NEW BLOG!!

Thank you for visiting this page. My new (and improved) blog BirthRitesAnthro can now be found at:  http://birthritesanthro.wordpress.com/ where I shall be writing about all things #birthrites, (M)otherhood, repro health issues and anthropology stuff in general. Do call by!

This site will stay live as an archive of my older material

Newsflash: Breasts are for feeding babies with!

I wanted to take a break in the current usual proceedings of reflecting upon my time in the field as a mother and to write about a more 'in the news' topic. There has been a week of virtual and physical world activity in support of Breastfeeding. I picked up on a record attempt in the UK for the most women (and babies I assume) breastfeeding simultaneously and a surge of campaigning and images in social media promoting support for all mothers in the practice of feeding one's baby with one's breast (novel idea, its bound to catch on!). 

I am at once overjoyed by the amount of beautiful images splayed across the internet of babes happily latched onto their mothers and also annoyed at the fact a week in the year needs devoting to highlight the support needed for said mothers. At risk of stating the obvious, breasts are for feeding babies with, that is why women have them, any other socially constructed benefit such as the beauty of them, their sexual attractiveness, the invention of special cloth devices to put them in and their marketability to entice heterosexual men to buy anything is merely an added extra. Though in some societies they seem to have got that the wrong way round and even more so have turned them into a weapon of offence in a feeding situation. 

I find the whole situation very odd, I'm sure my baby if she could enter into the debate, would be inclined to agree. That of course is my gut reaction to a world of silly rules, but by thinking anthropologically I can think of some more rational explications to this breast utility obsession. What exactly is it about the human condition that throughout time and place we change the way we relate to our bodies and what they do?  For what purpose does it serve to treat breasts as something other than a source of (emotional and physical) survival for a human infant? Whether we choose to use them for that purpose is a separate argument, put ultimately that is why they are there. 

For some cultural comparison here is a brief ethnographic vignette taken from my fieldwork diary: 

When I boarded the combi* this morning I wished it was possible to take a snapshot of the scene that greeted me. Apart from myself with nuzzling babe in arms there are four other women of varying ages from late teen to 30s (as usual at this time the combi was populated only by women going about daily business) all nursing babes or toddlers. As we chatted about the recent thunderstorms, how busy the city centre had become etc. no-one batted an eyelid at the amount of breasts on show, as they never do because if you have a baby or small child who is pining at your chest then you feed it - why wouldn't you?

*A combi is a micro-bus/van with seating that is used as public transport around the city.

That is what I would describe as a healthy social attitude to feeding one's young. This was by no means a special day and justified by a female only presence, it happens on any day regardless of the gender mix. People of any age and gender will stop and talk to you, kiss and coo at the baby without any hesitation about it being attached to a nipple. Here feeding is not a shameful or secret event and nor are women accused of 'making a point', they are simply feeding their child whether it be on public transport, in the workplace, at home or walking down the street (a skill to be valued in itself!). 

Mexico has a stereotype of machismo and of treating women poorly, and I certainly do not dispute the aspects of violence, maltreatment and appalling incidents of feminicide that occur. But lets get beyond the sweeping generalisations to turn the focus back on a so-called civilized and developed society such as the UK. 

Capitalism and Patriarchy Come Hand in Hand

The societies most offended by a woman using her body to ensure the survival of her baby are the most technologically and economically advanced, or that is to say are the most technologically and economically dominant. There has been a long tradition in feminist anthropology and social theory that questions the use of technology as a means of population control (for an introduction see Emily Martin for a distinct analysis of obstetrics and authoritative anatomy knowledge and Vanessa Maher (ed) for a collection of writings on breastfeeding). Population control in the theoretical sense involves the manipulation of social thought (common sense) and bodies for the common economic good of a nation - or for those that govern the nation. What economic purpose is served by controlling how a growing population is fed? Maybe that is one for the formula companies to answer!

From a feminist perspective I would argue that much has to do with the destructive illusion that gender equality is about making women more like men rather than acknowledging that biological difference is a strength particularly in terms of life creation and survival. Women are 'freed up' to enter back into the workplace and therefore should feel liberated about the choice of bottle feeding over breast. This....as opposed to the workplace adapting to the needs of a breastfeeding woman is the type of situation that makes breastfeeding an issue that then needs dealing with. Laws and policies must be devised and rights defended in order to ensure some smokescreen of equality in what is essentially a patriarchal work-space. Only in the most advanced capitalist societies do organisations need to create a policy for breastfeeding because in those societies women's bodies really are commodified and sexualised to a point where people have forgotten what breasts are for. And those that remember have to work hard to defend what is seen as a radical standpoint and feeding one's child becomes a Right rather than a normal bodily function...what a topsy-turvy world we live in!

Motherhood, birth and hormones in the Field: a reflection

A few weeks have passed by, a new life has left my womb and come to bless our family and the remainder of my small family unit has arrived (post-birth) to join me I the field. Theoretically it is my planned break in work activities and time to spend recovering from pregnancy and birth and bonding with my loved ones. I have longed for two months to see my husband and son again yet at the same time was apprehensive about how it would make me feel.

