Unsafe Motherhood
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Unsafe Motherhood

Mayan Maternal Mortality and Subjectivity in Post-War Guatemala

Nicole S. Berry

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eBook - ePub

Unsafe Motherhood

Mayan Maternal Mortality and Subjectivity in Post-War Guatemala

Nicole S. Berry

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About This Book

"[S]heds light not only on the obstacles to making motherhood safer, but to improving the health of poor populations in general."— Social Anthropology

Since 1987, when the global community first recognized the high frequency of women in developing countries dying from pregnancy-related causes, little progress has been made to combat this problem. This study follows the global policies that have been implemented in Sololá, Guatemala in order to decrease high rates of maternal mortality among indigenous Mayan women.

The author examines the diverse meanings and understandings of motherhood, pregnancy, birth and birth-related death among the biomedical personnel, village women, their families, and midwives. These incongruous perspectives, in conjunction with the implementation of such policies, threaten to disenfranchise clients from their own cultural understandings of self. The author investigates how these policies need to meld with the everyday lives of these women, and how the failure to do so will lead to a failure to decrease maternal deaths globally.

From the Introduction:
An unspoken effect of reducing maternal mortality to a medical problem is that life and death become the only outcomes by which pregnancy and birth are understood. The specter of death looms large and limits our full exploration of either our attempts to curb maternal mortality, or the phenomenon itself. Certainly women's survival during childbirth is the ultimate measure of success of our efforts. Yet using pregnancy outcomes and biomedical attendance at birth as the primary feedback on global efforts to make pregnancy safer is misguided.

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Year
2010
ISBN
9781845459963

