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.
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.
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.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.
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.
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.
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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