We are now a family group of 5 in the field site, I am two weeks postpartum and myself and new baby have not left the house since the birth. She is 100% healthy, feeds and sleeps well and therefore leaves me with time to reflect (and worry) about my work and period in the field, especially when the school run is taking place and everyone else is out of the house for a few hours. One could almost say I have too much time think, or in fact that I just think too much..fin!

I became so engrossed in my data collection during those first couple of months partly because it was going so well since our move to this house and partly because I was worried about not functioning well postpartum and everything generally going a bit wobbly. I also looked forward to taking a month off and being absorbed by family. Needless to say this has not happened. I had a very quick and simple (and exhilarating) birth leaving me physically in excellent condition and really I should know myself better by now! The truth is I can’t switch off completely no matter how hard I try, so I figure it is better not to try. Instead I’m worrying about the data I’m missing out on whilst in the house and the practicalities of what need to be achieved whilst I have some help around and also afterwards.

Whilst I’m doing my usual and unavoidable ‘getting on with it’ I’m managing an interesting emotional state – a combination of postpartum hormone cocktail and the closeness of having the family back together again. I had no idea actually how much I had missed the boys until they arrived and now it feels very clear just how much I have, do and will miss them. I also had no idea how much I missed my home and daily life. The old saying ‘out of sight, out of mind’ appears to ring true here and now these emotions are coming back to bite me on the bottom! I am also fighting at the same time with a will to carry on working and not neglecting my data collection.  It feels very much like the struggle between family/work/study/life balance that I face at home, only here there’s the added bonus of sunshine and exaggerated hormones.

I was helped very much yesterday by reading THIS article published a couple of years ago in Anthropology Matters. The paper consists of a discussion of the problems faced by Phd students who were carrying out anthropological fieldwork for extended periods (generally around 1yr). It definitely made me feel better about my own situation (taking comfort in other people’s misery!) and made me realise that I’m not doing too bad. I have been struggling with a decision about cutting my fieldwork period short and trying to figure out just how much data is enough for my thesis. This kind of thinking is based purely on my emotional reaction to the family being together again, though I don’t think there’s anything wrong in that. My Phd at the end of the day is a purely individual goal that admittedly is all about me and what I can achieve in my student and academic career. My family is about our collective unit and love, not too difficult to figure out what should take precedent! Or is it? Like many a ‘modern lady’ (sarcasm italics) I would actually like to have it all, though this appears to come with a price that leaves me in a constant state of emotional, psychological and physical compromise – very close to what I’m actually here to study in other women.

I have a deep concern about how much data is enough and what kind of quality it needs to be in order to achieve a fabulous doctorate thesis, but I am just as concerned about the ongoing affect this is having on my family unit and the overwhelming feeling that I just want to be at home curled up on the sofa with my babies reading their favourite stories and just being together.

Motherhood in the Field: "Mummy I want to go home"....

Coming up to about a month of our 10 month residence in the ethnographic field and last night I heard the words I have been dreading "Mummy I don't want to be in Mexico any more, I want to go home". If anything I'm surprised it took this long, though my eldest has always been sensitive to what's going on around her and is not likely to blurt this out at any given moment. I have to say I envy a child's ability to be honest with themselves and those surrounding them, in reality she was only echoing what I have often felt on the inside during this first month.

So far we have had arguments with landlords and house moves, infestations of head lice, regretful, unplanned trips to the jungle (long story!), occasional vomiting, over tiredness, insomnia and a spattering of general wobbling of confidence in what I'm here to achieve - and that's just me!

Having been witness to all this and only once have uttered the 'going home' words, (which to add context were said as an over-tired, outplayed four year old was refusing to put her own pyjamas on) before promptly falling fast asleep, has actually left me feeling immensely proud of eldest daughter and amazed at her adaptation skills.After spending a sleepless night worrying about my response/plan to these dreaded words, there was no mention of it the next morning as she happily chatted on about her plans for play that day.   She appears to be coping with this whole fieldwork thing much better then me! 

A positive house move to a neighbourhood where other children are at hand to play with and impending starting of pre-school have certainly helped smooth over this initial period. From my workload point of view it also allows me to stop pressurising myself into intense data collection as I will very soon have a short period of 5 child free hours a day to occupy myself with and a more defined 'work day'. I've never been a outspoken fan of routine, however, bringing a child into the field has forced me to have a structured routine that is beneficial to data collection. 

Pregnant belly and chatty four year old are also proving beneficial in the legitimising myself in surroundings and with informants arena. It's become quite useful when attached daughter begins most conversations for you, being an apprentice in the field one has much to learn about how children engage strangers in conversation and abstract useful information. So much so I'm beginning to wonder whether I can continue in her absence whilst she's at school!!

On a poignant note, coming to observe motherhood in a place where motherhood is everywhere  and in most aspects a very social event. Where women  work with babies or small children attached to them, where daily tasks are carried out and life goes on without a severe separation of activity and mothering spaces it allows me to reflect upon the fact that I have half my child stock here with me and will continue to do whilst I work and study for a doctorate degree. If anything, I am questioned here as to why I would leave another child behind - quite different to the conversations I had in the UK about why I would possibly want to bring a child with me.

