Rural-Urban Migration in Chiapas, Mexico: Antenatal Violence and the Disappearing of the Midwife

Congreso Internacional Feminismo y Migración: Intervención Social y Acción Política, (www.generatech.org/femigra)

by Jenna Murray de López, 9-11Feb 2012

This paper takes as its focus the migratory experience of pregnant bodies and how, through the transient stages of reproduction, they come to embody the disappearing of cultural birth practices. It is based upon ethnographic fieldwork carried out in Chiapas in periods between 2007-2011. Throughout this presentation I will speak of embodiment in relation to the definition of anthropologist Terence Turner (1994):

  • Body: as an individual psychological and sensuous response

And

  • Embodiment: as a material process of social interaction
  • I also use his argument of Bodiliness to help speak of the complex notion of pregnant identity and ‘a body, within a body’. I shall elaborate on concept this a little further on.

The Rural-Urban migration of bodies for both labour and cultural reasons is highly prominent in industrialising and developing nations. In a Latin American context Mexico provides a poignant example due to its contemporary history of neoliberal policies and their direct impact on most notably rural areas and gendered labour behaviour.

The state of Chiapas is chosen strategically as a discussion point due to its social, economic and political position in Mexico. In its recent political history Chiapas has been at the forefront of grassroots and indigenous movements, the most prominent being the Zapatista Army for National Liberation, who promote widely the equal inclusion of women at all levels and a strong feminist dialectic tradition challenging global ideologies. In this vain Chiapas attracts much attention and support from activists, academics and individuals from all over the world and is often depicted as a romantic corner of Mexico where change is almost always a foot. Though as with the construction of the down trodden indigenous image, the presentation of an autonomous utopia is a creation that benefits all sides to propagate notions in contrary to the typical negatives of the post-colonial nations and also when it suits, used to reinforce them.  In this sense also the rural, migrating woman has boundaries and meanings that shift depending upon the viewpoint of the speaker and listener (Lock 1993).

In a rural context women are often represented as a conflicting presence at once down trodden and abused whilst also being resilient and strong in the face of adversity. I refer here to what anthropologist Terence Turner argues as the appropriation of bodiliness. Observing that the body in contemporary capitalist society is a site of both social inequality and personal empowerment, Turner argues that the appropriation of bodiliness is the fundamental matrix or material infrastructure of the production of personhood and social identity (Csordas 1994:18), therefore demonstrating that internal and external constructs begin from the body as well as the body being a construct of the wider social structure. The ‘body in the world’ needs to be understood as something continuous and fluctuating like a river that flows in opposite directions and occasionally crashing together in a whirlwind. If we consider this metaphor it is possible to see how contradictions of self occur and also in relation to the analysis and representation of the pregnant body as a social body.

Whilst favour is paid to the women fighting for health and survival in rural areas, the experience of rural migrants in urban areas goes under explored. There appears to be a seamless transference of bodies and practices from one completely different environment to another. This is an aspect that goes unquestioned and unconsidered by health policy and practice.  By putting some ethnographic evidence onto the bones of this discussion, we can see that this is both the cause of further violence towards women and a process

In this paper I concentrate on young women who migrate to work or study in the city and later fall pregnant and also women who migrate for reasons beyond their control such as falling pregnant out of wedlock or as a result of being raped. In short women who arrive at urban towns with few or no support networks.  In the two cities where I carried out fieldwork these women tend self-identify as being indigenous with a few exceptions.

A focus on the types of services and resources available locally for pregnant women, allows for an alternative approach to the body which is understood as (McNay terms:) “lying at the threshold of subjectivity not in terms of a fixed biological essence, nor as a result of social conditioning” (McNay 1992), rather it flows continually between.

In Chiapas pressure to improve maternal mortality rates meets with political realms of the health economy that work to oppress traditional birthing practices. Urban midwifery is not supported by statutory or non-governmental institutions and midwives practice in relative autonomy and without regulation. Women migrating to urban spaces (particularly those travelling alone) are forced into a medicalized management of their pregnancy and to submit to social service intervention in exchange for receiving any level of care. Access to healthcare is orchestrated via coercive programmes that limit antenatal care and birth to a pathologised model of pregnancy. Women who have scarce resources in urban Chiapas are left at the mercy of politically charged medical systems and at high risk of violent practices such as sterilisation without direct or informed consent, unnecessary caesarean, verbal attacks and sexual abuse . (Castro 1999: 209; Castro and Erviti 2003; Diniz and Chacham 2004; Kendall 2009) .

Discussion  

Together with all Mexican States that have a high indigenous population and rural geographic, in Chiapas it was estimated at the beginning of this decade that around 63% of rural births were attended at home by a traditional midwife (Hunt, Glantz et al. 2002). It has been shown in studies that women in rural areas in Mexico prefer, when given the choice to seek pregnancy care from traditional attendants  (Hunt, Glantz et al. 2002; Smid, Campero et al. 2010). Although this behaviour is changing due to the growth of cash transfer welfare programmes and building of new hospitals and clinics equipped for high intervention birth – it highlights a strong presence of midwifery practices and social norms about the use of midwives as opposed to medical attention in most healthy childbearing situations. Most female migrants in the urban areas of Chiapas have come from rural areas where their knowledge of childbearing will be based upon local midwifery knowledge and practices of homebirth.