Chapter 1

LIFE, BIRTH, AND DEATH IN THE VILLAGE

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Life in Santa Cruz

When I first arrived in Santa Cruz I wondered how living in the shadows of three enormous volcanoes for generations would impact people in the village. The longer I stayed in Santa Cruz, the more I began to regard the volcanoes as pictures on the wall—what was far more relevant in organizing our lives was that we lived perched high on a mountainside. The terrain leading to Santa Cruz was so steep that no road had been built connecting the village to the outside world. Rather, to get to Santa Cruz, you had to come by boat, and then walk about five hundred meters uphill. One pick-up truck had been ferried over to the village some years before and it was the only available mechanized, albeit expensive, transport between the dock and the village itself. A thriving local economy of porters had developed since carrying weight up the hill was a challenge even for the young and able-bodied. The steep landscape also corralled people in the village—people wouldn't walk the hill unless necessary, or would refuse to walk it midday. For those unaccustomed to the terrain it was particularly grueling. Santa Cruz is the municipal seat, so visitors from other villages were obligated to trek up from the shore to conduct their official business (registering births, deaths, obtaining identity cards, paying taxes, etc.).
A lot of my time in Santa Cruz was spent in the central square. On the north end of the square was the centuries old Catholic church. To the south stood the new municipal building and a public clothes-washing site. To the west was the health post established by the Ministry of Health. The east side of the square was predominated by educational buildings: the preschool, library, and elementary school. The voter registration office was housed next to the library. The square itself had been renovated and was now a multi-use court, and was, consequently, one of most popular social hangouts in town. During recess hours, after school, after the workday, and on weekends the court filled with basketball and soccer games. If you weren't at the square to socialize then you often had to walk through it to get where you were going. The only other public buildings in town were the Juez de Paz [Judge of the Peace] and churches. Santa Cruz hosted three Evangelical churches, and a fourth was being built as I left.
Because Santa Cruz is built on a small plateau, the ability of the town to expand outward is limited by the steep hillsides. After becoming more familiar with the neighboring villages, I was surprised by how much Cruceños had embraced densification to make the most of their limited space. The Kaqchikel word jay translates into both “room” and “house,” mirroring the fact that traditional family compounds consist of several independent, one-room houses positioned around a courtyard, usually with a separate house for cooking. Yet one strategy that people in Santa Cruz adopted was to build one-room houses that shared a wall. Sometimes newer structures even connected rooms from the inside of the house. Another strategy for the more well-off was to build from concrete block and rebar. Inevitably, one could see metal rods sticking out of the roof that allowed the future expansion of the house upward. Unlike the other villages around the lake, very few houses still existed that were constructed out of cane poles bound together, with mud packed in between the crevices to form a wall. The majority of villagers use the locally manufactured adobe brick and wooden shutters. Some of these houses had tile floors while others had polished concrete and glass windows. The older styles of tile or straw roofs had disappeared in favor of corrugated metal. The metal was cheaper, easier to transport, and not as likely to cave in during an earthquake. It did, however, fly away in heavy winds, which could easily be a problem. Nevertheless, stories about running around in the dark and trying to find one's roof did garner laughs the next day.
In Santa Cruz, densification was needed not necessarily because of expanding nuclear families, but because children married and ideally brought their spouses back to live with their parents. According to the door-to-door census performed in 2000 by the auxiliary nurse working in the Santa Cruz health post, 240 heads of family were registered in the village with an average of 4.8 persons per house. A full 24 percent of all houses were female-headed, and these families had an average of 3.5 persons compared to 5.2 persons for a male-headed household. In addition, 50 percent of the population was under the age of 18. Since people tended to marry within the village, almost everyone was related to everyone else.
As the population increased while space remained constant, the question of what to do with waste became more and more problematic. The fields that people used to squat in to defecate or urinate were eliminated. Those who could afford it tried to put some sort of bathroom into their compound. According to the census 71 percent of houses (60 percent for female-headed) were recorded as having “adequate” facilities for the disposal of excrement, which in most cases meant a pit toilet, and in a few cases might have meant a septic tank. The other 29 percent, I found out over the course of two years, availed themselves in the houses of relatives, sought out now urban patches of land that weren't built on, or in the worst case, used public paths when no one was looking. One man frequently complained to me about the stink that wafted into his house from the undeveloped piece of land abutting his compound. He felt that he was living in a toilet. He was considering developing the land or putting up barbwire to stop his neighbors from defecating there.
But human waste was not the only problem that the tight space created for Cruceños. There was no “trash boat” that would carry away waste. Instead, the strategy seemed to be throwing trash over cliffs or throwing it into a steep stream bed, where the first rains would wash it away into the lake. Officially, only one cliff was the sanctioned dump. When you had trash you could tie it up in a plastic bag and give a passing child a few cents to dispose of it for you. In general, though, most of us burned our trash several times a week. Yet as more and more people occupied the spaces of the village, once the rains started, unofficial dumps started to flow into family compounds. The trash “problem,” people told me, was relatively new, because only in the last fifteen years had plastic come onto the scene. Before that all purchases were either wrapped in organic matter, like meat in banana leaves, or in newspaper, which could easily be burned or eventually breaks down. The fact that throwing things onto the ground was a common, not contraband, behavior might also have aggravated the trash problem. For example, much waste produced during a meal, like banana leaves or husks used to wrap corn dough, are thrown directly onto the floor and then swept up af ter eating. Throwing trash on the ground and walking away was not frowned upon unless the trash blew into someone's compound.