The emotional strain of leaving one child behind was something that I expected to struggle with, though it appears, as with my daughter that my son is adapting quite well to my skype presence and seemingly a less outwardly affected than I at our separation. The next challenge will be when we all come together in month's time and then have to separate again - with the addition of a new baby. The fear of not knowing how this will all pan out is driving my data collection each day and helping me maintain focus. I do wonder that without this added pressure what stage I would currently be at now...probably still looking for a cheaper, more comfortable house!

motherhood in the field: Separation and Arrival

The challenge has begun (on a matter of principle I refuse to use the word 'journey'!). In the early hours of this morning my four year old and I waved hasta luego to my husband and three year old son and began our journey to Mexico (aptly we left on mother's day). We will be apart for the next 2 months when they will come over to visit, in time for birthdays and await the birth of our third child. After that we shall become fragmented once more for four months. Already this gives me a deadline to work towards as I try to plan what aspects of fieldwork I can fit in within the next two months, whilst at the same time settling my four year old into her new surroundings, the last trimester of pregnancy and dealing with the temporary separation of our family.

I am aware that this preliminary post is sounding rather balanced and sensible. It must be noted that as I write I am only halfway through travelling to the fieldsite and having set off at some ungodly hour this morning am actually far too tired to think or feel the gravity of the situation. Less than 24 hours since we said our hasta luegos I am yet able to comprehend the emotions of leaving one of my children and partner behind.

I received some interesting comments and tweets after my last post relating to the topic of parenthood in the field and the work/motherhood balance in general. A consensus amongst many was the idea that fieldwork could/should be done for short periods and that finding a time to parent would be difficult. This did make me reflect on the perspective of my children and how appropriate it was to bring them into the field, but this was constantly outweighed by the acceptance of my chosen discipline of anthropology and desire to complete an in depth ethnography of my subject in question. Although compromise is the key to most things in life (most definitely concerning parenthood!) I am quite confident in defending the point that my field data would itself be compromised (and not in a positive way) if I didn't commit to a substantialy lengthy period. Wanting to understand pregnant and maternal subjectivities at least deserves one to be around for the gestation of the phenomenon. A field context is important here, my acompanying child and growing fetus are along for the ride for various practical (and biological) reasons. I want to understand motherhood and pregnant bodies in a Mexican context so I don't see too much problem with bringing my own bodily accessories into the fieldsite. Who knows, it may even result in an advantage...I'm sure my children will be the judge of that!

Motherhood in the Field : a new thread

I am about to embark on a years worth of anthropological fieldwork into social pregnancy and maternal subjectivities. It is my aim to spend the next 10 months 'hanging out' with pregnant women and their families, midwives and other health professionals and generally anyone who can stand my presence and questions for a long period of time!

In preparation for the field I have learnt much about interview techniques, fading into the background (or not!), the effect of the researcher on the fieldsite, best way to take notes etc. but little about the specific aspects of my own life that cannot be suspended in animation whilst I go about my field life. 

MOST NOTABLY MY FAMILY...

I have found noted in odd ethnographies and papers where anthropologists have noted the presence of their children (Sheper-Hughes in Death Without Weeping, Gutmann in The Meanings  of Macho), some reflections/mentions of pregnancy in the field (Rapp in Testing Women, Testing the Fetus , Ivry in Embodying Culture) and nothing so far on leaving one's small children behind to go into the field (though I am happy to stand corrected). I have come to conclusion that like much ethnographic fieldwork mysteries it must come to to initiation and guarded experience. Arguably if ethnography is to be a reflexive practice there needs to be a space for discussing such experience - it is either woefully lacking or I have failed to find it. 

I have decided to treat my posts here over the next year as a thread for my field experience and its clashes/coincidences with motherhood. This way such reflections may stay out of my confidential field notes and I will have a space to reflect upon myself and hopefully open up a discussion space for all parent anthropologists to contribute. 

OVER THE NEXT YEAR I SHALL EXPERIENCE THE FOLLOWING (in my personal life as mum, wife and woman): Being accompanied in the field by a small child; leaving another small child and husband at home for the duration; being pregnant with third child; birthing said third child and continuing in the field. 

Have I gone mad?? Is a question on the lips of many..Is it ethical/moral to separate one's young family in the name of fieldwork and what right do I have to do so? I have been asked and have asked myself many of the same and similar questions HOWEVER, as is the concern of many a fledgling academic - as much as I love to theorise about the cultural construction of the human body, my womb does have a shelf life; women have to fight hard in academia to achieve their goals and qualifications; I live under the illusion that if we can't have it all we can at least try; although I struggle to find published evidence I surely am not the first woman (or parent) to be in this situation.

Crash, burn or be successful...only experience will prove my resilience and that of my family!

Reviewing writings from the Past

Prompted by a recent Twitter thread I have published an edited version of my MA thesis on this blog (http://letterfromchiapas.blogspot.co.uk/p/archive-ma-writings-on-gender-and.html and also as a note on https://www.facebook.com/LetterFromChiapasBlog).

I wrote the original thesis entitled : Multiple Gender Identities of the Isthmus Zapotec and the Transition of the Household into a Neoliberal Mexico back in 2006. As well as the submission for my MA in Social Anthropology is was also intended as the project for my first attempt at gaining a PhD (which turned into a major disaster but that's for another time and place!).

