Toward an Anthropology of Birth

Subsequent to 1970, increased anthropological interest in birth assistance and midwifery practice moved the field beyond brief ethnographic accounts and surveys to more contextualized analyses of birth. This growing attention to the ways in which pregnancy and delivery are culturally shaped generated an important literature on the management of birth in industrialized societies. From the 1970s, more women anthropologists entered the field. Inspired by the second wave of feminism and with greater access to information about birth practices derived from empirical observations, they began to explore birthing systems as local systems of knowledge and praxis, grounded in broader cultural and social contexts

(see Davis-Floyd & Sargent, 1997, for a thorough review of this literature). Among the cutting-edge research from this phase in the anthropology of birth is McClain's (1975) work on cognition and behavior regarding pregnancy and birth in Mexico in which she introduced the term "ethno-obstetrics" and approached birth as a cultural system in the process of transformation.

One aspect of the cultural patterning of birth that elicited attention in the emergence of the anthropological study of birth was the issue of variations that exist in the characteristics of those who are allowed to attend births and offer specialized assistance to the parturient. In most societies, a woman is attended by other women, often kin, who provide emotional support and generalized knowledge regarding labor and delivery. Some societies also have a specialist to assist at birth. In the anthropological literature, this specialist is usually referred to as a midwife, although the World Health Organization has favored the term "traditional birth attendant," to differentiate those who are biomedically trained from other birth specialists. A few societies encourage women to deliver alone, without the participation of a midwife or indeed any companions (see, e.g., Sargent, 1982, 1989; Trevathan, 1987).

Cross-cultural comparison of the characteristics of midwives has focused on recruitment to the role, acquisition of skills and knowledge, status, and the midwife's role in prenatal care, at delivery, and in the postpartum. Cosminsky (1976) provided the first substantial review of existing data on this topic. Cosminsky's review, based on a variety of secondary ethnographic and medical sources, surveys the role of the midwife in providing prenatal care, delivery assistance, treatment of the newborn, and postnatal care. Subsequently, her own ethnographic research provided systematic and in-depth analyses of Guatemalan midwifery (Cosminsky, 1976, 1982).

Cosminsky found that worldwide, most midwives are female, postmenopausal, and have had children of their own. Recruitment to the role of midwife may be based on spiritual calling, inheritance, or personal inclination. Dreams or visions are sometimes used as signs that a woman should be a midwife. For example, in Guatemala, Cosminsky reports that a midwife usually has suffered ill health and a shaman may divine the cause as a warning to take up the calling of midwifery or risk severe consequences from God. Most commonly, midwives acquire training by means of apprenticeship, a pattern documented in Africa, Latin America, Asia, and the

United States. While midwives usually occupy a respected position in society (e.g., in Jamaica, peninsular Malaysia, and much of Africa), exceptions exist; in India, for instance, the position of midwife (dai) is allocated to low-caste women, because of the association of birth and bodily fluids (Jeffery & Jeffery, 1993). Similarly, Rozario describes the position of the dai in Bangladesh as very low status. The dai is usually very poor, elderly, with no formal education or training (Rozario, 1998, p. 161). There is often little or no remuneration for her work, although the dai are recognized as experienced and useful as birth attendants. The case studies Rozario presents indicate that the dai does not provide prenatal or postpartum care, but initiates her involvement during labor. She suggests that the Bangladeshi pattern is typical of the region, and probably of most of South Asia. Worldwide, proliferation of biomedical facilities has often resulted in a decline in respect for local midwives, as women increasingly seek care from biomedical practitioners.

The landmark 1978 publication of Jordan's Birth in Four Cultures inspired a generation of anthropologists to pursue empirically based comparative studies of birth and legitimized the grounded study of human reproduction (Ginsburg & Rapp, 1991). Jordan referred to her own approach as "biosocial," with an emphasis on the feedback between biology and culture. Prior to Jordan's work, there was a distinct lack of data useful for a holistic comparison of childbirth, and almost no research based on direct observation of normal births. Medical reports presenting cross-cultural examples tend to focus on physiology, and often on abnormal features of birth. Jordan sought to emphasize the social interactional aspects of birth, such as the nature of the decision-making process during parturition, and the extent of material and emotional support for the woman during pregnancy and labor. Broadly, she proposed a biosocial framework for the collection and analysis of data, that would integrate local meanings of birth with associated "biobehaviors." Accordingly, she developed a methodology to isolate features of the birth process that would serve as units for cross-cultural comparison.

As the specific cases employed in her book, she compared birthing systems in Sweden, Holland, Yucatan, and the United States, thus illustrating the possibility of cross-cultural analysis in this domain of inquiry. Methodologically, she proposed that the study of birth requires direct observation. Given that birth involves bodily functions and bodily displays, collecting data by survey or primarily by structured interviews is fundamentally inadequate. In contrast, anthropological participation is recommended as an explicit methodological device "intended to give the investigator access to the knowing how of birth, that is to say, to the behaviors in which participants engage as competent performers of system-specific ways of doing birth" (Jordan, 1978, p. 8). Participant observation, combined with standard structured means of data collection, provide the foundations for a holistic representation of the birth process.

In addition to providing ethnographic detail about each system, Jordan's research offered policy recommendations to encourage accommodation between biomedical and indigenous birthing systems that would acknowledge the perspectives of both systems. Most significantly, she argued that birth is always a cultural production. She applied this perspective to biomedicine as well as to local birthing systems, thus generating an enduring interest among anthropologists of reproduction in the cultural shaping of biomedical obstetrics.

During the 1980s, anthropologists followed Jordan's groundbreaking work with detailed ethnographic studies conducted in many parts of the world. The first edited collections focusing on pregnancy and birth in cross-cultural perspective date from this period (Kay, 1982; MacCormack, 1982/1994). Ethnographic research in this phase portrays viable local birthing systems, confronted with challenges from an imported biomedical system, usually legitimized by the state. Correspondingly, numerous anthropologists have detailed the resistance and accommodation of local practitioners and women seeking maternity care. A substantial body of research examines the impact of birth technology on local practice, and the global exporting of the biomedical (American), technocratic model of birth (Davis-Floyd, 1992; Davis-Floyd & Sargent, 1997).

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