Fertility Regulation

Cultures differ in their understandings of fertility and the process of conception. For example, work on Sri Lanka (Nichter & Nichter, 1987) has found the first few days immediately following the cessation of menstruation is considered the most fertile, due to perceptions that the womb is most open to conception before and immediately after menstruation. Likewise, women are considered fertile immediately following childbirth due to the open state of the womb. Humoral notions of hot/cold and wet/dry also affect fertility. Given that the "safe period" is a common means of family planning in Sri Lanka, the provision of fertility cycle education combined with the use of condoms could result in a more effective usage of the "safe period" both for those wishing to postpone or space their children, or for those wishing to fall pregnant.

Many cultures have detailed knowledge of herbs, foods, and medicines for fertility regulation. Newman's edited work (1985) documents herbal medicines and other techniques used for menstrual regulation, the management of pregnancy, and assistance with labor in seven cultures, including Chinese-Malay, Afghanistan, Egypt, Colombia, Peru, Costa Rica, and Jamaica. Indigenous means of fertility regulation remain popular even when modern means of contraceptives are available, because they coincide with local understandings of the body, are controlled by women, are readily available and are socially and culturally acceptable. Humoral rationales underlie many cultures' understanding of reproductive processes and many of the indigenous medicines used in fertility regulation involve manipulating the body's humoral balance to enhance fertility or to delay it. In Cali, Colombia, one cause of menstrual delay is understood to be impurities in the womb or menstrual blood, or the accumulation of cold in the vagina. Remedies that purify the womb and restore humoral balance or others defined as purgatives are used to cure delayed menstrual periods (Browner, 1985).

Anthropological studies show how contraceptives are understood to work on women's and men's bodies in a wide variety of perceived ways and with a wide range of effects, and are mediated by a variety of social relationships, institutions, knowledges, beliefs, and practices (Russell, Sobo, & Thompson, 2000). Access to and use of modern contraceptive technologies has had a dramatic impact upon women's reproductive health, not least of which is a decrease in maternal mortality due to childbirth and induced abortion. It has had a major impact upon women's lives and bodies, enabling women to play greater roles as producers and allowed couples greater control over the timing of children and the number of children they may have. For many women and men this has had positive effects allowing them to express their sexuality free from the anxiety of pregnancy. At the same time, the use of modern contraceptives also involves a range of negative side-effects, of variable severity. These have primarily affected women who are the main users of contraceptives. An important debate within studies of fertility regulation by feminist anthropologists has been the extent to which modern contraceptives enhance women's empowerment and reproductive choice and rights (Petchesky & Judd, 1998).

Medical anthropologists have been involved in a range of "acceptability studies" to assess how local beliefs, social and cultural contexts, and behaviors will affect the acceptability of various fertility regulation methods (Polgar & Marshall, 1978). Across different cultures, the modes of action of various contraceptives differ and reveal local understandings of the workings of the body and factors influencing fertility. Neither the physiological responses nor attitudes toward any contraceptive technology can be distinguished from the wider context in which it is used (Gammeltoft, 1999). McCormack (1985) notes how in Jamaica the contraceptive pill is thought to work by mechanically blocking sperm from reaching the uterus. Pills are believed to build up within the body over time, requiring the use of a castor oil "wash-out" to cleanse the body, or periodic cessation of the pill. Other studies have suggested other modes of action of the pill, from weakening the body and blood, or through heating and drying out the womb (DelVecchio Good, 1980). In Northeast Thailand, injectable contraceptives are frequently associated with side-effects, such as tired arms, amenorrhoea, thinness, weakness, and chills, as the "bad" blood that is normally expelled through menstruation accumulates in the body causing a cold state (Whittaker, 2000). In Vietnam, the intra-uterine device (IUD) is understood to weaken a woman's blood and be detrimental to her health (Gammeltoft, 1999). In many places, such as Peru, the IUD is understood to be capable of moving through the body and cause injury to the heart or lungs (Maynard Tucker, 1986).

Contraception is associated with increased weakness and vulnerability to ill health in many cultures, which may be mitigated by following other folk medical practices and dietary regimes. For example, Morsy (1980) and Nichter (1996b) report that in Sri Lanka and Egypt, respectively, the ingestion of powerful drugs such as oral contraceptives is understood to require the consumption of nourishing foods to strengthen the body. Only rich women who can afford a "nourishing" diet are considered able to take the oral pill. In this way, side-effects from contraception may also be mediated by class.

The meanings of contraceptives and the negotiation of their use are influenced by and influence local economic values, ethical and religious concerns, political ideologies, gender relations, and kinship systems (Russell et al., 2000). Decisions whether to adopt family planning methods also entail considerations of social and economic constraints. Sobo's work in Jamaica highlights the importance of issues of power, gender relations, and trust involved in the use of contraceptives (Sobo, 1993a, 1993b). In other contexts, such as Bangladesh, where use of contraceptives may invoke a husband's anger and violence, women may prefer to use contraceptives that can be administered clandestinely and infrequently (Stark, 2000).

Studies of contraception have also entailed the study of the health care systems delivering services. Anthropologists have studied the ways in which delivery of services reflects the broader social and political context and the quality of the relationships between health workers and their clients. Maternowska's (2000) study of a family planning clinic in Haiti provides an analysis of the power relations and how these reflect and perpetuate the ideologies and political and economic realities of wider society. Thompson (2000) describes how in Chiapas, Mexico, within the context of an ongoing guerilla campaign by indigenous people against the state, family planning is suspected of being part of a genocidal campaign to limit the number of indigenous people. As local elites, health care workers can reinforce the views of local people as ignorant and ignore or deride the fears and side-effects reported by users (Nichter, 1996b; Whittaker, 1996).

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