Delivering Health
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Honorable Mention for the Association for Feminist Anthropology's Rosaldo Book Prize, 2021

Maternal health outcomes are a key focus of global health initiatives. In Delivering Health, author Lydia Z. Dixon uncovers the ways such outcomes have been shaped by broader historical, political, and social factors in Mexico, through the perspectives of those who are at the front lines fighting for change: midwives.

Midwives have long been marginalized in Mexico as remnants of the country's precolonial past, yet Dixon shows how they are now strategically positioning themselves as agents of modernity and development. Midwifery education programs have popped up across Mexico, each with their own critique of the health care system and vision for how midwifery can help. Delivering Health ethnographically examines three such schools with very different educational approaches and professional goals. From San Miguel de Allende to Oaxaca to Michoacán and points between, Dixon takes us into the classrooms, clinics, and conferences where questions of what it means to provide good reproductive health care are being taught, challenged, and implemented. Through interviews, observational data, and even student artwork, we are shown how underlying inequality manifests in poor care for many Mexican women. The midwives in this book argue that they can improve care while also addressing this inequality. Ultimately, Delivering Health asks us to consider the possibility that marginalized actors like midwives may hold the solution to widespread concerns in health.
Chapter 1: Midwifery in Mexico and Beyond
Chapter 2: Breaking out of the “Uterus Box”
Chapter 3: Maternal Conditions
Chapter 4: Obstetrics in a Time of Violence
Chapter 5: Modern Tradition
Conclusion: Creating Demand and Demanding Change



Publié par
Date de parution 15 novembre 2020
Nombre de lectures 0
EAN13 9780826501158
Langue English
Poids de l'ouvrage 1 Mo