Photo from  http://www.azull.com

Re-reading, editing and re-posting sections of this thesis has presented me with some opportunity for reflection. The original tweet thread from @icdad and @ThinkMexican reminded me of the months of thinking, reading and writing about the complexities of gender and sexuality constructions in Latin America I had done, that now seem a distant past. Just what happens to all that stuff we learn in our early academic and educational journey? Does it just get compartmentalised, archived in the memory banks until prompted by an external force to come to the fore again? 

Surely on many levels this previous knowledge hoard must inform my thinking and understanding of the world today? I just don't spend much time reflecting upon it.... I now realise that is a shame.

As well as a reminder of my first in depth anthropological thinking into gender and economy, reading this thesis has demonstrated en evolution in my writing. It's difficult to read academic work from the past, it makes me cringe - I admit to never revisiting my undergrad assignments - I don't think I have the stomach for it! Opinions and ideas without much substance is a polite way to describe my undergrad self... What I would probably now write on my own student's feedback as "This discussion has some potential, however..."

I think perhaps its a good idea to have a reunion with my past self every now again, catch up with how I arrived at my current state of being and maybe learn a few things about where I'm going! 

If I could draw my PhD....

If I was able to express in art what I'm trying to do by analysing what is inside and how women feel it would look like this:

Salvador Dali City of Drawers

If only I could embody Salvador Dali that is!

This last couple of weeks I've been trying to get to grips with pregnant embodiment via a multiple body analysis (using Lock and Scheper-Hughes' notion of Individual Body, Social Body and Body Politic). I'm finding that as with theories of embodiment themselves I am awash with mental imagery and physical feelings of what it is to embody a social (and cultural) idea of what reproducing is and what having an occupied womb feels like. What I'm finding most problematic is turning this into something tangible, that makes sense to those outside of my head who are given the task of deciphering what it is I'm trying to say. 

Studying the humanities (or social science - when it comes to anthropology no-one can decide!) has introduced, rejuvenated and reaffirmed a love for artistic expression. I'm finally able to connect how humans have coped with a lack of the right words to describe how they feel - what they have done with a burning desire to express how they experience the world. Making me at once liberated and dismayed that no matter how much I would like to dance my way through a viva voce I will never be allowed.

I have discovered one saving grace though, the work of Julia Kristeva  and her writings about poetic language and the semiotic chora (the pre-lingual subject in process). From what I can begin to understand is that she is willing to explore the pre-cultural human in the womb, ourselves before we become social selves. This entails trying to grasp what urges are and can be - if there is any chance that some part of us cannot be explained via the route of social construction. 

I spend so much of my time thinking about how our every thought and feeling is manipulated by our surroundings and experiences - a very European approach to a world we have perhaps lost touch with, a spirituality that has been analysed away. Kristeva has bought something back for me, in a way given me permission to think through my own birth experiences and those of others. To be able to dig deep into other cultures and narratives that celebrate a female, maternal, real, connection to the earth - a way of metaphorically kicking off my shoes and feeling the earth or sand in between my toes. I can close my eyes and see liquid, blood, organs, space and what I imagine to be the collective wombs of women around the world, I can imagine myself swimming through dark, sticky red liquids that relate to womanhood and reproduction.

If I only I could find the right words......

Birth Story

 BIRTH STORY: Ina May Gaskin and The Farm Midwives is racing toward the finish line with finishing costs mounting--seeking women and men who share our enthusiasm for what Ina May and the Farm Midwifery clinic have achieved in the last 40 years; since the 1970s these counterculture heroines have inspired hundreds of thousands of women to believe in their bodies’ natural ability to birth safely and beautifully. Today, with nearly one-third of all U.S. babies delivered via c-section, their knowledge and skills are more needed than ever.




This amazing film project has been put together by two women who describe themselves as "two filmmaking mothers who have been inspired by the important work of world-famous midwife Ina May Gaskin and her incredible colleagues. We've spent the last two and a half years juggling cameras, microphones, hard drives, preschool drop offs, nursing infants, pregnancy, editing schedules, babysitting schedules, American express bills, and vomiting four-year-olds"...


It seems to me that in 2012 we are really racing towards positive change and realisation of just how important respectful birth is and how we treat birth reflects how we are as a society as a whole ... 

Anthropology contributing to the World...

Here is a link to my latest post and part report on my sister blog from the RAI conference Anthropology in the World Conference in London: http://researchingsecurity.wordpress.com/our-publications/conference-papers/what-can-anthropologists-offer-to-security-studies/ 

I attended a great panel on anthropology's potential in the environment of security studies, this timed perfectly with the paper I've been writing (see previous June post) about the long term effect on conflict in Chiapas and reproductive health services. It also reaffirmed by belief in what ethnographic methods and anthropological theory can contribute to revealing the lived experience of people. Especially when all we get from projected media images are scenes of violence and fear to keep us away. It is often so easy to forget that individuals and families continue to live daily in these environments and continue to have the same food, shelter,water, employment, relationship issues that exist in places of relative peace. Collecting, representing and reflecting upon the stories of others reminds us to look beyond the situation to the people involved in it. 

For my mothers.... para mis mamas

Wall Painting at Luna Maya Birthing House SCLC where my first child was blessed to be born

I feel inspired to write this post today, not only as I sit comfortably in bed with my mother's day breakfast, listening to my children play (occasionally scream and argue) downstairs BUT because as orchestrated as this day may be I don't think it matters where or when or why the inspiration to reflect overcomes us.


