Conflict and Reproductive Health in Chiapas, Mexico: Disappearing the Midwife
Jenna Murray de López (Phd Candidate, University of Manchester)
This paper draws upon fieldwork carried out in urban locations of Chiapas two periods 2007-2009 and a following 3 months in 2011. The original aim of this fieldwork was to investigate types of antenatal care available to women in urban locations and record women’s experiences of such services. Ethnographic data collected during these periods have culminated in my current PhD project which focuses on Political Economy of Pregnancy in Chiapas.
Throughout these initial fieldtrips I became more and more aware of intersecting themes of the impact of armed conflict in the region on women’s lives and how this manifested in everyday practices such as those in the healthcare system. In the urban spaces of Chiapas it can be easy to forget that the region is still categorised as being in ongoing low-intensity armed conflict, it sounds strange but even as an outsider after a while the movement of soldiers in trucks, in and around the towns becomes normalised into everyday life. I’ve been quite influenced by Michael Taussig in my thinking around ‘normalization’ of violence in Latin America and think a lot about how this contributes to maintaining what Nancy Sheper-Hughes refers to as the “Grey Zones” – the everyday forms of harassment, abuse and violence that shape the fabric of women’s existence. In the Nervous System Taussig writes about the different levels of violence in a society that become accepted as tolerable so that other violent acts must be increasingly horrific enough in order for people to share an experience of ‘true violence’.
Before training as an anthropologist I was a social worker and have an undergraduate background of social policy and critical social work studies. For this reason parallel to my interest in what is understood as violence and how this plays out in everyday life I also began to take notice of the part that public health policy plays in legitimising violent practices – for my research in particular in terms of legitimating practices of obstetric violence.
My research has focused particularly on two cities where I have found regular practice of using local midwives (both traditional birth attendants mainly mestiza and professionally trained and licensed midwives Mexican and foreign) for antenatal, perinatal and postnatal care, often in tandem with receiving medical care in clinics. For these women it is often deemed that there are issues relating either to mother or baby that “the doctor doesn’t see” or that they wish to be reassured with “a human touch”. Women interviewed in this city refer to having confidence and trust in la partera or la senora, this integrated use of both traditional and medical healthcare suggests that many women are identifying and negotiating support on an individual needs basis. Their wider social understanding of pregnancy incorporates more than a clinical model of reproduction and there are cultural practices that must be undertaken to assure a healthy pregnancy and baby. These ethno-theories of pregnancy are explanatory models about how damage to the foetus can be caused and have physical, spiritual and psychological symptoms. Ethno-theories vary for individual women depending upon their social class, ethnic-background, religion and locality. There are some common themes that often centre on the emotional wellbeing of the foetus and the woman’s responsibility to ensure a safe environment and journey for the foetus to the outside world. Medical and ethno-theories are used interchangeably and are manipulated by women and medical practitioners precisely because they make sense of experience that draws upon local knowledge.
Returning to the title of this paper – I propose the notion of disappearing the midwife to describe how a woman’s only choice in the urban context is to receive medicalized management of her pregnancy and birth – a model that openly rejects the concept of midwifery as valid knowledge – is actively working to rid the society of its cultural, woman centred birth practices. By not recognising her as a legitimate form of care for pregnant women – the urban midwives are practising in hidden spaces and have effectively disappeared in terms of a social presence and from reproductive health discourse. Obstetric violence understood as a consequence of structural and direct low intensity conflict violence and committed to maintain power relations between genders continues to be a major global health problem– the normalised violent practices that many women are subjected to in pregnancy and childbirth translates to a situation where universal attempts to improve health exacerbate rather than improve the problem. Ongoing and ignored conflict in the region only serves as a catalyst for such violence to be maintained.