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SERIES EDITORS: Svea Closser, Emily Mendenhall, Judith Justice, & Peter J. Brown
Policy to Practice: Ethnographic Perspectives on Global Health Systems illustrates and provides critical perspectives on how global health policy becomes practice, and how critical scholarship can itself inform global public health policy. Policy to Practice provides a venue for relevant work from a variety of disciplines, including anthropology, sociology, history, political science, and critical public health.
Delivering Health
Midwifery and Development in Mexico
Nashville, Tennessee
© 2020 by Vanderbilt University Press
Nashville, Tennessee 37235
All rights reserved
First printing 2020
Library of Congress Cataloging-in-Publication Data
Names: Dixon, Lydia Zacher, 1980– author.
Title: Delivering health : midwifery and development in Mexico / Lydia Z. Dixon.
Description: Nashville : Vanderbilt University Press, [2020] | Series: Policy to practice | Includes bibliographical references and index.
Identifiers: LCCN 2020015428 (print) | LCCN 2020015429 (ebook) | ISBN 9780826501134 (paperback) | ISBN 9780826501141 (hardcover) | ISBN 9780826501158 (epub) | ISBN 9780826501165 (pdf)
Subjects: LCSH: Midwifery—Mexico. | Midwives—Training of—Mexico. | Midwifery—Study and teaching—Mexico.
Classification: LCC RG963.M6 D59 2020 (print) | LCC RG963.M6 (ebook) | DDC 618.200972—dc23
LC record available at
LC ebook record available at
To my daughter Juno, and to all the midwives and the mothers
1. Midwifery in Mexico and Beyond
2. Breaking Out of the “Uterus Box”
3. Maternal Conditions
4. Obstetrics in a Time of Violence
5. Modern Tradition
CONCLUSION: Creating Demand and Demanding Change
If the body of this book has not made it clear enough, I want to sincerely acknowledge the incredibly hard work done by the midwives, students, doctors, nurses, school administrators, public health workers, and activists whose struggles and achievements I have tried to make sense of here. Along the way, I met many people working in the world of women’s health in Mexico with starkly divergent ideas about how to improve health outcomes and experiences; yet, despite their differences, they all reflected a passion for the women, families, and communities they were trying to help. The level of trust and openness extended to me was humbling, and I hope that I have done well by these diverse actors to represent their work.
While the research for this book took years, the final writing phases of it went relatively quickly. I want to thank the whole team at Vanderbilt University Press, but especially my editor, Zack Gresham, for his kindness, encouragement, and humor. His positivity kept me going during this process. I thank my reviewers, too, who made this book stronger through their careful readings and suggestions.
This book and the research that went into it could not have been completed without the following generous sources of funding: The Fletcher Jones Foundation Fellowship, Dr. Dard Magnus Rossell Memorial Award, UC Irvine Associate Dean’s Fellowship, Inter-American Foundation Dissertation Research Fellowship, UC Irvine Center for Organizational Research, UC Irvine Global Health Framework Research and Travel Fellowship, UC MEXUS, and the UC Irvine Department of Anthropology. My initial introduction to professional midwifery in Mexico was funded through a University of Chicago Human Rights Internship Program. This book probably would not have been finished at all without the amazingly productive UC Irvine Steele/Burnand Anza-Borrego Desert Research Station writing retreat, where many feverish revisions were completed, and without the support of the Faculty Success Program (through the National Center for Faculty Development and Diversity) provided by CSU Channel Islands. Large portions were also originally written over excellent coffee at the Catalina Island Brew House, my default office for many years.
This is a project that reflects my journey into the world of midwifery and women’s health in Mexico as it has unfolded over the past eighteen years. As such, I must acknowledge the many mentors, teachers, colleagues, family members, and friends who supported my passion for this topic over the years, especially when it was not clear exactly where it would lead. While at UC Irvine, Michael Montoya, Leo Chavez, and Kris Peterson helped me frame this project and made it stronger. Hours of kitchen table and late-night phone conversations with the extremely knowledgeable and experienced women’s health practitioners Alison Bastien, Annelle Taylor, and Kate Norman Frometa, who all work or have worked intimately with the populations described in this book, led to many breakthroughs in my analysis. I deeply value the feedback and support I have received along the way from colleagues and friends, including Caitlin Fouratt, Natali Valdez, Cheryl Deutsch Croshere, Taylor Nelms, Ather Zia, Sana Sadiq, Janny Li, Stevie Rea, Mark Durocher, Lee Ngo, Michael Hurley, Carole Browner, Vania Smith-Oka, Mounia El Kotni, and Veronica Miranda.
Finally, I thank my family for their patience, advice, and love throughout this process. My father, Christian Zacher, was a life-long scholar who passed away in 2019. His kind and thoughtful advice about writing and academia in general have helped me at every step of the way; his wife, Kay Bea Jones, and sister, Cathie Zacher, continue to extend that support. My mother, Judith Zacher, made me feel at home in hospital wards from a young age by taking me to work with her and showing me the creative and compassionate side of medicine; much of this book was also written at her kitchen table and was certainly inspired by her hard-earned perspective on health care. Mary Jo and Scott Dixon have been incredibly supportive of my family as I have tried to balance my work and motherhood. My siblings, Jessica Zacher Pandya and Sam Zacher, talked me through it all with humor and continue to inspire me with their own weighty achievements. Had I not picked up Jessica’s dog-eared copy of Ina May Gaskin’s Spiritual Midwifery while crashing on her couch one night back in the ’90s, I may never have gone down this path. My brother-in-law, Mihir Pandya, was the first to even suggest I turn my interest in midwifery into a PhD in anthropology and has offered me much practical and thoughtful advice along the way. Meg Moir (not quite a sister, but close enough) was with me for this whole journey and kept me balanced when I got off course.
My daughter Juno was a part of this story from the beginning and tagged along with me during much of this research. My husband Pete and son Castor came along in the middle of it all, giving me the support to finish this project and inspiration to think about what comes next.
I studied birth for years before I experienced it myself. I thought I knew what to expect. Of course, experiencing birth was nothing like observing it, even as a doula helping others during labor. 1 When it came to the birth of my own child, I was completely surprised by the pain.
My hips were breaking apart. A searing, ripping pain took my breath away and seemed only slightly better when I yelled with my full lung capacity. When I looked at my midwife, Doña Guadalupe, she was gazing out into space, arms crossed, a slight smile on her face. 2 In other words, she was not nearly concerned enough to match my own level of panic. She could have been making a shopping list or thinking about what to cook for breakfast. As I lurched around the bedroom like a rabid animal, searching for some position to give me relief, she slowly pushed herself out of the chair where she had been waiting, watching, for the past hour. As she did so, she looked over at my doula and, with a slight chuckle, said to her in Spanish, “These gringas are always the screamers, right?”
I was pretty surprised by my own volume, but I felt like it would be literally impossible to be silent. I flashed back to the first birth I had seen, with this same midwife at the CASA (Center for the Adolescents of San Miguel de Allende) midwifery clinic where I was an intern right out of college a few years before. It was a small clinic in the central Mexican city of San Miguel de Allende, Guanajuato, and was associated with a professional midwifery school—the first of its type in the country. The birth I saw then was so serene and completely silent, but for a few measured grunts at the end. It had seemed achievable. I had certainly studied enough about birth (through doula trainings and volunteer work) in the intervening years to feel like I would get it right and do it gracefully. My own birth wouldn’t even need to be in the CASA clinic, I had decided—which was why I was now laboring so loudly at home, across town from CASA. The thought passed as another contraction came on and I inhaled in anticipation of the unstoppable and out-of-control-feeling noises.
Doña Guadalupe made her way across the room and knelt down on the floor by the bed. She began to make a sort of floor nest of pillows and chucks pads. I watched her with one eye as I swayed and rocked, silently begging her to tell me it was time to deliver my first baby. She did not meet my eyes. Instead, she unhurriedly pulled items out of her small backpack: a cassette player, a candle, some brown glass homeopathic jars, a little kit of gloves and some other medical equipment, wrapped in sterile brown paper and sealed with masking tape. She lit the

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