The Cultural Context Of Therapeutic Choice

This book examines the factors influencing women's choices of obstetrical care in a Bariba community in the People's Republic of Benin, West Africa. When selecting a research topic, I decided to investigate health care among the Bariba for several reasons. First, I had served as a Peace Corps Volunteer in northern Benin (then Dahomey) and had established a network of contacts in the region. In addition, I had worked for a year as assistant manager of a pharmacy in a northern town and had become interested in the pattern of utilization of health care services by urban residents. This three-year residence proved an invaluable asset in preparing and conducting research in the northern region. In particular, I was able to establish relationships with several indigenous midwives whose families I already knew both from prior research experience and mutual friend ships. These relationships enabled me to obtain detailed information regarding obstetrical practice and thus form the foundation of this book. The fieldwork upon which the book is directly based was conducted between June 1976 and December 1977 and sponsored by the F ord-Rockefeller Popula tion Policy Program, the Social Science Research Council, the National Science Foundation, and the FUlbright-Hays Doctoral Dissertation Research Program. The Ford-Rockefeller Population Policy Program funded the project as a collab oration between myself and Professor Eusebe Alihonou, Professor Agrege (Gynecologie-Obstetrique) at the National University of Benin.

This book examines the factors influencing women's choices of obstetrical care in a Bariba community in the People's Republic of Benin, West Africa. When selecting a research topic, I decided to investigate health care among the Bariba for several reasons. First, I had served as a Peace Corps Volunteer in northern Benin (then Dahomey) and had established a network of contacts in the region. In addition, I had worked for a year as assistant manager of a pharmacy in a northern town and had become interested in the pattern of utilization of health care services by urban residents. This three-year residence proved an invaluable asset in preparing and conducting research in the northern region. In particular, I was able to establish relationships with several indigenous midwives whose families I already knew both from prior research experience and mutual friend ships. These relationships enabled me to obtain detailed information regarding obstetrical practice and thus form the foundation of this book. The fieldwork upon which the book is directly based was conducted between June 1976 and December 1977 and sponsored by the F ord-Rockefeller Popula tion Policy Program, the Social Science Research Council, the National Science Foundation, and the FUlbright-Hays Doctoral Dissertation Research Program. The Ford-Rockefeller Population Policy Program funded the project as a collab oration between myself and Professor Eusebe Alihonou, Professor Agrege (Gynecologie-Obstetrique) at the National University of Benin.

Contraception is an issue of considerable concern to a great many heterosexually active people. Yet the impact of contraceptive technologies in the world today, in particular their implications for kinship, gender relations, and other aspects of social life, receives relatively little scholarly attention. This book brings a new perspective to the study of contraception, by collecting together in one volume leading experts in the fields of contraception, family planning and reproductive health. Contributors look at the social, economic, political and cultural contexts in which contraceptive providers and recipients make decisions about whether and what forms of contraception to use. User perspectives (whether those of recipients or providers of contraceptive services) are taken seriously, as are the perspectives of policy-makers and development experts. With its in-depth, case-study approach, this challenging book will appeal to practitioners and planners in the fields of family planning and reproductive health, as well as to students and academics of applied and medical anthropology, health studies, gender and development studies, or anyone interested in the social, cultural and ethical issues raised by contraceptive technologies.

Traces the horror of obstetric fistula—a condition that has been largely forgotten in the developed world—and lays out a plan for its eradication. Millions of women suffer from obstetric fistula, a catastrophic childbirth complication that exists today mainly in the world’s poorest countries. Fistulas are created by the prolonged pressure of the fetal head in the birth canal during obstructed labor, which grievously injures a woman’s bladder, leaving her incontinent. With a fistula, a woman’s life revolves around futile attempts to control her condition and the stigma associated with it. Abandoned by their loved ones, ostracized from their communities, and cut off from modern surgical care, which can repair fistulas and return patients to full health, these women suffer wretchedly. Based on over 20 years of personal experience with fistula patients in multiple African countries, Dr. L. Lewis Wall’s Tears for My Sisters describes the ancient history of obstetric fistula, tracing it as far back as ancient Egypt. An expert in repairing obstetric fistula, Dr. Wall explains how these injuries occur and how Western medicine developed the technical capacity to overcome obstructed labor and repair fistulas. Arguing that obstetric fistula results from a general disregard for women’s human rights and reproductive health around the globe, he lays bare the obstacles that poor women face in getting emergency obstetric care. Finally, he presents a solution to this problem based on the inspiring story of Drs. Reginald and Catherine Hamlin, who created a hospital system in Ethiopia to care for fistula patients, improve health care, and eradicate these injuries. Providing these women with a much-needed voice, this compassionate book is the first to tell the comprehensive story of this tragic but preventable condition. It is compelling reading for everyone interested in women’s health, reproductive rights, the history of medicine, and social justice.

This collection of essays both reframes disability in terms of social processes and offers a global, multicultural perspective on the subject. It explores the significance of mental, sensory and motor impairments in light of fundamental, culturally determined assumptions about humanity.

This benchmark collection of cross-cultural essays on reproduction and childbirth extends and enriches the work of Brigitte Jordan, who helped generate and define the field of the anthropology of birth. The authors' focus on authoritative knowledge—the knowledge that counts, on the basis of which decisions are made and actions taken—highlights the vast differences between birthing systems that give authority of knowing to women and their communities and those that invest it in experts and machines. Childbirth and Authoritative Knowledge offers first-hand ethnographic research conducted by anthropologists in sixteen different societies and cultures and includes the interdisciplinary perspectives of a social psychologist, a sociologist, an epidemiologist, a staff member of the World Health Organization, and a community midwife. Exciting directions for further research as well as pressing needs for policy guidance emerge from these illuminating explorations of authoritative knowledge about birth. This book is certain to follow Jordan's Birth in Four Cultures as the definitive volume in a rapidly expanding field.

Central to this book are Gbigbil women's experiences with different "reproductive interruptions": miscarriages, stillbirths, child deaths, induced abortions, and infertility. Rather than consider these events as inherently dissimilar as women do in Western countries, the Gbigbil women of eastern Cameroon see them all as instances of "wasted wombs" that leave their reproductive trajectories hanging in the balance. The women must navigate this uncertainty while negotiating their social positions, aspirations for the future, and the current workings of their bodies. Providing an intimate look into these processes, Wasted Wombs shows how Gbigbil women constantly shift their interpretations of when a pregnancy starts, what it contains, and what is lost in case of a reproductive interruption, in contrast to Western conceptions of fertility and loss. Depending on the context and on their life aspirations--be it marriage and motherhood, or an educational trajectory and employment, or profitable sexual affairs with so-called "big fish"--women negotiate and manipulate the meanings and effects of reproductive interruptions. Paradoxically, they often do so while portraying themselves as powerless. Wasted Wombs carefully analyzes such tactics in relation to the various social predicaments that emerge around reproductive interruptions, as well as the capricious workings of women's physical bodies.