PAC’s effectiveness in the absence of rigorous statistical evidence that the intervention reduces maternal mortality. Suh argues that pragmatically assembled PAC data convey commitments to maternal mortality reduction goals while obscuring the frequency of unsafe abortion and the inadequate care women with complications are likely to receive if they manage to reach a hospital. At a moment when African women face the highest risk worldwide of death from complications related to pregnancy, birth, or abortion, Suh’s ethnography of PAC in Senegal makes a critical contribution to studies of global health, population and development, African studies, and reproductive justice.

front cover of Formulas for Motherhood in a Chinese Hospital
Formulas for Motherhood in a Chinese Hospital
Suzanne Gottschang
University of Michigan Press, 2018
What happens to pregnant women when the largest country in the world implements a global health policy aimed at reorganizing hospitals and re- training health care workers to promote breastfeeding? Since 1992, the Chinese government has led the world in reorganizing more than 7,000 hospitals into “Baby- Friendly” hospitals. The initiative’s goal, overseen by UNICEF and the World Health Organization, is to promote the practice of breastfeeding by reorganizing hospital routines, spaces, and knowledge in maternity wards and obstetrics clinics. At the same time, China’s hospitals in the mid- 1990s operated as sites where the effects of economic reform and capitalism increasingly blurred the boundaries between state imperatives to produce healthy future citizens and the flexibility accorded individuals through their participation in an emerging consumer culture.

Formulas for Motherhood follows a group of women over eighteen months as they visited a Beijing Baby- Friendly Hospital over the course of their pregnancies and throughout their postpartum recoveries. The book shows how the space of the hospital operates as a microcosm of the larger social, political, and economic forces that urban Chinese women navigate in the process of becoming a mother. Relations between biomedical practices, heightened expectations of femininity and sexuality demanded by a consumer culture, alongside international and national agendas to promote maternal and child health, reveal new agents of maternal governance emerging at the very moment China’s economy heats up. This ethnography provides insight into how women’s creative pragmatism in a rapidly changing society leads to their views and decisions about motherhood.


front cover of Health in Ruins
Health in Ruins
The Capitalist Destruction of Medical Care at a Colombian Maternity Hospital
César Ernesto Abadía-Barrero
Duke University Press, 2022
In Health in Ruins César Ernesto Abadía-Barrero chronicles the story of El Materno—Colombia’s oldest maternity and neonatal health center and teaching hospital—over several decades as it faced constant threats of government shutdown. Using team-based and collaborative ethnography to analyze the social life of neoliberal health policy, Abadía-Barrero details the everyday dynamics around teaching, learning, and working in health care before, during, and after privatization. He argues that health care privatization is not only about defunding public hospitals; it also ruins rich traditions of medical care by denying or destroying ways of practicing medicine that challenge Western medicine. Despite radical cuts in funding and a corrupt and malfunctioning privatized system, El Materno’s professors, staff, and students continued to find ways to provide innovative, high-quality, and noncommodified health care. By tracking the violences, conflicts, hopes, and uncertainties that characterized the struggles to keep El Materno open, Abadía-Barrero demonstrates that any study of medical care needs to be embedded in larger political histories.

front cover of Managing Motherhood, Managing Risk
Managing Motherhood, Managing Risk
Fertility and Danger in West Central Tanzania
Denise Roth Allen
University of Michigan Press, 2004

In Managing Motherhood, Managing Risk, Denise Roth Allen persuasively argues that development interventions in the Third World often have unintended and unacknowledged consequences. Based on twenty-two months of fieldwork in the Shinyanga Region of west central Tanzania, this rich and engaging ethnography of women's fertility-related experiences highlights the processes by which a set of seemingly well-intentioned international maternal health policy recommendations go awry when implemented at the local level.

An exploration of how threats to maternal health have been defined and addressed at the global, national, and local levels, Managing Motherhood, Managing Risk presents two contrasting, and oftentimes competing, definitions of risk: those that form the basis of international recommendations and national maternal health policies and those that do not. The effect that these contrasting definitions of risk have on women's fertility-related experiences at the local level are explored throughout the book.

This study employs an innovative approach to the analysis of maternal health risk, one that situates rural Tanzanian women's fertility-related experiences within a broader historical and sociocultural context. Beginning with an examination of how maternal health risk was defined and addressed during the early years of British colonial rule in Tanganyika and moving to a discussion of an internationally conceived maternal health initiative that was launched on the world stage in the late 1980s, the author explores the similarities in the language used and solutions proposed by health development experts over time.

