According to the WHO, maternal health refers specifically to the health of women during pregnancy, childbirth and the postpartum period,[i] but what exactly do we mean by maternal health from a medical anthropological perspective?
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| Photo: Simone Pereira |
Medical anthropology is concerned with health issues, such as those that affect maternal health, throughout the whole world as well as through time. Medical anthropologists investigate health as a biological condition, as well as the cultural construction of symptoms and treatments, and the nature of international between biology, society, and culture. At the same time, medical anthropologists do not just accept one particular health care system, such as Western biomedicine, as holding monopoly on health knowledge and effective treatment, but rather investigate all health systems as cultural products.[ii]
Medical anthropologists seek to understand maternal health as:
- Cultural conceptions, such as culturally constituted ways of experiencing pregnancy and childbirth;
- social connections, such as the type of relations that exist within the family or within society and the world political and economic system generally;
- human biology, such as the threat of microscopic pathogens on the mother's bodily system and the body's immune responses to such threats.[iii]
Even though pregnancy and childbirth seem to
be biological, objective occurrences, the handling of such, can be coloured by
its cultural context. E.g. Emily Martin found that metaphors derived from
industrial production are used by biomedicine to describe childbirth. In this
biomedical cultural model of birth 1) the doctor is portrayed as the manager of
the labouring process; 2) the uterus is portrayed as the machinery of
reproduction; 3) the mother is some kind of labourer, and 4) the baby is the
production. Martin explains that this metaphor of labor dehumanizes the
experience. The women are not taken into account as a human being, instead her
uterus is seen as a tool that allows doctors to get closer to producing a
new product.[iv]
Another medical anthropologist, Brigette Jordan has found that different cultures have different ideas about pregnancy, delivery, and maternal health. In many non-biomedicine health care systems, traditional birth attendants provide support to women in childbirth, whereas Western biomedicine has created a full medicalization and high-tech childbirth. Here 1) high-tech machinery is used to monitor pregnancy and birth; 2) surgery may be used to widen birth portal and remove the baby, and 3) medications are used to deal with the pain or speed up the birthing process. Jordan describes how the roles often differ in the different health care systems, whereas the role of the traditional birth attendants often is to assist the family in fulfilling their decisions, birth often becomes viewed as an "illness" in biomedicine/hospitalised systems which needs to be "treated," whereby the mother becomes the patient, and the doctor takes charge.[v]
Despite the fact that maternal health is culturally relative, as illustrated above, the reality remains that maternal mortality and morbidity remain a problem for many women worldwide. In 2014 about 800 women died due to complications of pregnancy and child birth every day. Almost all of these deaths have occurred in low-resource settings, even though most could have been prevented.[vi]
Judith Justice assessed international efforts from a medical anthropological perspective, and found that efforts to reduce to improve maternal and child health has had an overemphasis on top-down approaches, inadequate attention to disparities in national health resources, and failure to recognise local diversity within nations can act as barriers. She recommends that international funds should be made available to cover initial costs of improving maternal and child health, as well as support the implementation of programmes at the local level, since poorer nations are not always able to meet all the local challenges of programme implementation.[vii]
Another medical anthropologist, Brigette Jordan has found that different cultures have different ideas about pregnancy, delivery, and maternal health. In many non-biomedicine health care systems, traditional birth attendants provide support to women in childbirth, whereas Western biomedicine has created a full medicalization and high-tech childbirth. Here 1) high-tech machinery is used to monitor pregnancy and birth; 2) surgery may be used to widen birth portal and remove the baby, and 3) medications are used to deal with the pain or speed up the birthing process. Jordan describes how the roles often differ in the different health care systems, whereas the role of the traditional birth attendants often is to assist the family in fulfilling their decisions, birth often becomes viewed as an "illness" in biomedicine/hospitalised systems which needs to be "treated," whereby the mother becomes the patient, and the doctor takes charge.[v]
Despite the fact that maternal health is culturally relative, as illustrated above, the reality remains that maternal mortality and morbidity remain a problem for many women worldwide. In 2014 about 800 women died due to complications of pregnancy and child birth every day. Almost all of these deaths have occurred in low-resource settings, even though most could have been prevented.[vi]
Judith Justice assessed international efforts from a medical anthropological perspective, and found that efforts to reduce to improve maternal and child health has had an overemphasis on top-down approaches, inadequate attention to disparities in national health resources, and failure to recognise local diversity within nations can act as barriers. She recommends that international funds should be made available to cover initial costs of improving maternal and child health, as well as support the implementation of programmes at the local level, since poorer nations are not always able to meet all the local challenges of programme implementation.[vii]
[i] World Health Organisation, 'World Health
Report 2014' (2014)
[ii] M Singer, Introducing
Medical Anthropology: A Discipline in Action, Altamira Press, New York,
2007.
[iii] Based upon model provided by
Singer, as above.
[iv] E Martin, The Woman
in the Body, Beacon Press, 1989
[v] B Jordan, Birth in Four Cultures, Illinois,
Waveland Press, 1992
[vi] World
Health Organisation, 'World Health Statistics 2014' (2014)
[vii] J
Justice, 'The Politics of Child Survival' in Global Health Policy, Local Realities. L Whiteford and L Manderson,
eds. Boulder, Lynne Rienner, 2000