As far as I know it's only Mother's Day in the UK today, but it allows me to think of all the women I know wherever they are in the world. When I want to think about what a Mother, Mum or Mummy is I cannot think  of this soley in terms of 'she who has born a life'.... Of course the very act of creating a new life biologically is incredibly sacred, special and an experience seriously under threat globally due to the way reproduction is treated by dominating capitalist forces and the medical Dire-rachy as is the usual tone of my posts. Today though, I wish to remain positive and divert my virtual activism to one of pure LOVE ...

Scheper-Hughes and Warrior 

Motherhood in my understanding is very far removed from the physical, spiritual connection to the womb, the act of being a mother (without any of the accusatory adjectives we so like to place before it) is a social act, one created from love, necessity, desire, situation - that involves the not so simple act of caring for someone or something in an unconditional manner, regardless of the consequences - something anthropologist Nancy Scheper-Hughes has written of as [M]Otherhood. Exploring the darker side of a mother's love and quest for survival, Scheper-Hughes' celebrated ethnography of a Brazilian shanty town Death Without Weeping forces us to really explore the nature of caring and the social construction of the right type of caring we are conditioned in to believing in the UK (and associated homogenised countries). Dealing with the nature of infanticide in this shanty town context where women battle against the most extremes of poverty, starvation, abandonment and spiritual awareness, one is forced to confront the question of just how humane it is to try and survive at all costs if the only result will be further suffering.... ultimately it leads to the very deep questioning as to exactly what lives we are here to lead and for whom?  
At it's best, this piece of writing is provocative and celebratory of a specific type of motherhood that quite frankly takes one brave warrior to keep going! As with any female academic worth her publishing salt Scheper-Hughes is not without her critics - I'm finding this happens a lot with feminist anthropologists who promote activism with their work - but am of the ilk where the belief is you have to shout loudly in order to get the attention, provoke a reaction and then have the discussion about how REAL it all is. 


Today I celebrate all the beautiful women who have come before me - those of my own blood relation who birthed, cared for and laid set the high standard of unconditional love that flows through my cherished family. My great grandma, great aunts, nana and mum who have been at my side during both of my (re)births and have taught me to overcome so much. I celebrate the lives of my grandmother-in-law and my mother-in-law who have lived lives that to me seem so far removed from my reality that I often confuse them with a Gabriel Garcia Marquez novel!!


To all the women and honary MotherMen who have cared for me, dried my tears, reassured me, helped me birth and filled me with so much love and desire to live sometimes I feel I could burst... Especially to th@se who have challenged me, made me stop and think and understand that as a person I am a teeny tiny spec of dust in this world... but not one without meaning...


For the love and respect of all [M]Others...... Thank you for the JOY! 

Kiki Suarez - My Head is Full of Children

A Review of Ethnography Literature concerned with Medical Education and Obstetrics

Working on context and history the following review attempts to discuss what's there and what's missing - in order that I may find a place for myself in the vast space of Anthropology of Pregnancy... 
Creative Commons License now applies to my blog (see link on right hand side for blurb). A quick email/comment in regards to correct and respectful referencing of work always appreciated and discussion always welcome :)

 ‘Now for the sense of ‘context’. Most generally it is a name for a whole cluster of events that recur together – including the required conditions as well as whatever we may pick out as cause and effect.’ (Richards 1936)

    This review of ethnographic and theoretical literature relating to the learning of obstetrics and medicine begins with a discussion of context, or more specifically a theory of contexts. I refer here to the practice of Articulation (Grossberg 1992) – where the construction of one set of relations comes out of another. Ethnography of pregnancy in Chiapas should be revealed as montage, interrelating contexts that result from social theory and cultural practice rubbing against one another (as proposed by Taussig 1992). Wanting to find out about the actual experience of pregnant women must include a focus on the knowledge, power and practices that inhabit their world. ‘Articulations are never simple and singular; they cannot be extracted out of the interlocking context in which they are possible’ (Grossberg 1992). In this way I wish to take account of obstetrical medicine as cultural practice, as it is reflected onto a specific society via the pregnant body. It will become clear from my review of ethnography centred around medical education that medicine as an all-encompassing cultural practice outside of a UK/US context, is an aspect that has been somewhat neglected.

    Grossberg advocates that to understand a practice one must historically and theoretically (re)-construct it context (1992). In doing so such (re)-constructing should inevitably lead to the processes of learning (Lave and Wenger 1991). For this reason I have also included literature that analyses the historical construction of medicine and anatomy, without which a present day context would not exist.  In the course of unpicking existing ethnography of medical learning (or any kind of learning to be in the world) one is instantly presented with multilayered dispositions. Evans (2006) explains these dispositions as an embodied understanding of a particular way of being amongst others. Relating her analysis of social learning and violence to the work of Lave and Wenger (1991) and their theory of legitimate peripheral participation Evans argues for the recognition of emotion in the learning process. In doing so she highlights the importance of the varying and tacit things that contribute to the practice of learning. Echoing Lave and Wenger’s sentiment that learning is a cultural context that is best analysed outside of an institutional context Evans’ discussion in this paper is useful for beginning to think about learning as socially constructed practices.