In regards to the country as a whole, in urban areas a 93% of recorded live births take place in hospital (Scheper-Hughes and Lock 1987) and estimates state that 38% of all recorded live births in hospital are by caesarean section[1]. This is way above the recommended average of 15% and is a topic that has received some research attention over recent years, and was also initially the main focus of my own fieldwork. A more brutal reading of these statistics would read that the 38% of pregnant women who enter a hospital are met by a birth attendant who will cut open her abdomen and uterus, while the remaining 62% who achieve a vaginal delivery will have a deep perineum cut as part of routine episiotomy practice.

Midwifery in the urban context is an interesting cross over of indigenous and mestizo religious, cultural and lay medical knowledge practices. Spanish speaking, mestiza midwives are more often sought out for antenatal and postnatal conditions, as a complimentary attention to state medical care. This happens for various reasons though particularly in terms of financial incentive and social pressures. A pregnant woman who has migrated alone with no established social networks would have little access to a midwife practicing in the urban context.  In the capital city of Tuxtla Gutierrez midwives are practically unheard of to most women.

Women whom I have spoke to in the urban locations of San Cristobal de Las Casas and Tuxtla Gutierrez, who had few social networks when pregnant speak of avoiding or not accessing any form of antenatal care for various reasons, the most common being:

  • Mistrust in institutions
  • Violent or Racist attitudes of medical staff on previous attempts
  • Fear of having to pay for treatment or no knowledge of welfare support due to language barriers
  • Unable to because of employment
  • Not familiar with the concept of antenatal care in a medical context

Women who did access some form antenatal check up were sent by their employer, had some familiar contact in the city or arrived at public clinics alone and were referred to a hostel connected to the clinic. Women resident in the hostel were the most likely to receive regular antenatal check ups and support post partum. Women who are employed, usually in a domestic role are back at work within days of giving birth.

I would like to conclude this brief overview by returning to my introductory notes on Turner’s notion of embodiment and my developing of his appropriation of bodiliness as a political project. The title of my paper uses admittedly strong terminology disappearing and violence – two words associated with migration discourse, though usually in terms of what happens before rather than after. I use disappearing 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 traditional 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 midwives are practising in hidden spaces and have effectively disappeared from in terms of a social presence and from reproductive health discourse.

I use violence to describe much of the maternal care that women are subjected to in public institutions.  Having little or no record of antenatal care and no family support can leave a woman vulnerable to unnecessary surgical intervention and associated abuses when she arrives at the hospital in labour.

Of the women I have met and birth attendants interviewed throughout my fieldwork I have found that those women entering one specific Regional Maternity Hospital for a first full term pregnancy, not only overwhelmingly had a birth outcome of C-Section after reportedly having had a healthy pregnancy, but also I find a regular practice of what is termed a classical incision – a vertical cut through the abdomen to reach the uterus, which is then cut horizontally. In WHO guidelines and medical publications the classical incision is described as something that should only ever be practised in cases where there are literally minutes to intervene before mother or baby die, or other strong clinical evidence. It is a practice rarely used in industrialised nations.

The scar left behind after such an intervention holds multiple complication for the woman – in physical, economic and symbolic terms- this scar comes to represent violence and represents on the whole societal attitudes to women of specific social and ethnic categories. The physical and economic effects from the wound restrict a woman’s movement, ability to earn money and chances of future pregnancies. Symbolic effects I shall touch upon in my finishing sentences:

Pregnant Embodiment: as a material process of social interaction demonstrates the State’s role in the production of personhood and social identity of pregnant women, who in this case are also migrants. The 3 inch scar from belly button to pubic bone seals the process and marks the woman’s body as a site that represents the continuing death of cultural woman centred birth practices.

References

Castro, A. (1999). “Commentary: Increase in Caesarean Sections May Reflect Medical Control Not Women’s Choice.” BMJ: British Medical Journal 319(7222): 1401-1402.

Castro, R. and J. Erviti (2003). “Violations of Reproductive Rights during Hospital Births in Mexico.” Health and Human Rights 7(1): 90-110.

Csordas, T. J. (1994). Embodiment and experience : the existential ground of culture and self. Cambridge, Cambridge University Press.

Diniz, S. G. and A. S. Chacham (2004). “”The Cut above” and “The Cut below”: The Abuse of Caesareans and Episiotomy in São Paulo, Brazil.” Reproductive Health Matters 12(23): 100-110.

Hunt, L. M., N. M. Glantz, et al. (2002). “CHILDBIRTH CARE-SEEKING BEHAVIOR IN CHIAPAS.” Health Care for Women International 23(1): 98-118.

Kendall, T. (2009). “REPRODUCTIVE RIGHTS VIOLATIONS REPORTED BY MEXICAN WOMEN WITH HIV.” Health and Human Rights 11(2): 77-87.

Lock, M. (1993). Encounters with aging: mythologies of menopause in Japan and North America. Berkeley; London, University of California Press.

McNay, L. (1992). Foucault and feminism : power, gender and self. Cambridge, Polity.

Scheper-Hughes, N. and M. M. Lock (1987). “The Mindful Body: A Prolegomenon to Future Work in Medical Anthropology.” Medical Anthropology Quarterly 1(1): 6-41.

Smid, M., L. Campero, et al. (2010). “Bringing Two Worlds Together: Exploring the Integration of Traditional Midwives as Doulas in Mexican Public Hospitals.” Health Care for Women International 31(6): 475-498.

Turner, T. (1994). Bodies and anit-bodies: flesh and fetish in contemporary social theory. Embodiment and Experience: the existential ground of culture and self. T. J. Csordas. Cambridge, Cambridge University Press.


[1] In Mexico estimation is required to correct for under-reporting of c-section deliveries in private facilities

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