A Good Position for Birth

Aminata Maraesa

Description

In order to understand the local realities of health and development initiatives undertaken to reduce maternal and infant mortality, the author accompanied rural health nurses as they traveled to villages accessible only by foot over waterlogged terrain to set up mobile prenatal and well-child clinics. Through sustained interactions with pregnant women, midwives, traditional birth attendants, and bush doctors, Maraesa encountered reproductive beliefs and practices ranging from obeah pregnancy to 'nointing that compete with global health care workers' directives about risk, prenatal care, and hospital versus home birth.

Fear and shame are prominent affective tropes that Maraesa uses to understand women's attitudes toward reproduction that are at times contrary to development discourse but that make sense in the lived experiences of the women of southern Belize.

Sujets

• Latin American Studies
• Political Science
• Latin American
• CAB Direct (database)
• Health
• World
• Caribbean

Informations

• Publié par: Vanderbilt University Press
• Date de parution: 23 novembre 2018
• Nombre de lectures: 0
• EAN13: 9780826522023
• Langue: English
• Poids de l'ouvrage: 3 Mo

Extrait

A GOOD POSITION FOR BIRTH
A Good Position for Birth
PREGNANCY, RISK, AND DEVELOPMENT IN SOUTHERN BELIZE
Amínata Maraesa
Vanderbilt University Press
Nashville
© 2018 by Vanderbilt University Press
Nashville, Tennessee 37235
All rights reserved
First printing 2018
This book is printed on acid-free paper.
Manufactured in the United States of America
Library of Congress Cataloging-in-Publication Data on file
LC control number 2017044710
LC classification number RG963.B42 M37 2018
Dewey classification number 362.19820097282—dc23
LC record available at lccn.loc.gov/2017044710
ISBN 978–0-8265–2200–9 (cloth)
ISBN 978–0-8265–2201–6 (paperback)
ISBN 978–0-8265–2202–3 (ebook)
To Kennon Rodney and Miss Margaret Edwards, whose lives—and deaths—have altered my understanding of and relationship with Toledo. And for Afinatou, Safouane, and Douniya, because I love you infinity times pi times the oven you bake the pie in .
Contents
Figures and Tables
Acknowledgments
Introduction
1. Local Values in Action
2. Risk and Blame
3. In a Good Position
4. Fearless Encounters
5. “Obeah Pregnancy” and the Power of Shame
6. Adoption and Anthropological Complicity
7. Of Birth . . . and Death
Notes
References
Index
Figures and Tables
Figures
All photographs are by the author, except as noted.
1. Punta Gorda market with women in Kekchi-style dress selling vegetables
2. Punta Gorda market with Mennonite men selling watermelons
3. The satellite television company in Punta Gorda
4. Stickers affixed to a village shop vitrine
5. The slogan of a popular Belizean brand of purified bottled water reads, “The Melting Pot of Races”
1.1. A Kekchi woman and her children at a mobile health clinic
1.2. Baby suspended from the rafters in a lepob
1.3. Nurse Ical administering a vaccination on mobile clinic in Branch Mouth. Photo courtesy of Skyler Paccio
2.1. Village buses lined up at midday for their return voyages from Punta Gorda
2.2. Nurse Caal administering prenatal care at the San Juan rural health center
3.1. Miss Margaret’s framed TBA certificate reads, “The Ministry of Health certifies that M. Margaret Edwards has satisfactorily completed a course of training, 1987, in Practical Midwifery to enable her to perform efficient service as a traditional birth attendant in Westmoreland Village, Punta Gorda Road, Toledo District”
3.2. Miss Margaret standing in the doorway to her home. With limited telecommunications in Toledo, unannounced visitors knew that Miss Margaret was home only if they saw her door open
3.3. Miss Margaret’s hands ’nointing a woman who arrived complaining of excessive postpartum bleeding
3.4. Kekchi woman carrying her baby in a lepob
3.5. Bush doctor identifying plants at Itzama Medicinal Garden, Golden Stream, Toledo. Photograph by Patrycia Sulich
4.1. Wooden-slat, thatched house in rural Toledo
4.2. Rosalia bent over Elizabeth, timing the fetal heartbeat
4.3. Full width of a Kekchi woman’s skirt, hanging to dry on the side of a house in Esperanza village
4.4. Local blue crabs in a barrel
7.1. Sign erected at the entrance of Punta Gorda after the death of MaSauce. “Peini” is the name given to the area by the first Garifuna settlers
7.2. View of the sign leaving Punta Gorda erected after the death of MaSauce
7.3. The new hospital under construction in rural Toledo (2008)
7.4. Miss Margaret in her home with the author
Tables
1. Ethnic Composition: Belize and Toledo District (2010)
2. Parity of Women Attending Prenatal Clinic at Punta Gorda Hospital (July 2006)
1.1. Rural Health Center Data for the San Juan Catchment Area, pop. 5,150 (2003–2005)
1.2. Rural Health Center Data for the San Juan Catchment Area (2013–2015)
1.3. Maternal Deaths and Maternal Mortality Rates (1998–2013)
2.1. PG Prenatal Clinic Attendance and Parity
2.2. PG Prenatal Clinic Attendance and Marital Status
Acknowledgments