This set of "official" maternal health risks is then compared to an alternative set of risks that emerge when attention is focused on women's experiences of pregnancy and childbirth at the local level. Although some of these latter risks are often spoken about as deriving from spiritual or supernatural causes, the case studies presented throughout the second half of the book reveal that the concept of risk in the context of pregnancy and childbirth is much more complex, involving the interplay of spiritual, physical, and economic aspects of everyday life.


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The Medical Delivery Business
Health Reform, Childbirth, and the Economic Order
Perkins, Barbara Bridgman
Rutgers University Press, 2004


Americans at the end of the twentieth century worried that managed care had fundamentally transformed the character of medicine. In The Medical Delivery Business, Barbara Bridgman Perkins uses examples drawn from maternal and infant care to argue that the business approach in medicine is not a new development. Health care reformers throughout the century looked to industrial, corporate, and commercial enterprises as models for the institutions, specialties, and technological strategies that defined modern medicine.

In the case of perinatal care, the business model emphasized specialized over primary care, encouraged the use of surgical and technological procedures, and unnecessarily turned childbirth into an intensive care situation. Active management techniques, for example, encouraged obstetricians to accelerate labor with oxytocin to augment their productivity. Despite the achievements of the childbirth and women’s health movement in the 1970s, aggressive medical intervention has remained the birth experience for millions of American women (and their babies) every year.

The Medical Delivery Business challenges the conventional view that a dose of the market is good for medicine. While Perkins is sympathetic to the goals of progressive and feminist reformers, she questions whether their strategies will succeed in making medicine more equitable and effective. She argues that the medical care system itself needs to be fundamentally "re-formed," and the reforms must be based on democracy, caring, and social justice as well as economics.


front cover of Medicalized Motherhood
Medicalized Motherhood
Perspectives from the Lives of African-American and Jewish Women
Jacquelyn S. Litt
Rutgers University Press, 1999
The 1946 publication of Dr. Benjamin Spock's Baby and Child Care signaled the pervasive influence of expert 'medicalized motherhood' in mid-twentieth-century America. Throughout the previous two decades, pediatricians and women's magazines alike advised mothers of the importance of physicians' guidance for the everyday care of their children, and Spock's book popularized this advice, particularly among white, middle-class women.

When Jacquelyn S. Litt interviewed African-American and Jewish women who raised their children in the 1930s and 1940s, she found that these women responded to experts' advice in ways uniquely shaped by their ethnicity, race, and class. For middle-class African-American and Jewish women, medicalization took place in ethnically/racially segregated networks and functioned as a collectively held strategy for social advance as much as a set of technical practices for raising healthy children. For poor, single African-American mothers, everyday networks offered limited access to medical institutions or mainstream norms. Medical discourse was largely controlled by white women and men, which left these women disempowered in medical institutions and marginal to dominant definitions of acceptable mothering.

Litt's book is enriched with many narratives from the mothers themselves. Both the women's voices and her acute sociological research bring to light how medicalized motherhood, while not the single cause of difference and inequality among the women, was a site where they were produced.

logo for Temple University Press
Midwifery and Childbirth in America
Judith Rooks
Temple University Press, 1999
Childbirth is both a profound experience and a contested subject. The experience of women has complex medical, historical, cultural, and public policy dimensions. In this book, Judith Rooks achieves the rare feat of bringing these dimensions together in a way that  can be appreciated by health care planners, midwives, physicians, and women considering pregnancy.

The author vividly describes the history of struggle among health care providers over the meaning and handling of the birth process. The medical model and the midwifery model continue to collide today, the former focusing on pathology and monitoring the patient for it, the latter focusing on birth as a normal, healthy process.

The education and professional training of those who care for women during pregnancy, childbirth, and the important postpartum period reflects these divisions. Obstetrics, family physicians, midwives, nurses, and others play roles in providing the necessary care. In focusing on midwives, Rooks deals fairly and sensitively between certified nurse-midwives and direct-entry midwives, most of whom lack formal educational preparation in midwifery.