   A substantial amount of ethnographic work exists in regards to traditional midwifery practice and apprenticeship in Mexico (see Jordan 1993; Sesia 1996; Davis‐Floyd 2001; Tinoco-Ojanguren, Glantz et al. 2008; Mills and Davis-Floyd 2009; Smid, Campero et al. 2010). The learning experience and development of the medical profession in Mexico has come under little scrutiny in existing ethnography. An anthropological approach to medical education should focus on the cultural conditions of practices, what is being learnt and then how this translates into practice. The medical student understood as apprentice in a specific community of learning provides an appropriate space for this to happen. The year of social service that a Mexican student must complete at the end of their degree – where they are often sent to rural or heavily oversubscribed urban clinics demonstrates the ultimate passage of apprenticeship and presents the opportunity of an ethnographic understanding of interrelation between medical/traditional practices [1].

Historical Analysis and ethnography of Medical learning

‘...the body is simultaneously a physical and symbolic artefact,..both naturally and culturally produced, and...securely anchored in a particular historical moment...[Yet] we take scientific discourse about human biology to be not simply a narrative but a universal truth...we assume that it applies anywhere at any time and transcends time and place’ (Lock 1993)

   In medical terms the specific historical anchor of the body that Lock is referring to can be found in the development of anatomical dissection and pathology – the emergence of the medical gaze. The anatomical approach was based on the assumption that the more one knew of structure, the better one understood of function (Sinclair 1997:44). By stripping away the layers of the human body its different functions were exposed and translated into fact by prominent physicians of that time. Social and historical analysis of anatomy practices as knowledge creation tends to be based in the Foucauldian assertion that: ‘The gaze plunges into the space that it has given itself the task of traversing...In anatomo-clinical experience, the medical eye must see the illness spread before it...it is the body itself that has become ill’ (2003:166-167).  This anatomo-clinical experience of the medical gaze is a crucial historical juncture that denotes a shift in relationship between physician and patient, ownership of illness and diagnosis becomes that of the physician. From what they are able to see and feel, which must conform to what already exists in text, the physician is now expert of the body that is somehow detached from the subjectivity of the patient.

Anatomical theatre, University of Leiden 1596 online source: Wikipedia

   The practice in anatomical theatres (16^th and 17^th Century), for apprentice physicians was one of observation, of master refereeing from text to body (as opposed to creating text from the body present). The transmission of personally acquired experience to publicly available knowledge is further challenged via the classical artistic style of the period that depicted the dissected body parts and the events themselves (excellent analysis of anatomical art history can be found in: Martin 1989; Sinclair 1997; Massey 2005). Depictions of dissected bodies as artist impressions served to transmit tacit knowledge as concrete medical fact as soon as it appeared in print. This is particularly poignant in regards to the historical construction of the female body, reproductive organs and the pathologizing of pregnancy and birth. During the eighteenth century the publication of two highly regarded obstetric atlases contributed substantially to the epistemological reformulation of childbirth as a medical rather than domestic concern. ‘Stark, brutal and fetishistically naturalistic, these eighteen-century obstetric images medicalized and pathologized childbirth in an unprecedented way (Massey 2005). By pathologizing pregnancy and birth the female body was not only affirmed as a passive recipient of diagnosis, the pregnant body took on s similar representation to ill bodies in need of regulating and treatment. The peculiar aesthetic of the medical gaze– ‘the practitioner’s ability to describe the body persuasively and elegantly, in infinitesimal detail from the inside out’ (Massey 2005) -  culminated in a medical recognition of the foetus as a life product, an entity completely separate from the mother. 

Jan van Rymsdyk's most famous plate from William Hunter's "Anatomy of the Human Gravid Uterus".

     A significant aspect of the anatomical approach is the loss of lay meanings for words used in a medical context (Martin 1989; Sinclair 1997; Martin 1999; Kitzinger 2006), and also how under the medical gaze ‘unambiguous words apply unambiguously to unambiguous things’ (Sinclair 1997). What Sinclair means by this is that things are given a name and then measured as normal or abnormal according to that name. In The Woman in the Body: A Cultural Analysis of Reproduction, Martin (1989) analyses at length the terminology for the female body’s varying life cycle processes such as ‘degenerate’, ‘weakened’, ‘withdrawn’ and ‘lack’. This sentiment in regards to the use of eponyms and body function adjectives is echoed by Kitzinger in her discussion of obstetric language: ‘Gynaecologist’s names are attached to parts of women’s bodies and processes of reproduction as if these men had invented them; Fallopian tubes, Bartholin’s glands...If the baby does not engage...it may be because [the woman] has an ‘inadequate’ pelvis. When the cervix is slow to dilate, it is...’incompetent’...’ (2006:22).   This use of language then becomes a way of seeing the world, how students come to categorise bodies in their social world. 

      When presenting their theory of situated learning Lave and Wenger state that participation ‘is always based on situated negotiation and re-negotiation of meaning in the world’ (1991).  The process of transformation that a student will experience involves applying such ‘unambiguous’ terms in everyday life and practices, therefore also demonstrating a shift in how those students will begin to see all aspects of their lives through the medical gaze. The anatomical model forms the basis of medical education and alongside this the pathology model– the body as ill, the machine as broken. The primary stages of medical learning involve ‘scientising the self’ and the world around you (Sinclair 1997), the eponyms used in anatomy and pathology medicine reinforce the notion that this scientific basis itself is a masculine episteme – or as Sinclair so directly states in his ethnography, that: ‘Medicine is a man’s world’ (1997:143).

