Women's Bodies, Women's Worries

Health and Family Planning in a Vietnamese Rural Commune

Tine Gammeltoft

• Publisher: Taylor & Francis
• Year: 2012
• Print ISBN: 9781138987180
• eBook ISBN: 9781136112980
• Edition: 1
• Topic: Social Sciences
• Subtopic: Regional Studies
• Index: Social Sciences

The first fully-fledged ethnography on health-related issues to come out of contemporary Vietnam, Women's Bodies, Women's Worries is a study of women's lives in a rural commune in Vietnam's Red River delta. Starting as an examination of the impact of Vietnam's ambitious family planning policy on the health and lives of rural women, the study explores historical and contemporary socio-cultural forces which influence the lives of Vietnamese women. What begins as an investigation of contraceptive side effects becomes an inquiry into the daily lives of rural women, an examination of the moral ideologies by which women's lives are circumscribed, and an exploration of the ways women themselves manage and negotiate the moral demands and social relations which constitute daily lives. In addition, the book provides a sympathetic account of the everyday lives and concerns of rural women while also including theoretical considerations of the social grounding of bodily experience, the cultural meanings of health and illness, and the everyday politics of emotional expression.

Chapter 1

Introduction

When I asked Chuyến, the commune Party Secretary, why so many women seemed to have problems with their IUDs (intrauterine devices),¹ he answered, ‘Do you know the saying “The last drop of water breaks the camel’s back” (Giọt nư

c đ

lên lung con lạc đà)l You should put that on the front page of your book.’

Background

The IUD is central to the Vietnamese family planning programme; three out of four users of modern methods of contraception rely upon it (GSO 1995). However, as both lay people, health workers and researchers in Vietnam have noted, an alarming number of Vietnamese women have serious problems using the IUD (e.g., Phạm Bích San 1993; Sundström 1994; Knodel et al. 1995; Johansson et al. 1996a, 1996b). When I was first in Vietnam in 1992, women’s problems with the IUD were less known among foreign observers. The country had only just begun its policy of opening up to the West and very few foreign-language studies of health or family planning existed. Embarking on fieldwork in a Red River delta rural commune, I was therefore surprised to note the widespread dissatisfaction with the IUD among women.

One of the first women I talked to during my fieldwork told me about the serious health problems she had encountered with the IUD:

‘After I had the IUD inserted I felt weak and tired and my periods became much stronger. Once I felt so exhausted that 1 had to rest for a whole month and could not work. I had pains in my back and stomach and a lot of discharge, and after a year I had the IUD removed.’

Another woman, complaining of the frequent pregnancies among IUD users, said:

‘You know, in the old days, heaven decided how many children one would have. Today we have the IUD, so heaven still decides.’

Many other women told stories of heavy bleedings and heavy bodies, aching backs and stomachs, and feelings of weakness and exhaustion, which they all ascribed to their use of the IUD. After a few weeks of work in the commune, I summed up in my diary:

‘This week I heard even more examples of heavy bleedings and unwanted pregnancies with IUDs. It is disastrous. Women sometimes have their IUDs inserted in secret because their husbands do not allow them to have an IUD, fearing that it may impair their working ability. ‘

The massive problems Vietnamese women experience with their IUDs – including health problems, expulsions, and accidental pregnancies – are quite disturbing, particularly in a situation where the IUD is the most common form of contraception in a fairly ambitious national family planning programme. Explanations of women’s IUD problems abound in Vietnam. Women’s Union² cadres often say that ‘it is a disease of the mind’, that women simply blame all their troubles in life on the IUD. Others relate IUD problems to the poor quality of care in reproductive health services, including a lack of technical skills among providers (Đ

ỗ Trọng Hiêu et al. 1995a). Some see in IUD problems a form of quiet ‘resistance’ to a heavy-handed family planning programme (Johansson et al. 1996a). Some providers suggest that the IUD – which is today imported from the US – is too large for the uterus of Viet namese women (Jain et al. 1993). Commune women themselves often say that their bodies are ‘weak already’ and thus cannot bear the additional disturbance which an IUD causes. This was also what Chuyến referred to when he compared the IUD to the ‘last drop of water’ breaking the camel’s back.