This book describes clearly and with documented scientific evidence the specific benefits of the midwifery approach to the care of pregnant women and their families. In clear language accessible to the lay reader, Rooks summarizes the research on the unintended effects of obstetrical interventions, such as episiotomies, epidurals, C-sections, and continuous electronic fetal heart monitoring, and the effectiveness and important benefits of an approach that focuses on the positive potential of childbearing, as contrasted with a narrow focus of potential for pathology. While she acknowledges the importance of access to medical care, extensive research shows the advantages of the midwifery approach. Much that passes for "routine" obstetric care in the United States has been found to be unnecessary, ineffective, or even harmful when applied to women with normal pregnancies.

The  arguments over the control of childbirth are set in the context of recent changes in health care, including the current transition to managed care; the impact of the women's movement and movements for natural childbirth, home birth, and breastfeeding; and women's fear of and concern about the pain associated with labor. Rooks also explains the influence of the reports and recommendations of prestigious scientific and health-policy commissions and of federal initiatives and programs on the care provided to pregnant women in this country. She contrasts U.S. practices with those of comparable industrialized countries like the European states, Canada, Australia, New Zealand, and Japan.

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Midwives and Mothers
The Medicalization of Childbirth on a Guatemalan Plantation
By Sheila Cosminsky
University of Texas Press, 2016

The World Health Organization is currently promoting a policy of replacing traditional or lay midwives in countries around the world. As part of an effort to record the knowledge of local midwives before it is lost, Midwives and Mothers explores birth, illness, death, and survival on a Guatemalan sugar and coffee plantation, or finca, through the lives of two local midwives, Doña Maria and her daughter Doña Siriaca, and the women they have served over a forty-year period.

By comparing the practices and beliefs of the mother and daughter, Sheila Cosminsky shows the dynamics of the medicalization process and the contestation between the midwives and biomedical personnel, as the latter try to impose their system as the authoritative one. She discusses how the midwives syncretize, integrate, or reject elements from Mayan, Spanish, and biomedical systems. The midwives’ story becomes a lens for understanding the impact of medicalization on people’s lives and the ways in which women’s bodies have become contested terrain between traditional and contemporary medical practices. Cosminsky also makes recommendations for how ethno-obstetric and biomedical systems may be accommodated, articulated, or integrated. Finally, she places the changes in the birthing system in the larger context of changes in the plantation system, including the elimination of coffee growing, which has made women, traditionally the primary harvesters of coffee beans, more economically dependent on men.


front cover of No Alternative
No Alternative
Childbirth, Citizenship, and Indigenous Culture in Mexico
By Rosalynn A. Vega
University of Texas Press, 2018

Recent anthropological scholarship on “new midwifery” centers on how professional midwives in various countries are helping women reconnect with “nature,” teaching them to trust in their bodies, respecting women’s “choices,” and fighting for women’s right to birth as naturally as possible. In No Alternative, Rosalynn A. Vega uses ethnographic accounts of natural birth practices in Mexico to complicate these narratives about new midwifery and illuminate larger questions of female empowerment, citizenship, and the commodification of indigenous culture, by showing how alternative birth actually reinscribes traditional racial and gender hierarchies.

Vega contrasts the vastly different birthing experiences of upper-class and indigenous Mexican women. Upper-class women often travel to birthing centers to be delivered by professional midwives whose methods are adopted from and represented as indigenous culture, while indigenous women from those same cultures are often forced by lack of resources to use government hospitals regardless of their preferred birthing method. Vega demonstrates that women’s empowerment, having a “choice,” is a privilege of those capable of paying for private medical services—albeit a dubious privilege, as it puts the burden of correctly producing future members of society on women’s shoulders. Vega’s research thus also reveals the limits of citizenship in a neoliberal world, as indigeneity becomes an object of consumption within a transnational racialized economy.


front cover of Obstetrics and Gynecology in Low-Resource Settings
Obstetrics and Gynecology in Low-Resource Settings
A Practical Guide
Nawal M. Nour
Harvard University Press, 2016

Responding to the growing need for tried-and-trusted solutions to the reproductive health care issues confronting millions of women worldwide, Obstetrics and Gynecology in Low-Resource Settings provides practical guidelines for ensuring the delivery of quality OB/GYN care to women in resource-poor countries. Including contributions from leading clinicians and researchers in the field, this welcome overview fills an important gap in existing medical literature on women’s health care and will be an invaluable resource for doctors, clinicians, and medical students at all stages of their careers who work in the global health arena.