    Understanding the development of biomedical discourse through the detailed writing of thinkers such as Foucault or Martin is an essential starting point for the study of medicine and medical learning. This is however, one aspect of a study and is in no terms complete if one wishes to make sense of cultural context and local practices. Ethnographic study must go beyond what Good and Good (1993) argue to be the portrayal of a monolithic “biomedicine” that is treated itself as a conceptual category. In their preliminary analysis of the learning experiences of preclinical medicine at Harvard University, they remind us of the dangers of the diametrically opposing views in much medical anthropology between “biomedicine” and “traditional healing”. They point out that this is not helpful in anthropological analysis and culminate in a view of traditional medicine as untouched by biomedicine and vice versa. At its extreme, the use of biomedicine as a conceptual category fails to take into account the agency and interpretations of the people being studied and does not deal with the different types of medical discourses at play in an educational institution.

   In depth ethnographic studies of the medical student as apprentice learner, in the educational setting are limited and have come under criticism for paying minimal attention to the external influences, personal meanings and the phenomenology of ‘specialized medical worlds’ (Good and Good 1993; Sinclair 1997; Atkinson and Pugsley 2005).

   The most prominent examples of medical education ethnographies are: Merton and Kendell (eds) The Student Physician (1957); Becker et al’ Boys in White (1961); Bloom’s Power and Dissent in the Medical School (1973); and Sinclair’s Making Doctors: an institutional apprenticeship  (1997). Although not an exhaustive list, it is clear from these titles that there is a long tradition of ethnographic research in medical education in a UK and US context. Whilst they vary in focus from institutional mechanisms (Merton and Kendall 1957; Bloom 1973); professional socialisation (Merton and Kendall 1957; Becker 1961; Sinclair 1997) and power and authoritative knowledge (Bloom 1973; Good and Good 1993; Sinclair 1997), none pay particular attention to the interlinking social contexts and the influence of outer society inside the medical school or vice versa. ‘To say that a practice is defined by its effects is to locate the practice in its connections to its exterior, to that which is other to it’ (Grossberg 1992:53 my emphasis). Instead, ethnographies set in medical education environments have tended to isolate the students and the learning activity from the political, economic and social contexts of the outside world. Sinclair does present the argument that previous ethnographies have failed to deal with the influence of medical specialities that they have ‘been passed over in favour of the assumed homogeneity of the teaching institution’ (1997:14), his work does make a decent attempt to break away from this. Sinclair’s ethnography is still limited in some respects due to its use of the biomedical model as a conceptual category somehow frozen in historical context. Preliminary work by Good and Good is by far the most useful text for considering ‘...the phenomenological dimensions of medical knowledge, on how the medical world, including the objects of the medical gaze...are reconstituted in the process...’ (1993:83) of learning to be a doctor.   

    Anthropological and sociological literature on medicine and reproductive health in Mexico evidences that medical curriculum and clinical authoritative knowledge have their roots in European and North American practices. Ethnography of midwifery models and practices identifies the use and influences of biomedicine (Jordan 1993; Davis‐Floyd 2001), though the opposite has not occurred in any study of medical or obstetric practice outside of a historical analysis. This instead tends to fall into the trap already discussed of the untroubled monolith “biomedicine” and/or medical “discourse”, untainted by personal meanings or the world of disease and suffering (Good and Good 1993).

    Existing medical education ethnography is useful for the general theoretical arguments it presents towards cultivating a professional identity and exclusive community of practice. However a deeper understanding of the organisational structure of the Latin American medical school; how authoritative knowledge is culturally absorbed and changed; the more complex interlinking contexts of gender, class and ethnicity; and professional/social status of obstetrics is needed in order to understand its role in pregnancy and childbirth in a local context.

“Iatronic Epidemic” and its links to Authorative knowledge in contemporary cultural education systems

   Links between authoritative knowledge, political economy and relations to the State are well documented themes in medical anthropology and also anthropology of pregnancy (Ginsburg and Rapp 1995; Szurek 1997; Ivry 2010) and further connection needs to be made to the role of State (in local and global contexts)and how this informs educational curriculum and the things that medical students learn. This is an argument that Bloom (1989) puts forward in his paper on the sources of resistance to change in medical schools. By analysing the evolution of organisational structure of medical school in varying countries and regions he demonstrates how medical education is inextricably linked to the health service system. Bloom provides a useful model of the Latin American medical school which he generalises as:

‘autonomous professional school connected to the central administration of the university but with no connection to other parts of the university, combined with open admission immediately after secondary school and student activism’ (Bloom 1989).

Though not entirely unproblematic in its generalisation (particularly between the public/private institutions), this is a useful definition when thinking about the position of the medical school as straddling the general university space, elite professional status space and with the university hospitals, a direct connection to the public health service in action. Medical learning does not happen in a vacuum away from cultural practice and society and one could assume that the curriculum must reflect the direct practices of the hospital or clinic – which in turn are driven by health and welfare initiatives of that given time. The nature of apprentice learning will also mean that students are learning from physicians who continue to practice, moving between an idealised text book static medicine and a multi-layered, everyday practice of medicine defined by cultural, political and economic contexts. 