Despite the fact that the situation was more complicated, most older Cruceños viewed Santa Cruz as a village of agriculturalists. Indeed, one day I met a frustrated surveyor in the town square who reported that at house after house he asked people what they did and they responded that they were agriculturalists. Then he would ask them how much land they had and they would say none. He would then have to ask several more questions until their method of income generation finally fit into one of the boxes he could mark. Every family in Santa Cruz used to have access to land, but in the middle of the last century collectively owned land was carved up and privatized. As the interests of outsiders in the lake grew, villagers sold off the flat lands by the shore that they used for their crops.1 Now many families are left without any land to farm at all. Regardless of how many families own land, every family knows that corn is of central importance to their survival. The village is surrounded by milpa [fields of corn]. To plant the milpa, a field must be “cleaned” using a machete to chop down all of the growth, after which it is left fallow to allow the weeds to die, and then the corn seeds are planted in small mounds. As the corn begins to grow it must be cleaned again of new weeds. Eventually the milpa can be harvested. In Santa Cruz, people frequently plant squashes and beans in their milpa, though they generally refer to it as only corn. On the steep, un-terraced mountainsides, yields are poor and corn is never exported from Santa Cruz for sale.
The steepness and cramped space of Santa Cruz did not mean, however, that Cruceños had no food stuffs to cultivate to abundance. Fruit trees, like avocados, fit well into the landscape. The trees around the village were individually owned but there was a local market in leasing a tree for a season. The municipality of Santa Cruz was renowned for the quality of its jocote, another tree fruit, and thus they commanded a high price at markets in Panajachel or Sololá. Bananas presented a similar case. Many people had bananas planted both in their courtyards and on any other land they might have had. Bananas could always be taken to the market and sold for some extra cash in one day. Many of the bananas grown in Santa Cruz were heirloom or non-commercial varieties [casera], and thus they commanded a higher price than the left-over Chiquita bananas that got bussed up from the coast. Perhaps the most notable export from Santa Cruz was the coffee. Since coffee grows well on steep slopes, much of the land too steep to cultivate otherwise had been planted in coffee. Unlike many other villages around the lake, there was no mechanized way to process coffee in the village. In the past families would spend several weeks around the harvests doing the job by hand. In recent years, however, the harvests were sold after picking, but before processing, to outsiders. Finally, many men and children in Santa Cruz spent a significant amount of time fishing. Rights to fish in the lake with a net from a canoe were passed down in families between male kin. You could see men in canoes out every morning either catching small fish or diving for small crabs, which they could sell locally. Little boys would fish with a piece of line directly from docks, bringing anything they caught home to their families. Since the sweetness of the fish and crabs in Santa Cruz was well known, middlemen (or in this case middle women) came to Santa Cruz once a week to buy fish and take it back to their own villages to sell. Regardless of the fact that each compound might no longer cultivate a piece of land with corn, agricultural activity was commonly part of people's everyday lives.
The income that people generated from agricultural activities was, however, usually a supplement to their “day job.” Some of the more lucrative jobs in Santa Cruz for men were foreman/contractor, tailor, shop owner, real estate dealer, pastor, and owner or driver of a boat taxi. Some of the less lucrative but more plentiful jobs were day laborer agriculturalists, assistant (ayudante) (to a “guardian,” or skilled construction worker), harvester and seller of firewood, and porter. The village also had one car driver and one barber.
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ILLUSTRATION 4. Husband and wife collecting their catch in Santa Cruz
A variety of other jobs were available to women who wanted to earn extra cash by working outside of the home. One of the most difficult jobs that was predominantly performed by women was harvester and seller of firewood. As deforestation became more and more of a problem in the municipality of Santa Cruz, women had to walk farther and farther away to find wood. Conversely, this meant that they had to carry full bundles of wood on their backs from farther distances. Another traditional job for a woman was to work as a “muchacha.”2 During births, deaths, and other special occasions, families would frequently need the assistance of someone who could prepare food, serve guests, keep things clean, and just generally help out. Muchachas were also sought out by tiendas [small stores], as they had to be paid far less than a man for doing equal work.
Women in Santa Cruz were extremely talented and well-renowned weavers. Women from other towns would visit to place special orders for a huipil, the traditional blouse that women wore. Cruceñas also made money doing bordado [hand-stitching]. They decorated cloth both for other locals, and again, for outsiders who came seeking their services. While neither of these activities was particularly lucrative, they were convenient as a woman could work at home during any extra time she might have.
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ILLUSTRATION 5. Weaver in Santa Cruz.
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ILLUSTRATION 6. Woman hand stitching a huiple.
The influx of gringos3 along the shore heavily impacted women's ability to earn cash. Many weavers attempted to sell their wears directly to tourists and a few had branched out from traditional cloths to hand-woven purses and scarves. While these products commanded a better price, during the rainy season, when tourism was slower, it was difficult to survive on this alone. New jobs for women had also been created; the four hotels for tourists that were on the shore were predominantly staffed by females, who cooked the meals and cleaned the rooms. Women working these jobs made as much in four hours as a man doing agricultural day labor for another villager made in eight. Women also sought out opportunities to wash clothes or clean the houses of the local gringo chalet owners. The cleaning jobs were frequently done by married women with families both because a husband who worked at the house usually got his wife the job and because women could bring their children with them. The hotel jobs, on the other hand, were most normally sought out by younger, unmarried women. Several of the hotel workers had left their jobs after getting married since their husbands said that they couldn't fulfill their home duties and work the hours the hotels demanded at the same time. The wage labor for women, however, opened up possibilities for female-headed households to be economically viable.
