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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.

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.