PROLOGUE

      Birth on the Threshold

      Mumtaz was nineteen years old when I first met her in her home in Nochikuppam, Madras (now called Chennai), the capital of Tamil Nadu, in 1993.¹ She lived in a one-room thatched house that looked out onto a sandy beach dotted with fishing catamarans and then onto the Indian Ocean beyond. I entered her house with a group of four other women, all of whom worked for the Working Women’s Forum (WWF), a women’s organization based in Madras. Kasthuri and Komala were both health workers for WWF; Durga was a health supervisor; and Mary was a coordinator who came along to help with translations. We all stooped our backs to pass through the doorway into the house and sat in a circle with Mumtaz and her one-year-old son. Mumtaz’s son had been born right in this house, and we came to talk with her about his birth. It was increasingly difficult to find women in this city who had their deliveries at home, so I was interested to know more about the events of the birth.

      Mumtaz was the seventh daughter born into a Muslim family. Her eldest sister was educated through high school,² but Mumtaz and her other sisters did not receive any formal education. She was married when she was seventeen and had her first baby when she was eighteen. Her mother-in-law lived in Royapettah, an area of Madras north of Nochikuppam. Her husband spent most of his time in that house in Royapettah with his first wife and their three children but would come to see Mumtaz once or twice a week. When she married him, Mumtaz did not know that her husband already had a wife. When he came to visit her he would bring her enough money for food. He refused to let her work outside of the home since he said she did not need to work as long as he was providing her with money. Mumtaz’s own mother and one of her sisters lived in Nochikuppam, close to Mumtaz.

      Mumtaz had been planning to have her delivery in Kasthurba Gandhi Hospital, one of the largest public hospitals in Madras, where most women from Nochikuppam went for their deliveries. Her mother had told her that she should go to the hospital because it was considered unlucky (rāci illai) to have the baby at home and because in the hospital there were many people to take care of everything and to clean the mother and baby.

      Mumtaz’s labor pains began in the middle of the night. She tried to bear the pain alone for a while by whispering “Allah, Allah, Amman” to herself. But when the pains became too severe she called for her mother. Her mother sent a neighbor off to summon an auto-rickshaw to take her daughter to the hospital, and then she came quickly to Mumtaz’s house and prepared an herbal medicine (kaṣāyam) to help speed up the labor. The baby was born before the man returned from getting the rickshaw. Mumtaz explained that she had delivered the baby right in the doorway (vācal) of the house. As soon as the baby was born, even before the placenta had come out, Mumtaz’s mother ran to summon Komala, who came immediately and helped with the delivery. Although Komala was not mandated to conduct deliveries in her capacity as a WWF health worker, she had some basic knowledge of the procedures involved because she had received training in maternal and child health care in order to become a health worker for WWF and she frequently accompanied women to the hospital for their deliveries.

      Komala boiled some water to wash her hands and a razor blade and then helped deliver the placenta while Mumtaz was still on the doorstep. Komala cut the umbilical cord and tied it with a piece of household thread. She put the placenta in a pot and buried it on the beach in a hole which was deep enough that the stray dogs roaming on the beach would not be able to dig it up. Komala then washed and wiped Mumtaz and her baby, changed Mumtaz’s clothes, and took them inside the house to lie down and rest. After three days, Komala took Mumtaz to the hospital to register the birth. Since the baby had been born at home, the hospital staff gave Mumtaz and the baby a tetanus shot and dressed the baby’s umbilical cord.

       . . .

      I met a number of other women throughout Tamil Nadu who, like Mumtaz, had been planning to deliver their babies in a hospital but in the end suddenly found themselves delivering at home. What struck me was the fact that several of these women told me that they had delivered their babies right in the doorway (vācal), the threshold between the home and the world. In Tamil Nadu this is considered to be a vulnerable space through which evil influences can pass, and a fierce mask or a scarecrowlike image is often posted above the doorway on the outside of the house to ward off evil spirits.³ It is also considered to be a sacred space, one which Tamil women decorate every day at dawn with geometric designs made of rice flour known as kōlams. These kōlams bring blessings to all sentient and nonsentient beings who pass in and out of the house throughout the day.⁴ The vācal is considered to be both vulnerable and sacred because of its association with the movement back and forth between a private, protected space and a public arena. When women say that they delivered their babies “right on the vācal,” it can be understood as a metaphor for the transition from the private space of the home to the public domain of the hospital.⁵ Because these are women from poor communities in Tamil Nadu, the hospitals in which they are increasingly giving birth are government-subsidized public hospitals.

      The saying that one has given birth right on the vācal is not simply a metaphor for a shift from one institutional site (i.e., the family and the midwife) to another institutional site (i.e., the public hospital as a site of both the state and biomedicine), but also symbolizes a shift in systems of knowledge about the body in general and women’s reproductive bodies in particular. Women like Mumtaz, who report having given birth right on the thresholds of their houses, are quite literally straddling divergent systems of meaning. And the vulnerability attributed to the vācal mirrors the tension experienced by women and by communities as they negotiate multiple understandings of the bodies they inhabit.

      This is a book about birth on the threshold, about movement and change in the conceptualization and experience of childbirth. (I use the term “childbirth” in an inclusive way to refer to processes of pregnancy, delivery, and the postpartum period, as well as to practices of birth control as they affect the experience of childbirth.) More specifically, this is an ethnographic study of how modernity was impacting the experiences of poor women during childbirth in the South Indian state of Tamil Nadu at the end of the twentieth century, and of the transformations of the cultural constructions of gender—particularly of maternity—produced in this process. Like Margaret Jolly, I am interested in how the relationship between maternity and modernity is experienced, understood, and represented.⁶

      One of the key points I want to make is that to speak of “how modernity impacts childbirth” is not to imply that there is one monolithic thing that we can call “modern birth” in the contemporary global order. Although the modernizing project, including the interest in promoting biomedical systems of knowledge, is global in scope, it is interpreted and acted upon in unique ways at the microphysical level by individual actors, collectivities, and institutions. In this book I examine the ways in which particular aspects of the modernizing process are localized to create a unique, or vernacular, form and experience of modern birth among lower-class women in Tamil Nadu. Here “local” refers not only to specific national, regional, and community contexts, but also to class and gender categories, namely lower class and female.⁷ This is a crucial point, since women whom I met were critical of the class- and, to some extent, caste-based forms of discrimination which they faced in public hospitals, and they were acutely aware of how their class and gender status constrained