I thank first and foremost the people in Belize who shared their time with me throughout my fieldwork and beyond. To protect their anonymity, I cannot identify individuals by name, but please know that I am grateful for your kindness and your offering of the sensitive and personal information that has contributed to this work on reproduction. I am forever indebted to Shanon Rodney for taking care of my children, taking care of me, and eventually including us in her household and extended family network. I must acknowledge the invaluable assistance of the Ministry of Health and the many officers and personnel who facilitated my quest for knowledge. I also wish to thank GIFT and its employees for opening their doors to my project and giving me an initial start in the field. Finally, I am deeply appreciative of the many individuals who assisted me over the internet (especially Mr. Marvin Moody and the Statistical Institute of Belize) in acquiring last-minute data from archival sources in Belize and Ruth McDonald for hospital logistics and data. Thank you to Santiago Shol and Eduardo Salam for their assistance with the Kekchi-English translations, Ignasi Clemente for Spanish help, and Tyrone Avila for Garifuna grammatical correctness.
I thank my academic interlocutors Connie Sutton, Aisha Khan, Emily Martin, Don Kulick, Ulla Dalum Berg, Jack Murphy, Lauren Fordyce, Alyshia Gálvez, and Kristina Baines who provided continuous encouragement, advice, and critical reflection throughout. I especially thank Rayna Rapp for her unwavering support and confidence in my work and for looking out for me on countless occasions. And thank you Theodore Kirkland, Mark Payne, and Mohammad Hassan for your initial faith in me.
I am deeply appreciative of my many friends who maintained their belief in my madness—without your support this work would not exist (I love you Lynda, Sadiqa, Latá, and Nara). Brigitte et Daniel, je n’y serais pas arrivée sans vous . Nicole, my rock together young until we die. And Madala who was there literally from day one. But of course, Afinatou, Safouane, and Douniya: you never cease to exhibit incredible patience with a stressed-out mom. Thank you for allowing me to uproot you from the City and replant you in the bush. Life begins anew. I dream of fish. Aum Shanti .
Generous funding for various stages of this research and writing was provided by the Wenner Gren Foundation for Anthropological Research, the International Women’s Anthropology Conference, and internal grants at New York University.
A heartfelt thank you to my editor, Michael Ames.
Portions of Chapters 4 , 5 , and 6 also appear in Maternal Health, Pregnancy-Related Morbidity, and Death among Indigenous Women of Mexico and Central America: An Anthropological, Epidemiological and Biomedical Approach , edited by David Schwartz and published by Springer (2018).
Introduction
“Here we could have as many babies as we want. We no have no laws against that.”
Comment I often heard from pregnant women at the prenatal clinics
“Mr. Price say mek we build the nation!”
Teodora, a thirty-eight-year-old Mopan Maya woman discussing pregnancy 1
It is early Wednesday morning, February 2006, in Punta Gorda, the only town in the southernmost Toledo district of Belize. The sea laps at the rocky coastline, hens shepherd their broods, and schoolchildren join their peers across the country as they stand to start the day with the national anthem. Most wear uniforms, although some do not have shoes, and all learn from a very young age to be proud citizens of this peaceful democratic nation located between Central American and Caribbean political unrest and economic instability. Strolling down the sidewalk and past the open-air classrooms are the many pregnant women who come to shop, visit friends, and attend the prenatal clinic at the town hospital. Some are accompanied by young children, and others must hurry home to cook for those returning from school. For some, this is a first child, while for others who have had four, five, or more children already, this pregnancy confirms their belief that only God knows how many they will have. Although all are eligible for the free prenatal care offered through the Ministry of Health (MOH), most will not take advantage of these services until the second or third trimester, when their bodies have confirmed the existence of the pregnancy, and many will deliver their babies at home without the presence of a trained birth attendant—abiding by the folk-wisdom of the mothers before them who ensured the safe delivery of their babies through a particular kind of prenatal massage believed to set the fetus “in a good position” for birth.
Since the mid-1900s, the training of village-level health workers and “traditional birth attendants” (TBAs) by the Belizean MOH has been part of a World Health Organization (WHO) development model to encourage rural-dwelling women to engage with official medical care providers and close the purported ideological gaps between global public health-care initiatives and local practices, thereby legitimating a specific role for traditional practitioners alongside the nurse-midwives who dominate the domain of public health. In 2000, Giving Ideas for Tomorrow (GIFT), a US-based nongovernmental organization (NGO), began a TBA training program in Toledo that sparked the controversies associated with foreign involvement in local affairs observable during my fieldwork in 2006. 2 On the periphery of mainstream maternity care are “bush doctors,” the traditional healers who influence the health-care decisi