The reproductive health risks that all women face are greatly exacerbated when health care facilities are inadequate, equipment and medications are in short supply, and well-trained medical staff are few and far away. Often in these settings, the sole doctor or medical professional on hand has expertise in some areas of women’s reproductive care but needs a refresher course in others.

This informative guide features hands-on, step-by-step instruction for the most pertinent OB/GYN conditions—both acute and chronic—that health care workers in the field confront. The authors examine a wide range of topics, including: strategies to reduce maternal mortality and stillbirths; infectious and sexually transmitted diseases, including malaria and HIV; cervical cancer; contraception; prenatal, delivery, and newborn care; and complications arising from gender-based violence and female genital cutting. Published in a convenient format with a durable binding, this reference will be an essential companion to health care providers throughout the world.


front cover of A Pleasing Birth
A Pleasing Birth
Midwives And Maternity Care
Raymond De Vries
Temple University Press, 2005
Women have long searched for a pleasing birth—a birth with a minimum of fear and pain, in the company of supportive family, friends, and caregivers, a birth that ends with a healthy mother and baby gazing into each other's eyes. For women in the Netherlands, such a birth is defined as one at home under the care of a midwife. In a country known for its liberal approach to drugs, prostitution, and euthanasia, government support for midwife-attended home birth is perhaps its most radical policy: every other modern nation regards birth as too risky to occur outside a hospital setting. In exploring the historical, social, and cultural customs responsible for the Dutch way of birth, Raymond De Vries opens a new page in the analysis of health care and explains why maternal care reform has proven so difficult in the U.S. He carefully documents the way culture shapes the organization of health care, showing how the unique maternity care system of the Netherlands is the result of Dutch ideas about home, the family, women, the body and pain, thriftiness, heroes, and solidarity. A Pleasing Birth breaks new ground and closes gaps in our knowledge of the social and cultural foundations of health care. Offering a view into the Dutch notion of maternity care, De Vries also offers a chance of imagining how Dutch practices can reform health care in the U.S. not just for mothers and babies, but for all Americans.

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The Politics of Potential
Global Health and Gendered Futures in South Africa
Michelle Pentecost
Rutgers University Press, 2024
The first one thousand days of human life, or the period between conception and age two, is one of the most pivotal periods of human development. Optimizing nutrition during this time not only prevents childhood malnutrition but also determines future health and potential. The Politics of Potential examines early life interventions in the first one thousand days of life in South Africa, drawing on fieldwork from international conferences, government offices, health-care facilities, and the everyday lives of fifteen women and their families in Cape Town. Michelle Pentecost explores various aspects of a politics of potential, a term that underlines the first one thousand days concept and its effects on clinical care and the lives of childbearing women in South Africa. Why was the First One Thousand Days project so readily adopted by South Africa and many other countries? Pentecost not only explores this question but also discusses the science of intergenerational transmissions of health, disease, and human capital and how this constitutes new forms of intergenerational responsibility. The women who are the target of first one thousdand days interventions are cast as both vulnerable and responsible for the health of future generations, such that, despite its history, intergenerational responsibility in South Africa remains entrenched in powerfully gendered and racialized ways.

The Ohio State University Press, 2003

In the early twentieth century, shifting attitudes and new public health standards brought an unprecedented interest in and effort to regulate issues affecting reproduction and maternity. Maternal and infant health, nutrition, and medical care came under scrutiny, as did the issue of birth control. While the prior gained public support, the latter remained controversial. Though some reformers saw birth control as an important part of maternal welfare, others sought to separate it from more popular reforms. The careers of the four prominent but usually neglected reformers (Elizabeth Lowell Putnam, Ethel Sturges Dummer, Mary Ware Dennett, and Blanche Ames) examined in this book embody the struggle to define and resolve these tensions.

The study of these reformers offers a new perspective on more recognized leaders in the arena of reproductive health and rights, especially the U.S. Children's Bureau and Margaret Sanger. Putnam's elitism contextualizes the class politics of the Bureau, underscoring its sensitivity to the vulnerable and its innovative approach to public health. Dummer reminds us of roads not taken by policy makers in the Bureau, accentuating the differences between a child-centered and a woman-centered agenda. Dennett highlights the obstacles to women reformers in the formal political sphere, while Ames's penchant toward maternalism and compromise also led to difficulties. Together, they illustrate the complexities of formulating an effective approach to securing reproductive rights and health.


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