Birth on the Threshold. Cecilia Van Hollen
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and dietary practices in a variety of settings.65 Finally, I interviewed governmental and nongovernmental administrators working on women’s health policy issues at the state and national levels.
Map 2. Field sites in Tamil Nadu, Indian, 1995.
My research in Kaanathur-Reddikuppam and in Madras was supplemented by brief visits to low-income communities in and around several other cities and towns throughout Tamil Nadu, including Chengalpattu, Madurai, Dindigul, Vellore, Kanchipuram, and Adiramapattinam (Tanjavur District) (see Map 2). The visits to Chengalpattu were facilitated by a local organization called the Rural Women’s Social Education Centre (RUWSEC). All other visits were arranged by the Working Women’s Forum. In each place I met with the same range of people whom I met in my primary research sites. The purpose of these visits was to see to what extent the information I got in Madras and Kaanathur-Reddikuppam was generalizable for Tamil Nadu as a whole.
I also conducted a brief study in the maternity ward at Apollo Hospital, a prestigious private hospital in Madras catering to a wealthy clientele. Although I do not delve into the details of this research, my findings there serve as a comparative backdrop to my discussion of maternal care for lower-class women. Finally, I gathered government documents and other materials relating to the history of MCH policy in Tamil Nadu from both the Tamil Nadu State Archives and the library attached to the Tamil Nadu Department of Public Health.
Many people have asked me whether it was difficult to get women to speak with me openly about their childbirth experiences. The assumption seems to be that such a topic, which deals with women’s reproductive bodies, would be too personal or embarrassing to discuss or would even be taboo in the Indian cultural context. Although it is true that women felt embarrassed to discuss these matters openly with men and that mothers and daughters often did not discuss these things, what I found was that in general this was a topic which women were very quick and even eager to discuss with me and with each other once they had already been through the process of childbirth.66 (Women who were pregnant with their first child tended to be much more reticent.) In fact, I often found that I would begin a conversation with one woman in her home and within a half hour four or five other women in the neighborhood, who had gotten wind of the conversation, would join us, eager to add their commentary on the subject. This made for lively discussions but made it excruciatingly difficult to tease apart the diverse voices in the process of transcribing taped interviews.
One of the reasons that women seemed comfortable discussing these issues may have to do with the fact that there has been such a longstanding infrastructure of governmental and nongovernmental health workers going into people’s homes to collect health data on families and to educate about and advocate in favor of family planning and MCH care. Initially many women assumed that I was in fact some kind of governmental or nongovernmental health worker. At first this was somewhat of an impediment, for I found that many women seemed to be feeding me opinions and stories which would support the family-planning and MCH propaganda they were so used to hearing. At other times, the assumption that I was a government representative had the opposite effect and women saw me as a vehicle for making demands on the government to improve MCH services in their communities. My hope is that my writings on this topic will in fact serve this purpose. The other most common initial misconception about my role was the assumption that I was a doctor, and women came to me with complaints of a variety of ailments.
When it became clear that I was neither health worker nor doctor, but rather that I was a medical anthropologist who was as interested in learning about the details of religious ritual activities surrounding birth and about the use of local herbs and dietary practices as I was in learning about women’s allopathic concerns during childbirth, some women grew frustrated and felt that I was wasting their time. Others became more and more intrigued and welcomed the fact that I took a genuine interest in some of their non-allopathic practices rather than coming to condemn such practices as harmful and superstitious. And those women who were intrigued by the nature and scope of my inquiries were also curious to know about practices and beliefs surrounding childbirth in America and came to view our conversations as cross-cultural dialogues.
The fact that I had a child myself made an enormous difference in the nature of our discussions. When I talked with women about childbirth during my trip in 1993 I did not have a child of my own. And just as women were reluctant to discuss the details of their birth experiences with their daughters or daughters-in-law who had not yet had their first child, they were hesitant to speak freely with me about this subject. In part there was a sense that it was taboo to do so, and in part there was a sense that I simply would not and could not understand. When I began my research in 1995, however, and explained to women that I had a child myself and told them about my own birth experience, they were much more at ease talking with me. The difference did not only lie with their attitude toward me but also with my attitude toward them. Having been through childbirth myself I did feel as though I could understand their experiences more fully, despite the social and cultural factors which made our birth experiences vastly different. Having been through it myself, I felt I had a much better base of phenomenological, social, and biomedical knowledge from which to formulate questions and respond to inquiries.
Many anthropologists have commented that it must have been a great “in” to have had my very young daughter, Lila, with me; that it must have helped me gain acceptance in Indian society, and that this must have benefited my research immensely, especially given the topic of the research. In my more cynical moments, the implication of these comments seemed to be that having a baby must be even better than the traditional anthropological props, like cigarettes and money, for getting “informants” to take you into their homes and divulge their secrets. It was wonderful to be living in Tamil Nadu with my family and sharing with them a part of the world which has long been a central part of who I am. It was particularly significant to me that Lila was starting out her life with an experience that I hope will influence her lifelong perception of the world. The fact that her first words alternated between English and Tamil was somehow very touching. And of course having a young child did in many ways open doors to friendships as she and many of our neighbors’ children played together every day. My research, however, was not focused on my immediate neighborhood but rather required me to commute all around the city, down to Kaanathur-Reddikuppam, and occasionally farther afield to other parts of Tamil Nadu. It did not make sense to drag her along with me wherever I went, into hospitals, homes, government offices, and libraries. In fact, I felt that because of the demands of her age (six months to one and a half years), having her with me during my research would have been disruptive and would have made it very difficult for me to concentrate on what others were saying or doing. Instead, most of the time Lila remained home and part-time in a local day care, and I had to contend with being a somewhat frenzied working mother in India just as in America.
OUTLINE OF THE CHAPTERS
For the most part, each chapter in this book addresses a different aspect of the modernizing process and analyzes the impact that this process is having on poor women’s experiences during childbirth in Tamil Nadu. In addition to its thematic organization, the book is also organized loosely according to the chronology of the experience of childbirth itself. Thus, Chapters Three through Six emphasize pregnancy, delivery, family planning, and the postpartum period in consecutive order. Family planning is placed in between delivery and the postpartum period, since certain contraceptive methods are undertaken in hospital maternity wards before mothers return home from their deliveries. I have taken this chronological approach in the hope of conveying some sense of the flow of the experience of childbirth for the women whom I met.
Chapter One addresses the theme of the professionalization of obstetrics as one aspect of the modernizing process. Focusing on the colonial period, this chapter provides a background for understanding the historical context within which the profession of obstetrics emerged in India. As in other colonial contexts, the issues of childbirth and of the professionalization of obstetrics played a critical role in the civilizing discourse of colonialism in India.67 Chapter Two shows how the debates and policies regarding the professionalization