Finally, a number of children worked in Santa Cruz, though there were only a few jobs they regularly performed, and all were badly paid. One of the main sources of income for kids was carrying goods up the hill. Renting the car for a trip from the dock to the village cost a flat rate of 25 Q,4 but if one had only a few things it was far cheaper to hire a porter than to rent the car. Cases of soda and beer or propane gas tanks are good examples of smaller things that needed to go up to the village. Children's work was not as highly valued as that of men, and when a load could be carried by either, a child would earn less for equal work. Many families hiring a porter, therefore, preferred to hire a child over an adult. With the influx of gringos, children now crowded the dock hoping to be able to carry a tourist's backpack from the boat to a hotel. Two other infrequent sources of cash for kids were disposing of trash or running errands. Gringos frequently used children as a local mail service, paying them a postage fee to hand deliver a message. It is important to note that while many men and women did work for cash, only the poorest of the poor children had to work. Many of these were illiterate, and their parents needed their incomes to supplement the family. They, therefore, were not able to go to school.
Yet even those who could go to school were frequently challenged to get a good education. Most of the village schools on the west side of Lake Atitlán (like Santa Cruz) were staffed by teachers from the town of San Pedro La Laguna. San Pedro boasted a secondary school that certified teachers, and since there was such easy access to the profession, a disproportionate number of Pedranos chose to be teachers.5 The positions at local schools in San Pedro quickly filled, so Pedranos applied to work in different schools around the lake. With a water taxi service available between San Pedro and the villages on the west side of the lake (like Santa Cruz), teachers could still live at home with their families and commute to work. What this meant for the schools on the west side of the lake was that their teachers were in general waiting to take the next boat out. Schools in the area were hopelessly under funded and since few villagers were formally educated, the schools needed teachers who were leaders and interested in building the community. But parents complained that many Pedranos had no interest in improving the schools in which they taught—rather teachers tried to spend the absolute minimum amount of time possible at work. Most Pedranos were seen as commuters whose community was elsewhere. This inspired little confidence in local schools.
Despite this bleak picture the elementary school in Santa Cruz, called Tecun Uman, boasted several unique advantages over, for example, the school in Tzununá (the only other village in the municipality that had the same population of youth). The Santa Cruz school profited from having very good directors over the past years. One of the first Cruceños to graduate with his teaching credential was hired on to teach at the local elementary. After several years he rose to the position of director. The implicit knowledge of the community that he possessed by being Cruceño significantly contributed to the success of the school. He made it a personal campaign to get all children enrolled in school and he visited houses where children were not attending to converse with the parents about the necessity of literacy and education in present-day Guatemala. As an insider he knew who had children and where they lived. He also was able to visit people's houses without them feeling like this was an “official” visit—a feat not easily accomplished by an outsider. In 2002, a new director who was a Pedrano was appointed. This director also was extremely devoted to the education of the pupils, willing to work long hours and he even slept in Santa Cruz if need be. As luck would have it, both directors got along well and were like minded in terms of values and pedagogy.
Elementary education in Santa Cruz has also been significantly impacted by the presence of foreigners. Many of the gringos in the chalet community on the shore either are or were teachers in their home countries, so working with the elementary school seemed like an obvious way for them to contribute to the community. In 1998 the gringos founded an organization called Amigos de Santa Cruz to offer support to the schools and students. It was incorporated as a 501(c)3 under US law in 2001. Working with the director of the school and the Ministry of Education in Sololá, Amigos was able to coordinate the resources going into the school and offer significant financial support. Tecun Uman was one of the few public schools that provided full scholarships for every pupil—this meant that every child received textbooks, notebooks, pencils, paper, etc. To improve the pedagogy, Amigos made an agreement with the Ministry of Education to supplement the school budget and increase the number of teachers hired per year, decreasing the number of children per classroom, and Tecun Uman students had access to a computer lab and the school boasted a secretary and a copy machine. Students also received a nutritious lunch or a snack. Though resources do not necessarily translate into education, many parents were more willing to send their children to a school where they received “gifts,” then one that was completely under funded.
As the description of all of the work and obligations portends, life in Santa Cruz was incredibly busy. We were woken up every morning at dawn by one of the Evangelical congregants greeting the new day and praying over a portable loud speaker. Cruceños who had to go to town would be gathered around the dock waiting to go with the first boat at 6:30 AM. Those tending the fields or collecting firewood would have been long gone, hoping to get home before the midday sun. Those still at home would be making tortillas and coffee, and getting ready for the day. At 7:30 most paid jobs and school began. Women who remained in the village during the day always had numerous chores to attend to: the compound needed to be swept; laundry needed to be done; corn would need to be prepared and soaked in lye for tomorrow's tortillas; pre-soaked corn would need to be drained, loaded into a plastic tub, and taken to the mill, where, if one waited too long there was inevitably a line; once the corn was ground, tortillas or tamalitos would need to be prepared, and any other cooking would need to be done. When possible, women would leave enough time to socialize with their kin or to attend a church activity. From midday onward, villagers would return from the fields or the woods or their trip to the city. Around 3:30 phalanxes of men could be seen climbing the paths back to the village. The square would then fill up with people playing sports and socializing. This was doubly so on the weekends. Despite all of the hustle and bustle, in Santa Cruz it was unusual to leave a compound completely unattended. Latches were more to secure a ...

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