But the problems which Vietnamese women experience with their IUDs reach far beyond the particular context of family planning in Vietnam, signalling a range of much more general issues. Today, efforts to control human fertility are immense throughout the world, and technologies for fertility control – whether for limiting or enhancing fertility – are under constant development and change. Reproductive technologies provide wide-ranging potential for control of human bodies and their reproductive capacities. As noted by Fathalla (1994), these technologies are double-edged weapons: while they may considerably enhance the ability of women and men to control their own lives and fertility, they may also be violently used by governments and other agencies to control the bodies and fertility of citizens.

Both in terms of health costs and social costs, women tend to bear the major burden of efforts to control fertility. Most fertility control technologies are developed for use by women and in most societies women are held responsible for matters related to reproduction and childcare. Given the global use of modern fertility control technologies and their vital importance to the lives of women all over the world, our knowledge of women’s own experiences with these technologies is strikingly limited. Since the mid-1970s, large ‘acceptability studies’ have been carried out, investigating the acceptability of different contraceptive methods to their potential users. This approach to contraceptive research has been questioned by feminist researchers and women’s health advocates, who maintain that assessments of contraceptive acceptability need to take into account contextual factors such as the social conditions of women’s lives and attributes of the service delivery system, rather than seeing acceptability as something inherent in the technology as such (cf. Spicehandler and Simmons 1994; Heise 1997). Also the ‘user perspective’ studies which have been conducted in recent years tend to remain relatively narrow in scope, often neither contextualizing women’s perspectives on fertility regulating technologies within their wider life situations nor providing qualitative insights into the experiences and perceptions of contraceptive users. Anita Hardon has noted:

Though they present us with a spate of descriptive statistics we learn relatively little from this existing body of knowledge about women’s experiences and views. More in-depth studies that contextualize fertility-regulation practices in people’s day to day lives are essential for understanding of user-views of fertility regulation methods (Hardon 1996, p. 7).

In order to improve women’s health and quality of life, it seems important to enhance our insights into the ways in which women themselves perceive and use fertility control technologies and to better understand how the uses of technology are mediated by both social relations and cultural meanings.

This book presents a social science perspective on a field and a set of issues which have until now been dominated by biomedicine and demography. While demographic and biomedical studies may provide valuable insights into the medical safety and effectiveness or the demographic impact of contraceptive methods, there are important issues which these studies do not illuminate. Despite a recent interest in ‘micro’ analyses, demographic studies often tend to focus on population dynamics at aggregate and general levels, ignoring more specific social interactions and relations. Biomedical studies tend to see the body as an object and bodily experiences as phenomena to be objectively measured and treated, ignoring the subjective experiences which are always also involved in efforts to manage bodies and control fertility.

In contrast, my aim with the present study has been to understand Vietnamese women’s own experiences with the IUD as a method of fertility control and to ground such understandings in the wider contexts of their lives. My analysis starts from an enquiry into women’s physical experiences of having an IUD inside their bodies and extends into the everyday worlds of family and community life, examining the social, moral, and political issues with which women’s experiences with the IUD are intertwined. Whereas most contraceptive research to date has focused rather narrowly on the technology as such, the focus of the present study will be on the lives in which technology is used. When an IUD is inserted into the body of a Vietnamese woman, it is also inserted into a life full of physical burdens and social stresses. A central argument of the study is therefore that neither physiological nor attitudinal reactions to a contraceptive device can be meaningfully distinguished from the social and cultural context in which contraceptive use takes place.

Theoretical and Analytical Premises

Technology plays a central role in the profound social changes the world is undergoing today. New technologies are transforming not only our everyday worlds, but also our bodies and sense of self. Importantly, however, as Donna Haraway points out, technology should not be seen as opposed to humans but as an integrated aspect of our selves:’The machine is not an it to be animated, worshipped, and dominated. The machine is us, our processes, an aspect of our embodiment’ (Haraway 1991: 180).

One important effect of the technologization of human life is a blurring of boundaries between human and non-human, a collapsing of conventional distinctions between nature and culture, body and technology, self and other, local and global (Haraway 1991, 1997; Strathem 1992; Featherstone and Burrows 1995). In recent social science writings on body-technology interfaces there has been a proliferation of the ‘cyborg’ image, not least inspired by Donna Haraway’s seminal ‘Manifesto for Cyborgs’ (Haraway 1985). Haraway writes: ‘By the late twentieth century, our time, a mythic time, we are all chimeras, theorized and fabricated hybrids of machine and organism; in short, we are cyborgs’ (1991: 150). The term cyborg refers to ‘cybernetic organism’, a self-regulating human-machine system. The transformation of humans into cyborgs has led Downey et al. (1995) to propose a ‘cyborg anthropology’, an anthropology which focuses on the ways in which technology mediates and transforms social relationships, bodies, and subjectivities. Cyborg anthropology explores ‘the production of humanness through machines’, arguing that ‘technologies participate actively in every existing realm of anthropological interest’ (Downey et al. 1995: 342–44). In today’s technologically mediated social worlds, the questions we confront concern the implications for human life and social relations of the uses of various kinds of technology. In which ways do specific technologies contribute to the shaping of new modes of agency and new forms of social relations? Which issues of power and control are involved? How are cultural meanings produced and changed through the social uses of technological artifacts?

