own birth experience, they were much more at ease talking with me. The difference did not only lie with their attitude toward me but also with my attitude toward them. Having been through childbirth myself I did feel as though I could understand their experiences more fully, despite the social and cultural factors which made our birth experiences vastly different. Having been through it myself, I felt I had a much better base of phenomenological, social, and biomedical knowledge from which to formulate questions and respond to inquiries.
Many anthropologists have commented that it must have been a great “in” to have had my very young daughter, Lila, with me; that it must have helped me gain acceptance in Indian society, and that this must have benefited my research immensely, especially given the topic of the research. In my more cynical moments, the implication of these comments seemed to be that having a baby must be even better than the traditional anthropological props, like cigarettes and money, for getting “informants” to take you into their homes and divulge their secrets. It was wonderful to be living in Tamil Nadu with my family and sharing with them a part of the world which has long been a central part of who I am. It was particularly significant to me that Lila was starting out her life with an experience that I hope will influence her lifelong perception of the world. The fact that her first words alternated between English and Tamil was somehow very touching. And of course having a young child did in many ways open doors to friendships as she and many of our neighbors’ children played together every day. My research, however, was not focused on my immediate neighborhood but rather required me to commute all around the city, down to Kaanathur-Reddikuppam, and occasionally farther afield to other parts of Tamil Nadu. It did not make sense to drag her along with me wherever I went, into hospitals, homes, government offices, and libraries. In fact, I felt that because of the demands of her age (six months to one and a half years), having her with me during my research would have been disruptive and would have made it very difficult for me to concentrate on what others were saying or doing. Instead, most of the time Lila remained home and part-time in a local day care, and I had to contend with being a somewhat frenzied working mother in India just as in America.
OUTLINE OF THE CHAPTERS
For the most part, each chapter in this book addresses a different aspect of the modernizing process and analyzes the impact that this process is having on poor women’s experiences during childbirth in Tamil Nadu. In addition to its thematic organization, the book is also organized loosely according to the chronology of the experience of childbirth itself. Thus, Chapters Three through Six emphasize pregnancy, delivery, family planning, and the postpartum period in consecutive order. Family planning is placed in between delivery and the postpartum period, since certain contraceptive methods are undertaken in hospital maternity wards before mothers return home from their deliveries. I have taken this chronological approach in the hope of conveying some sense of the flow of the experience of childbirth for the women whom I met.
Chapter One addresses the theme of the professionalization of obstetrics as one aspect of the modernizing process. Focusing on the colonial period, this chapter provides a background for understanding the historical context within which the profession of obstetrics emerged in India. As in other colonial contexts, the issues of childbirth and of the professionalization of obstetrics played a critical role in the civilizing discourse of colonialism in India.67 Chapter Two shows how the debates and policies regarding the professionalization of obstetrics during the colonial era are reflected in official structures of maternal and child health care in the postcolonial era. This chapter also describes the maternal and child health care services available to women for childbirth in my particular field sites in Tamil Nadu in 1995. Chapter Three looks at the value placed on consumption as a central marker of modernity in the contemporary global order. In India this has become particularly apparent in the context of post-1991 liberalization policies. Increasing consumer orientation has intensified and transformed pregnancy rituals in Tamil Nadu in such a way that these rituals publicized the auspiciousness of women’s fertility while simultaneously becoming an important context and conduit for the exchange of consumer goods from a pregnant woman’s kin to her in-laws, resulting in the construction of poor pregnant women as, what I call, “auspicious burdens.” Chapter Four examines the use of modern technologies which alter the nature of pain during delivery. Most of the women whom I met in Tamil Nadu wanted to have their labors medically induced with oxytocin drugs and were unaware of the possibility of using anesthesia and wary of this notion when presented with it for the first time. The particular use of pain medication among poor women in Tamil Nadu both draws on and transforms cultural constructions of women’s reproductive bodies, and of female power, or sakti, and is influenced by political-economic constraints of public maternity wards in Tamil Nadu. Chapter Five takes on the theme of population-control programs in the modern era, particularly as these programs have been implemented in the context of postcolonial international development projects. The internationally driven family-planning agenda has long overshadowed all other aspects of maternal and child health care in India, and Tamil Nadu has been touted as a model state in this regard. In this chapter, I show how this impacted poor women’s experiences during childbirth. Chapter Six addresses the transnational discourse of “development,” in its myriad forms, as a central element in the postcolonial modernizing process. I examine the postpartum period as a key site within which such discourses of development were maneuvered in Tamil Nadu. In particular I discuss the ways in which discourses of development constructed non-allopathic practices and systems of knowledge surrounding the mother’s and baby’s postpartum diets and baths as “unscientific” and therefore not only dangerous but immoral.
The issue of how poor women in Tamil Nadu made decisions about what kind of care to seek during childbirth is filtered throughout the various chapters of this book. This issue of “choice” is the central theme of the conclusion. By focusing on Kaanathur-Reddikuppam as a community in transition, this chapter examines how new constructions of maternity which emerged in the context of the modernization of childbirth in Tamil Nadu simultaneously compelled women to seek and repelled them from seeking childbirth-related care in allopathic institutions. Although some women were “choosing” to remain home for deliveries, they usually claimed to do so to avoid specific class-based forms of discrimination in hospitals, rather than to rebuke allopathic obstetrics itself. Some women said they were choosing to remain home only because new allopathic procedures were being introduced into the home-birth context. This is a specific form of resistance to a specific form of biomedicalization. This response does not necessarily reflect greater reproductive choices for these mothers. In fact, it could, potentially, have negative consequences for their health and the health of their babies.
With improvements in quality and monitoring, however, home-birth care could provide a model for women of all socio-economic classes in rural and urban India. Such a movement should not, however, be pursued at the expense of redressing the serious problems of discrimination within the public maternity hospitals.
CHAPTER 1
The Professionalization of Obstetrics in Colonial India
The “Problem” of Childbirth in Colonial Discourse
In the late nineteenth and early twentieth centuries, the management of childbirth emerged as a key issue in colonial and nationalist discourses in India, as it did in other colonial settings around the globe from Jamaica to the Sudan to Malaya and the Pacific Islands.1 The concern with childbirth in the colonies, particularly as it related to maternal and infant mortality, echoed anxieties arising around these issues in the European metropoles. Both in the metropole and on the periphery this heightened interest in childbirth arose due to growing awareness and pronatalist fears of depopulation trends. Depopulation, particularly among proletarians, was thought to threaten capitalist interests by shrinking the labor pool. In both the metropoles and their colonial outposts the provision of maternal and child health care was thus increasingly viewed as critical to the economic interests of the state since it held the promise of arresting depopulation.
In India colonial sympathizers and nationalists alike depicted