   The iatronic epidemic is a term used by Castro (2003; 2004; 2004; N.d. ) who has examined violations of reproductive rights in Mexican hospitals including practices of unnecessary caesarean sections, transcaesarean contraception insertion and sterilization without direct consent. By comparing ethnographic data with existing statistical data from the mid 1990s through to 2001, Castro et al (N.d. ) describe how obstetricians can be the driving force behind the rapid rise in caesarean sections, to a point where Mexico is now amongst the highest incidences in the world (Althabe and Belizán ; WHO 2009; Castro, Heimburger et al. N.d. ). An iatrogenic epidemic refers to a practise in relation to its effects, a problem caused by doctors by their own actions. In this case that of gyno-obstetricians in Mexican hospitals (public and private) and interventions in pregnancy and birth. Grossberg establishes that: ‘...a practise is not where it is...but at all of those sites where its existence makes a difference to the world’ (1992:53). Here there is a direct connection to Castro’s work and the theoretical basis’ of learning discussed in the introduction to this literature review. By providing further links to teaching hospitals and cultures of surgical intervention in the learning of obstetrics, Grossberg’s practice of articulation provides a tool for analysing the interlocking cause and effect from educational institution to wider societal context, from community practices to individual lives.

    The work of Castro in Mexico City public hospitals is the closet one becomes in trying to relate obstetrical education knowledge and practice in a Mexican context, and also in relation to political economic realms of health policy. There is a need to re-address some of the major issues brought out by Castro’s detailed ethnographic work, in respect that the context of pregnancy in Chiapas can never a stable subject of study. Since Castro’s data was collected Mexico has changed its President and majority party twice; there has been a global financial crisis; Millennium Development Goals have entered into their final phase; and baseline welfare provision has further developed (Seguro Popular and Oportunidades cash transfer programme) leading to clinical provision in more rural areas and with that further meshing of urban and rural medical practice. How medical and obstetric education has evolved alongside these political and economic stages and the links to economic crisis, structural violence and reproduction have yet to come under any ethnographic analysis.

    In essence there is a good existing base of ethnographic literature from which to build upon. Ethnography of reproductive health and pregnancy in Mexico also tends to reflect that of the wider literature – much analysis begins with the practice of qualified and experienced gyno-obstetricians. Where students and educational structure appear they tend to do so as a background concern. This may be because they are often in an observing, apprentice role and so are described for participation around the main character – the seasoned obstetrician or consultant. In doing so ethnographic understanding of learning medicine and obstetrics is so far absent from the focus on institutional practices – in so much that it could be accused of being taken as a given, as if the training of medical students is a dormant part of the wider context. This is in direct comparison to celebrated ethnographic studies of Mexican midwifery in terms of apprentice learning and meanings of professional that use learning practices as their very focus. I refer here again to Grossberg’s proposition that a practice located in its connections to its exterior and the interrelated effects it has on that exterior, is what opens up the practice and makes it visible to social analysis. In this respect ethnographic analysis of pregnancy and birth in Chiapas must take into account the learning of obstetrics and institutional identity as part of the wider context.

References

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Atkinson, P. and L. Pugsley (2005). "Making sense of ethnography and medical education." Medical Education 39(2): 228-234.

               

Becker, H. S. (1961). Boys in white : student culture in medical school. Chicago, University of Chicago Press.

               

Bloom, S. W. (1973). Power and dissent in the medical school. New York;London, Free Press ;Collier Macmillan.

               

Bloom, S. W. (1989). "The medical school as a social organization: the sources of resistance to change†." Medical Education 23(3): 228-241.

               

Castro, A. (2004). Contracepting at Childbirth: The intergration of reproductive health and popultation policies in Mexico. Unhealthy Health Policy: A Critical Anthropological Examination. A. Castro and S. Merrill. Plymouth Altamira.

               

Castro, A., A. Heimburger, et al. (N.d. ). Iatrogenic Epidemic: How Health Care Professionals contribute to the High Proportion of Cesarean Sections in Mexico, DAVID ROCKEFELLER CENTER FOR LATIN AMERICAN STUDIES.

               

Castro, A. and M. Singer (2004). Unhealthy health policy : a critical anthropological examination. Walnut Creek, Calif., AltaMira Press.

               

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

               

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Lave, J. and E. Wenger (1991). Situated learning : legitimate peripheral participation. Cambridge, Cambridge University Press.

               

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

               

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Martin, E. (1999). "The Egg and the Sperm: How Science has Constructed a Romance Based on Stereotypical Male-Female Roles." Signs: Journal of Women and Culture Vol. 16 no. 31: 485-501.

               

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Sesia, P. M. (1996). ""Women Come Here on Their Own When They Need to": Prenatal Care, Authoritative Knowledge, and Maternal Health in Oaxaca." Medical Anthropology Quarterly 10(2): 121-140.

               

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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.

               

Szurek, J. (1997). Resistance to Technology Enhanced Childbirth in Tuscany: The Political Economy of Italian Birth. Childbirth and Authorative Knowledge Cross-Cultural Perspectives. London, Univ. California Press: 287-314.

               

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[1] There have been some pilot programmes of incorporating local midwifery in clinical spaces for example see: 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.