The role of technology in biomedicine is one of the most obvious topics of interest for a cyborg anthropology. Biomedical technologies interfere directly with our bodily processes and functions, affecting not only human bodies but also the communities they constitute. The elderly man with the pacemaker, the woman undergoing infertility treatment, the young travellers carrying several different vaccines in their bodies – these are all examples of the blurrings of conventional boundaries between humans and machines which biomedical technologies involve (cf. Casper and Koenig 1996). Also in the realm of human reproduction, technologies and organic bodies are becoming closely interwoven. The technology at the centre of attention in this study, the intrauterine device, is but one example of the reproductive technologies which are currently changing not only our lives, but the concept of life itself (Franklin 1993 in Haraway 1997). Reproductive technologies are defined here to include technologies to create, prevent, monitor, and terminate pregnancies, as well as birthing technologies. As noted by Traweek (1993), most research and feminist theory on women, sciences, and technologies concerns reproductive technologies. Existing studies and feminist theories present widely differing perspectives on reproductive technologies: some view technologies as devices that increase women’s autonomy and choice (e.g., Haraway 1997); others see reproductive technologies as extensions of patriarchal control over female bodies (e.g., Arditti et al. 1985; Corea et al. 1985) or as first-world domination of third-world women (e.g., Morsy 1997).

Rather than starting from a preset and universal attitude towards reproductive technologies, the present study explores the specific uses and meanings of a particular kind of contraceptive technology in a particular social setting, investigating women’s own experiences of the technology within the context of their daily social lives. As with other kinds of technologies, reproductive technologies are not neutral or ‘innocent’ devices with similar uses and effects irrespective of cultural context. Rather, technology takes on differing meanings and has differing social implications depending on the context of its use (cf. Pfaffenberger 1992). In the present study the recognition of the varying and unstable effects of technologies on women’s lives opens up several areas of enquiry. As I shall outline below, in order to analyse reproductive technologies from an anthropological perspective, issues of human agency , human physiology and epistemology need consideration.

Human Agency

The first premise of this study concerns human agency. The study starts from the premise that even in situations of high structural constraint, women do make active choices concerning the tools that may enhance or limit their fertility. Such choices, however, are always contextual, and the analytical challenge therefore lies in tracing out the social conditions that produce and enable specific modes of acting. In this context it is particularly important to illuminate the local and global distributions of knowledge and power which shape and condition the choices women make. As Ginsburg and Rapp (1995: 5) note, ‘choices in reproductive technologies cannot be considered apart from international political and economic forces; … in any given situation, the market and politics structure what knowledge is relevant, ruling out many potential choices.’

In the context of this study, the focus on socially situated human agency involves a double consideration of (a) the social, economic, and political conditions under which women come to have IUDs inserted into their bodies and (b) women’s own desires and choices in the realm of fertility control. At a different analytical level, the focus on agency includes considerations of the ways women may actively employ reproductive technologies like the IUD to accomplish social purposes in everyday life. As we shall see, IUDs may be viewed as much more than devices for fertility control: they may be seen as ‘weapons of the weak’ (Scott 1985), as tools used by women to manage and negotiate everyday social relations. In this sense, reproductive technologies not only act upon women’s bodies, but are also used by women themselves actively to affect their social surroundings.

Human Physiology

The second premise of the study concerns human physiology. At issue here are the complex interchanges taking place between human bodies and technologies. In the context of the present study, the question is: how are we to understand the experiences that Vietnamese women have with their IUDs, the feelings of weakness and pain which are associat...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright
• Contents
• Acknowledgements
• Prologue
• 1. Introduction
• 2. Fieldwork
• 3. Planning Happy Families
• 4. The IUD and Women’s Health
• 5. Body and Health
• 6. Local Moral Worlds
• 7. The Expression of Distress
• 8. Conclusion: Antropologies of Suffering and Resistance
• References
• Index